4401
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Paciej P, Dziankowska-Zaborszczyk E, Ciabiada B, Bryła M, Maniecka-Bryła I. Years of life lost due to bronchial asthma in Poland between 1999 and 2013. J Asthma 2017; 55:668-674. [PMID: 28759291 DOI: 10.1080/02770903.2017.1355382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the years of life lost due to asthma in Poland between 1999 and 2013, with the use of the SEYLL measure (Standard Expected Years of Life Lost). METHODS The study was based on a dataset of 5,606,516 records gathered from death certificates of Polish residents from 1999 to 2013. The data on the deaths due to bronchial asthma and status asthmaticus (J45 and J46 according to ICD-10) were used for the analysis. The SEYLL, SEYLLp (SEYLL per person) and SEYLLd (SEYLL per death) were implemented to assess lost life years. The analysis of time trends was performed with the use of the join point model. RESULTS In 1999-2013, asthma and status asthmaticus were the cause of 11,380 deaths of Poles (0.20% of all deaths), resulting in 4.23 prematurely lost life years per 10,000 males and 3.22 years per 10,000 females. Over the analyzed years, the value of SEYLL decreased both for men and women. Every man who died due to bronchial asthma in Poland in the studied period, lost on average 19.12 years of life, and every woman 18.20 years. CONCLUSIONS The analysis of SEYLL indicated that premature mortality due to asthma is still a meaningful problem in the Polish population and a constant challenge for public health activities.
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Affiliation(s)
- Paulina Paciej
- a Department of Epidemiology and Biostatistics , Medical University of Lodz , Łódź , Poland
| | | | - Beata Ciabiada
- a Department of Epidemiology and Biostatistics , Medical University of Lodz , Łódź , Poland
| | - Marek Bryła
- b Department of Social Medicine , Medical University of Lodz , Lodz , Poland
| | - Irena Maniecka-Bryła
- a Department of Epidemiology and Biostatistics , Medical University of Lodz , Łódź , Poland
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4402
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Collins PY, Pringle B, Alexander C, Darmstadt GL, Heymann J, Huebner G, Kutlesic V, Polk C, Sherr L, Shih A, Sretenov D, Zindel M. Global services and support for children with developmental delays and disabilities: Bridging research and policy gaps. PLoS Med 2017; 14:e1002393. [PMID: 28922419 PMCID: PMC5603146 DOI: 10.1371/journal.pmed.1002393] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pamela Collins and colleagues explain the research and policy approaches needed globally to ensure children with developmental delays and disabilities are fully included in health and education services.
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Affiliation(s)
- Pamela Y. Collins
- Office for Research on Disparities & Global Mental Health, US National Institute of Mental Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Beverly Pringle
- Office for Research on Disparities & Global Mental Health, US National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Charlee Alexander
- National Academies of Sciences, Engineering, and Medicine, Washington DC, United States of America
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jody Heymann
- UCLA Fielding School of Public Health, WORLD Policy Analysis Center, Los Angeles, California, United States of America
| | - Gillian Huebner
- Maestral International, Washington DC, United States of America
| | - Vesna Kutlesic
- Office of Global Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Cheryl Polk
- HighScope Educational Research Foundation, Ypsilanti, Michigan, United States of America
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Andy Shih
- Autism Speaks, New York, New York, United States of America
| | - Dragana Sretenov
- Early Childhood Program, Open Society Foundations, London, United Kingdom
| | - Mariana Zindel
- National Academies of Sciences, Engineering, and Medicine, Washington DC, United States of America
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4403
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Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord 2017; 219:86-92. [PMID: 28531848 DOI: 10.1016/j.jad.2017.05.003] [Citation(s) in RCA: 748] [Impact Index Per Article: 106.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/02/2017] [Accepted: 05/06/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a leading cause of the disease burden for women of childbearing age, but the burden of MDD attributable to perinatal depression is not yet known. There has been little effort to date to systematically review available literature and produce global estimates of prevalence and incidence of perinatal depression. Enhanced understanding will help to guide resource allocation for screening and treatment. METHODS A systematic literature review using the databases PsycINFO and PubMed returned 140 usable prevalence estimates from 96 studies. A random-effects meta-regression was performed to determine sources of heterogeneity in prevalence estimates between studies and to guide a subsequent random-effects meta-analysis. RESULTS The meta-regression explained 31.1% of the variance in prevalence reported between studies. Adjusting for the effects of all other variables in the model, prevalence derived using symptom scales was significantly higher than prevalence derived using diagnostic instruments (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-2.0). Additionally, prevalence was significantly higher in women from low and middle income countries compared to women from high income countries (OR 1.8, 95% CI 1.4-2.2). The overall pooled prevalence was 11.9% of women during the perinatal period (95% CI 11.4-12.5). There were insufficient data to calculate pooled incidence. LIMITATIONS Studies in low income countries were especially scarce in this review, demonstrating a need for more epidemiological research in those regions. CONCLUSIONS Perinatal depression appears to impose a higher burden on women in low- and middle-income countries. This review contributes significantly to the epidemiological literature on the disorder.
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Affiliation(s)
- C A Woody
- The University of Queensland, School of Public Health, Herston, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
| | - A J Ferrari
- The University of Queensland, School of Public Health, Herston, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
| | - D J Siskind
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; The University of Queensland, School of Medicine, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - H A Whiteford
- The University of Queensland, School of Public Health, Herston, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
| | - M G Harris
- The University of Queensland, School of Public Health, Herston, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
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4404
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Lietzén R, Virtanen P, Kivimäki M, Korkeila J, Suominen S, Sillanmäki L, Koskenvuo M, Vahtera J. Change in β 2-agonist use after severe life events in adults with asthma: A population-based cohort study: Life events and bronchodilator usage among adults with asthma. J Psychosom Res 2017; 100:46-52. [PMID: 28789792 PMCID: PMC5556252 DOI: 10.1016/j.jpsychores.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/15/2017] [Accepted: 07/04/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This prospective, population-based cohort study of 1102 Finnish adults with asthma, examined whether exposure to stressful life events is associated with the intensity of usage of inhaled short-acting β2-agonists. METHODS Survey data was collected by two postal questionnaires. Baseline characteristics were obtained in 1998 and data on 19 specific stressful events (e.g. death of a child or spouse or divorce) within the six preceding months in 2003. Exposure to life events was indicated by a sum score weighted by mean severity of the events. Participants were linked to records of filled prescriptions for inhaled short-acting β2-agonists from national registers from 2000 through 2006. The rates of purchases of short-acting β2-agonists before (2000-2001), during (2002-2003) and after (2004-2006) the event exposure were estimated using repeated-measures Poisson regression analyses with the generalized estimating equation. RESULTS Of the 1102 participants, 162 (15%) were exposed to highly stressful events, 205 (19%) to less stressful events. During the 7-year observation period, 5955 purchases of filled prescription for inhaled short-acting β2-agonists were recorded. After exposure to highly stressful events, the rate of purchases of β2-agonists was 1.50 times higher (95% confidence interval (CI): 1.05, 2.13) than before the stressful event occurred. Among those with low or no exposure to life events, the corresponding rate ratios were not elevated (rate ratio 0.81, 95% CI: 0.66, 0.99 and 0.95, 95% CI: 0.83, 1.09 respectively). CONCLUSION An increase in β2-agonist usage after severe life events suggests that stressful experiences may worsen asthma symptoms.
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Affiliation(s)
- Raija Lietzén
- Department of Public Health, University of Turku, Turku, Finland.
| | - Pekka Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mika Kivimäki
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom
| | - Jyrki Korkeila
- Department of Psychiatry, University of Turku and Harjavalta Hospital, Satakunta Hospital District, Harjavalta, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland,Department of Public Health, University of Skövde, Skövde, Sweden
| | - Lauri Sillanmäki
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markku Koskenvuo
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
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4405
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Bussières AE, Gauthier CA, Fournier G, Descarreaux M. Spinal manipulative therapy for low back pain-time for an update. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:669-672. [PMID: 28904028 PMCID: PMC5597007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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4406
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Ellis BM, Newton JN. A new public health, tiered approach to improving musculoskeletal health through physical activity provision. J Public Health (Oxf) 2017; 39:429-432. [PMID: 28911218 DOI: 10.1093/pubmed/fdx105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Benjamin M Ellis
- Imperial College Healthcare NHS Trust, London, and Arthritis Research UK, Chesterfield, UK
| | - John N Newton
- University of Manchester and Public Health England, London, UK
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4407
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Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. THE JOURNAL OF PAIN 2017; 18:1027-1035. [PMID: 28400293 PMCID: PMC5581265 DOI: 10.1016/j.jpain.2017.03.008] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 02/06/2023]
Abstract
The dorsolateral prefrontal cortex (DLPFC) is a functionally and structurally heterogeneous region and a key node of several brain networks, implicated in cognitive, affective, and sensory processing. As such, the DLPFC is commonly activated in experimental pain studies, and shows abnormally increased function in chronic pain populations. Furthermore, several studies have shown that some chronic pains are associated with decreased left DLPFC gray matter and that successful interventions can reverse this structural abnormality. In addition, studies have indicated that noninvasive stimulation of the left DLPFC effectively treats some chronic pains. In this article, we review the neuroimaging literature regarding the role of the DLPFC and its potential as a therapeutic target for chronic pain conditions, including studies showing the involvement of the DLPFC in encoding and modulating acute pain and studies demonstrating the reversal of DLPFC functional and structural abnormalities after successful interventions for chronic pain. We also review studies of noninvasive brain stimulation of the DLPFC showing acute pain modulation and some effectiveness as a treatment for certain chronic pain conditions. We further discuss the network architecture of the DLPFC, and postulate mechanisms by which DLPFC stimulation alleviates chronic pain. Future work testing these mechanisms will allow for more effective therapies. PERSPECTIVE The structure and function of the DLPFC is abnormal in some chronic pain conditions. Upon successful resolution of pain, these abnormalities are reversed. Understanding the underlying mechanisms and the role of this region can lead to the development of an effective therapeutic target for some chronic pain conditions.
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Affiliation(s)
- David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland.
| | - Massieh Moayedi
- Faculty of Dentistry, and University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada
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4408
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Sagun K, Roy VK, Kumar RS, Ibrahim KS, Parimelazhagan T, Kumar NS, Gurusubramanian G. Antioxidant potential, anti-inflammatory activity and gastroprotective mechanisms of Mallotus roxburghianus (Muell.) against ethanol-induced gastric ulcers in Wistar albino rats. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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4409
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Rahman MM, Karan A, Rahman MS, Parsons A, Abe SK, Bilano V, Awan R, Gilmour S, Shibuya K. Progress Toward Universal Health Coverage: A Comparative Analysis in 5 South Asian Countries. JAMA Intern Med 2017; 177:1297-1305. [PMID: 28759681 PMCID: PMC5710570 DOI: 10.1001/jamainternmed.2017.3133] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Achieving universal health coverage is one of the key targets in the newly adopted Sustainable Development Goals of the United Nations. OBJECTIVE To investigate progress toward universal health coverage in 5 South Asian countries and assess inequalities in health services and financial risk protection indicators. DESIGN AND SETTINGS In a population-based study, nationally representative household (335 373 households) survey data from Afghanistan (2014 and 2015), Bangladesh (2010 and 2014), India (2012 and 2014), Nepal (2014 and 2015), and Pakistan (2014) were used to calculate relative indices of health coverage, financial risk protection, and inequality in coverage among wealth quintiles. The study was conducted from June 2012 to February 2016. MAIN OUTCOMES AND MEASURES Three dimensions of universal health coverage were assessed: access to basic services, financial risk protection, and equity. Composite and indicator-specific coverage rates, stratified by wealth quintiles, were then estimated. Slope and relative index of inequality were used to assess inequalities in service and financial indicators. RESULTS Access to basic care varied substantially across all South Asian countries, with mean rates of overall prevention coverage and treatment coverage of 53.0% (95% CI, 42.2%-63.6%) and 51.2% (95% CI, 45.2%-57.1%) in Afghanistan, 76.5% (95% CI, 61.0%-89.0%) and 44.8% (95% CI, 37.1%-52.5%) in Bangladesh, 74.2% (95% CI, 57.0%-88.1%) and 83.5% (95% CI, 54.4%-99.1%) in India, 76.8% (95% CI, 66.5%-85.7%) and 57.8% (95% CI, 50.1%-65.4%) in Nepal, and 69.8% (95% CI, 58.3%-80.2%) and 50.4% (95% CI, 37.1%-63.6%) in Pakistan. Financial risk protection was generally low, with 15.3% (95% CI, 14.7%-16.0%) of respondents in Afghanistan, 15.8% (95% CI, 14.9%-16.8%) in Bangladesh, 17.9% (95% CI, 17.7%-18.2%) in India, 11.8% (95% CI, 11.8%-11.9%) in Nepal, and 4.4% (95% CI, 4.0%-4.9%) in Pakistan reporting incurred catastrophic payments due to health care costs. Access to at least 4 antenatal care visits, institutional delivery, and presence of skilled attendant during delivery were at least 3 times higher among the wealthiest mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with the rates among poor mothers. Access to institutional delivery was 60 to 65 percentage points higher among wealthy than poor mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with 21 percentage points higher in India. Coverage was least equitable among the countries for adequate sanitation, institutional delivery, and the presence of skilled birth attendants. CONCLUSIONS AND RELEVANCE Health coverage and financial risk protection was low, and inequality in access to health care remains a serious issue for these South Asian countries. Greater progress is needed to improve treatment and preventive services and financial security.
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Affiliation(s)
- Md Mizanur Rahman
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan.,Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Anup Karan
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Delhi, India
| | - Md Shafiur Rahman
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Alexander Parsons
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Ver Bilano
- Department of Epidemiology and Biostatistics, Imperial College London, London, England
| | - Rabia Awan
- Pakistan Bureau of Statistics, Islamabad, Pakistan
| | - Stuart Gilmour
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
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4410
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Soriano JB, Abajobir AA, Abate KH, Abera SF, Agrawal A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Alam K, Alam N, Alkaabi JM, Al-Maskari F, Alvis-Guzman N, Amberbir A, Amoako YA, Ansha MG, Antó JM, Asayesh H, Atey TM, Avokpaho EFGA, Barac A, Basu S, Bedi N, Bensenor IM, Berhane A, Beyene AS, Bhutta ZA, Biryukov S, Boneya DJ, Brauer M, Carpenter DO, Casey D, Christopher DJ, Dandona L, Dandona R, Dharmaratne SD, Do HP, Fischer F, Gebrehiwot TT, Geleto A, Ghoshal AG, Gillum RF, Ginawi IAM, Gupta V, Hay SI, Hedayati MT, Horita N, Hosgood HD, Jakovljevic M(MB, James SL, Jonas JB, Kasaeian A, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Knibbs LD, Kosen S, Koul PA, Kumar GA, Leshargie CT, Liang X, El Razek HMA, Majeed A, Malta DC, Manhertz T, Marquez N, Mehari A, Mensah GA, Miller TR, Mohammad KA, Mohammed KE, Mohammed S, Mokdad AH, Naghavi M, Nguyen CT, Nguyen G, Le Nguyen Q, Nguyen TH, Ningrum DNA, Nong VM, Obi JI, Odeyemi YE, Ogbo FA, Oren E, PA M, Park EK, Patton GC, Paulson K, Qorbani M, Quansah R, Rafay A, Rahman MHU, Rai RK, Rawaf S, Reinig N, Safiri S, Sarmiento-Suarez R, Sartorius B, Savic M, Sawhney M, Shigematsu M, Smith M, Tadese F, Thurston GD, Topor-Madry R, Tran BX, Ukwaja KN, van Boven JFM, Vlassov VV, Vollset SE, Wan X, Werdecker A, Hanson SW, Yano Y, Yimam HH, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Lopez AD, Murray CJL, Vos T. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. THE LANCET. RESPIRATORY MEDICINE 2017; 5:691-706. [PMID: 28822787 PMCID: PMC5573769 DOI: 10.1016/s2213-2600(17)30293-x] [Citation(s) in RCA: 1502] [Impact Index Per Article: 214.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma are common diseases with a heterogeneous distribution worldwide. Here, we present methods and disease and risk estimates for COPD and asthma from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 study. The GBD study provides annual updates on estimates of deaths, prevalence, and disability-adjusted life years (DALYs), a summary measure of fatal and non-fatal disease outcomes, for over 300 diseases and injuries, for 188 countries from 1990 to the most recent year. METHODS We estimated numbers of deaths due to COPD and asthma using the GBD Cause of Death Ensemble modelling (CODEm) tool. First, we analysed data from vital registration and verbal autopsy for the aggregate category of all chronic respiratory diseases. Subsequently, models were run for asthma and COPD relying on covariates to predict rates in countries that have incomplete or no vital registration data. Disease estimates for COPD and asthma were based on systematic reviews of published papers, unpublished reports, surveys, and health service encounter data from the USA. We used the Global Initiative of Chronic Obstructive Lung Disease spirometry-based definition as the reference for COPD and a reported diagnosis of asthma with current wheeze as the definition of asthma. We used a Bayesian meta-regression tool, DisMod-MR 2.1, to derive estimates of prevalence and incidence. We estimated population-attributable fractions for risk factors for COPD and asthma from exposure data, relative risks, and a theoretical minimum exposure level. Results were stratified by Socio-demographic Index (SDI), a composite measure of income per capita, mean years of education over the age of 15 years, and total fertility rate. FINDINGS In 2015, 3·2 million people (95% uncertainty interval [UI] 3·1 million to 3·3 million) died from COPD worldwide, an increase of 11·6% (95% UI 5·3 to 19·8) compared with 1990. There was a decrease in age-standardised death rate of 41·9% (37·7 to 45·1) but this was counteracted by population growth and ageing of the global population. From 1990 to 2015, the prevalence of COPD increased by 44·2% (41·7 to 46·6), whereas age-standardised prevalence decreased by 14·7% (13·5 to 15·9). In 2015, 0·40 million people (0·36 million to 0·44 million) died from asthma, a decrease of 26·7% (-7·2 to 43·7) from 1990, and the age-standardised death rate decreased by 58·8% (39·0 to 69·0). The prevalence of asthma increased by 12·6% (9·0 to 16·4), whereas the age-standardised prevalence decreased by 17·7% (15·1 to 19·9). Age-standardised DALY rates due to COPD increased until the middle range of the SDI before reducing sharply. Age-standardised DALY rates due to asthma in both sexes decreased monotonically with rising SDI. The relation between with SDI and DALY rates due to asthma was attributed to variation in years of life lost (YLLs), whereas DALY rates due to COPD varied similarly for YLLs and years lived with disability across the SDI continuum. Smoking and ambient particulate matter were the main risk factors for COPD followed by household air pollution, occupational particulates, ozone, and secondhand smoke. Together, these risks explained 73·3% (95% UI 65·8 to 80·1) of DALYs due to COPD. Smoking and occupational asthmagens were the only risks quantified for asthma in GBD, accounting for 16·5% (14·6 to 18·7) of DALYs due to asthma. INTERPRETATION Asthma was the most prevalent chronic respiratory disease worldwide in 2015, with twice the number of cases of COPD. Deaths from COPD were eight times more common than deaths from asthma. In 2015, COPD caused 2·6% of global DALYs and asthma 1·1% of global DALYs. Although there are laudable international collaborative efforts to make surveys of asthma and COPD more comparable, no consensus exists on case definitions and how to measure disease severity for population health measurements like GBD. Comparisons between countries and over time are important, as much of the chronic respiratory burden is either preventable or treatable with affordable interventions. FUNDING Bill & Melinda Gates Foundation.
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4411
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Affiliation(s)
- Peter J. Hotez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- Scowcroft Institute of International Affairs, The Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America
- * E-mail: (PJH); (KOM)
| | - Kristy O. Murray
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Center for Vector-Borne and Zoonotic Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (PJH); (KOM)
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4412
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Roller pressure algometry as a new tool for assessing dynamic pressure sensitivity in migraine. Cephalalgia 2017; 38:1257-1266. [DOI: 10.1177/0333102417729114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To explore the validity of the roller pressure algometer as a new tool for evaluating dynamic pressure sensitivity by assessing its association with pain features and widespread pressure pain sensitivity in migraine women, and also to determine whether dynamic pressure algometry differentiates between episodic and chronic migraine. Methods One hundred and twenty women with migraine (42% chronic, 58% episodic) participated. Dynamic pressure sensitivity was assessed with a set of roller pressure algometers (Aalborg University, Denmark®) consisting of 11 rollers with fixed pressure levels from 500 to 5300 g. Each roller was moved at a speed of 0.5 cm/sec over a 60 mm horizontal line covering the temporalis muscle. The dynamic pain threshold (the pressure level of the first painful roller) and pain elicited during the pain threshold (roller evoked pain) were determined. Static pressure pain thresholds were assessed over the temporalis muscle, C5/C6 joint, second metacarpal, and tibialis anterior. Results Side-to-side consistency between dynamic pain threshold (rs = 0.769, p < 0.001) and roller evoked pain (rs = 0.597; p < 0.001) were found. Women with chronic migraine exhibited bilateral lower dynamic pain thresholds ( p < 0.01), but similar widespread pressure pain thresholds (all, p > 0.284) than those with episodic migraine. Dynamic pain threshold was moderately positively associated with widespread pressure pain thresholds (0.358 > rs > 0.700, all p < 0.001). This association was slightly stronger in chronic migraine. Pain during dynamic pain threshold was negatively associated with widespread pressure pain thresholds (−0.336 < rs < −0.235, all p < 0.01). Conclusions Roller pressure algometry was valid for assessing dynamic pressure sensitivity in migraine in the trigeminal area and is consistent with widespread static pressure pain sensitivity. Roller, but not static, pressure algometry differentiated between episodic and chronic migraine. Assessing static and dynamic deep somatic tissue sensitivity may provide new opportunities for evaluating treatment outcomes.
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4413
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Wang X, Guo G, Zhou L, Zheng J, Liang X, Li Z, Luo H, Yang Y, Yang L, Tan T, Yu J, Lu L. Health-related quality of life in pregnant women living with HIV: a comparison of EQ-5D and SF-12. Health Qual Life Outcomes 2017; 15:158. [PMID: 28851384 PMCID: PMC5575929 DOI: 10.1186/s12955-017-0731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/28/2017] [Indexed: 11/16/2022] Open
Abstract
Background This paper investigates the properties and performance of the two generic measures, EQ-5D and SF-12, for Health-Related Quality of Life (HRQoL) assessments of pregnant women living with HIV in Kunming City, Yiliang County, Daguan County, Longchuan County, Tengchong County, Longling County and Fengqing County in Yunnan Province, China. Methods As part of a screening programme for the prevention of mother-to-child transmission of HIV (PMTCT), a retrospective cross-sectional survey was conducted in the seven Maternal and Infant Health Care centers in Yunnan Province, China, between April and June of 2016. The demographic and HIV infection-related information used in the study was collected through questionnaires designed by the study’s staff. HRQoL information was collected using two generic scales: EQ-5D and SF-12. Results A total sample of one hundred and one pregnant women with a mean age of 30.4 ± 5.1 years was investigated. Average time elapsed since infection diagnoses was 5.8 ± 3.4 years. Only one infant (1.0%) was HIV positive, and 56 (55.4%) infants were HIV negative. The HIV status of 44 (43.6%) infants was unknown. The relationship between the EQ-5D functional dimensions and the PCS-12 and the relationship between the EQ-5D anxiety/depression dimension and the MCS-12 were stronger. Those whose PCS-12 and MCS-12 scores were at the median or lower were classified as being in worse health, while those over the median were classified as being in better health. Respondents who reported no problem on each of the EQ-5D dimensions was divided according to the median SF-12 component scores. Those who scored at the median or lower than the median were classified as being in worse health, while those higher than the median were classified as being in better health. The VAS scores were also significantly different than the median split of the SF-12 scores for these subjects. Conclusion EQ-5D and SF-12 showed a discrimination ability in measuring the HRQoL of pregnant women living with HIV. The construct validity was identified for EQ-5D and SF-12 in the study. The respective constructs of EQ-5D and EQ-VAS may not overlap. Pregnant women living with HIV in the study gave more weight to their mental health when they provided a total health rating in EQ-VAS. EQ-VAS could explain the limitations of the EQ-5D dimension scores with ceiling effects in the survey. The results of our study could help to determine the suitable HRQoL instruments for pregnant women living with HIV and provide evidence for the proper comparison of EQ-5D and SF-12.
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Affiliation(s)
- Xiaowen Wang
- Department of Public Health, Kunming Medical University, Yunnan, China.,Yunnan Centers for Disease Control and Prevention, Yunnan, China
| | - Guangping Guo
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Ling Zhou
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Jiarui Zheng
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Xiumin Liang
- Yiliang County Centers for Disease Control and Prevention, Yunnan, China
| | - Zhanqin Li
- Longling County Centers for Disease Control and Prevention, Yunnan, China
| | - Hongzhuan Luo
- Fengqing County Centers for Disease Control and Prevention, Yunnan, China
| | - Yuyan Yang
- Longchuan County Maternal and Child Health Care hospital, Yunnan, China
| | - Liyuan Yang
- Longling County Maternal and Child Health Care hospital, Yunnan, China
| | - Ting Tan
- Department of Public Health, Kunming Medical University, Yunnan, China
| | - Jun Yu
- Department of Public Health, Kunming Medical University, Yunnan, China
| | - Lin Lu
- Department of Public Health, Kunming Medical University, Yunnan, China. .,Health and Family Planning Commission of Yunnan Province, No. 309, Guomao Street, Kunming, Yunnan Province, China.
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4414
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Abstract
Heart failure (HF) remains the leading cause of hospitalization in older adults and is associated with increased morbidity and mortality despite the use of guideline-directed medical therapy. There has been tremendous progress in the development of novel transcatheter and interventional therapies for HF over the past decade. The evolution of structural heart disease interventions and interventional HF has led to a multidisciplinary heart team approach in the management of HF patients. Careful selection of the appropriate patient population and end points in future randomized controlled trials will be crucial to demonstrate the potential efficacy of the novel interventional HF therapies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Jinnette Dawn Abbott
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA.
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4415
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Chen SP, Ayata C. Novel Therapeutic Targets Against Spreading Depression. Headache 2017; 57:1340-1358. [PMID: 28842982 DOI: 10.1111/head.13154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
Migraine is among the most prevalent and disabling neurological diseases in the world. Cortical spreading depression (SD) is an intense wave of neuronal and glial depolarization underlying migraine aura, and a headache trigger, which has been used as an experimental platform for drug screening in migraine. Here, we provide an overview of novel therapeutic targets that show promise to suppress SD, such as acid-sensing ion channels, casein kinase Iδ, P2X7-pannexin 1 complex, and neuromodulation, and outline the experimental models and essential quality measures for rigorous and reproducible efficacy testing.
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Affiliation(s)
- Shih-Pin Chen
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Cenk Ayata
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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4416
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Kassebaum N, Smith A, Bernabé E, Fleming T, Reynolds A, Vos T, Murray C, Marcenes W. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res 2017; 96:380-387. [PMID: 28792274 PMCID: PMC5912207 DOI: 10.1177/0022034517693566] [Citation(s) in RCA: 1003] [Impact Index Per Article: 143.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Global Burden of Disease 2015 study aims to use all available data of
sufficient quality to generate reliable and valid prevalence, incidence, and
disability-adjusted life year (DALY) estimates of oral conditions for the period
of 1990 to 2015. Since death as a direct result of oral diseases is rare, DALY
estimates were based on years lived with disability, which are estimated only on
those persons with unmet need for dental care. We used our data to assess
progress toward the Federation Dental International, World Health Organization,
and International Association for Dental Research’s oral health goals of
reducing the level of oral diseases and minimizing their impact by 2020. Oral
health has not improved in the last 25 y, and oral conditions remained a major
public health challenge all over the world in 2015. Due to demographic changes,
including population growth and aging, the cumulative burden of oral conditions
dramatically increased between 1990 and 2015. The number of people with
untreated oral conditions rose from 2.5 billion in 1990 to 3.5 billion in 2015,
with a 64% increase in DALYs due to oral conditions throughout the world.
Clearly, oral diseases are highly prevalent in the globe, posing a very serious
public health challenge to policy makers. Greater efforts and potentially
different approaches are needed if the oral health goal of reducing the level of
oral diseases and minimizing their impact is to be achieved by 2020. Despite
some challenges with current measurement methodologies for oral diseases,
measurable specific oral health goals should be developed to advance global
public health.
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Affiliation(s)
- N.J. Kassebaum
- Department of Anesthesiology and
Pain Medicine, University of Washington, Seattle, WA, USA
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - A.G.C. Smith
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - E. Bernabé
- Division of Population and Patient
Health, King’s College London Dental Institute, London, UK
| | - T.D. Fleming
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - A.E. Reynolds
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - T. Vos
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - C.J.L. Murray
- Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA
| | - W. Marcenes
- Division of Population and Patient
Health, King’s College London Dental Institute, London, UK
- W. Marcenes, Division of Population and
Patient Health, King’s College London Dental Institute, Bessemer Road, Demark
Hill, London SE5 9RW, UK.
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4417
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Tang Y, Fung E, Xu A, Lan HY. C-reactive protein and ageing. Clin Exp Pharmacol Physiol 2017; 44 Suppl 1:9-14. [DOI: 10.1111/1440-1681.12758] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Ying Tang
- Department of Nephrology; Sun Yat-Sen Memorial Hospital; Sun Yat-Sen University; Guangzhou China
| | - Erik Fung
- Department of Medicine and Therapeutics; Li Ka Shing Institute of Health Sciences; CUHK-Shenzhen Research Institute; The Chinese University of Hong Kong; Guangzhou China
| | - Anping Xu
- Department of Nephrology; Sun Yat-Sen Memorial Hospital; Sun Yat-Sen University; Guangzhou China
| | - Hui-Yao Lan
- Department of Medicine and Therapeutics; Li Ka Shing Institute of Health Sciences; CUHK-Shenzhen Research Institute; The Chinese University of Hong Kong; Guangzhou China
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4418
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Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med 2017; 377:713-722. [PMID: 28834488 DOI: 10.1056/nejmoa1603693] [Citation(s) in RCA: 678] [Impact Index Per Article: 96.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low-income and middle-income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study. METHODS We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod-MR 2.1, were used to produce estimates of mortality and prevalence, including estimates of uncertainty. RESULTS We estimated that there were 319,400 (95% uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart disease in 2015. Global age-standardized mortality due to rheumatic heart disease decreased by 47.8% (95% uncertainty interval, 44.7 to 50.9) from 1990 to 2015, but large differences were observed across regions. In 2015, the highest age-standardized mortality due to and prevalence of rheumatic heart disease were observed in Oceania, South Asia, and central sub-Saharan Africa. We estimated that in 2015 there were 33.4 million (95% uncertainty interval, 29.7 million to 43.1 million) cases of rheumatic heart disease and 10.5 million (95% uncertainty interval, 9.6 million to 11.5 million) disability-adjusted life-years due to rheumatic heart disease globally. CONCLUSIONS We estimated the global disease prevalence of and mortality due to rheumatic heart disease over a 25-year period. The health-related burden of rheumatic heart disease has declined worldwide, but high rates of disease persist in some of the poorest regions in the world. (Funded by the Bill and Melinda Gates Foundation and the Medtronic Foundation.).
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Affiliation(s)
- David A Watkins
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Catherine O Johnson
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Samantha M Colquhoun
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ganesan Karthikeyan
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrea Beaton
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gene Bukhman
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohammed H Forouzanfar
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher T Longenecker
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bongani M Mayosi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - George A Mensah
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bruno R Nascimento
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Antonio L P Ribeiro
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Craig A Sable
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrew C Steer
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohsen Naghavi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ali H Mokdad
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher J L Murray
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Theo Vos
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Jonathan R Carapetis
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gregory A Roth
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
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4419
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Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. THE LANCET. INFECTIOUS DISEASES 2017; 17:1133-1161. [PMID: 28843578 PMCID: PMC5666185 DOI: 10.1016/s1473-3099(17)30396-1] [Citation(s) in RCA: 476] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. METHODS We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. FINDINGS In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000-763 000) and 60.6 million DALYs (95ÙI 56·0-65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI -0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940-2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction. INTERPRETATION LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. FUNDING Bill & Melinda Gates Foundation.
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4420
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Wang J, Wu X, Lai W, Long E, Zhang X, Li W, Zhu Y, Chen C, Zhong X, Liu Z, Wang D, Lin H. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017; 7:e017173. [PMID: 28838903 PMCID: PMC5640125 DOI: 10.1136/bmjopen-2017-017173] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Depression and depressive symptoms are common mental disorders that have a considerable effect on patients' health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA The PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738. RESULTS Eighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%). CONCLUSION Our study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
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Affiliation(s)
- Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Erping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaojian Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
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4421
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Hodder RK, Wolfenden L, Kamper SJ, Lee H, Williams A, O'Brien KM, Williams CM. Developing implementation science to improve the translation of research to address low back pain: A critical review. Best Pract Res Clin Rheumatol 2017; 30:1050-1073. [PMID: 29103549 DOI: 10.1016/j.berh.2017.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/06/2017] [Accepted: 05/31/2017] [Indexed: 12/21/2022]
Abstract
The evidence base regarding treatment for back pain does not align with clinical practice. Currently there is relatively little evidence to guide health decision-makers on how to improve the use, uptake or adoption of evidence-based recommended practice for low back pain. Improving the design, conduct and reporting of strategies to improve the implementation of back pain care will help address this important evidence-practice gap. In this paper, we.
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Affiliation(s)
- Rebecca Kate Hodder
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia
| | - Steven J Kamper
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Hopin Lee
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia; Centre for Rehabilitation Research, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Amanda Williams
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
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4422
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Carreira H, Williams R, Müller M, Harewood R, Bhaskaran K. Adverse mental health outcomes in breast cancer survivors compared to women who did not have cancer: systematic review protocol. Syst Rev 2017; 6:162. [PMID: 28807009 PMCID: PMC5557314 DOI: 10.1186/s13643-017-0551-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent increasing trends in breast cancer incidence and survival have resulted in unprecedented numbers of cancer survivors in the general population. A cancer diagnosis may have a profound psychological impact, and breast cancer treatments often cause long-term physical sequelae, potentially affecting women's mental health. The aim of this systematic review is to identify and summarise all studies that have compared mental health outcomes in breast cancer survivors, versus women who did not have cancer. METHODS This study will be a systematic review of the literature. Four databases, including MEDLINE and PsycINFO, will be searched to identify potentially relevant studies. The search expressions will use a Boolean logic, including terms for the target population (women who have had breast cancer), outcomes (psychiatric disorders) and comparators (e.g. risk, hazard). All mental disorders will be eligible, except those with onset normally occurring during childhood or strong genetic basis (e.g. Huntington disease). The eligibility of the studies will be assessed in two phases: (1) considering the information provided in the title and abstract; (2) evaluating the full text. Studies including women diagnosed with breast cancer 1 year or more ago and that provide original data on mental health outcomes will be eligible. Studies in which all women were undergoing surgery, chemotherapy or radiotherapy, or hospitalised or institutionalised, will be excluded, as well as studies that include patients selected on the basis of symptomatology. Two investigators will do the screening of the references and the data extraction independently, with results compared and discrepancies resolved by involving a third investigator when necessary. Study quality and risk of bias will be assessed across six broad domains. Results will be summarised by outcome, and summary measures of frequency and/or association will be computed if possible. DISCUSSION This review will summarise the evidence on the mental health outcomes of women who have been diagnosed with breast cancer. This information can be used to motivate further research and increase understanding of the most common mental health conditions affecting this growing population of women. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017056946.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London, UK
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rhea Harewood
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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4423
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Cheng X, Zhang G, Zhang L, Hu Y, Zhang K, Sun X, Zhao C, Li H, Li YM, Zhao J. Mesenchymal stem cells deliver exogenous miR-21 via exosomes to inhibit nucleus pulposus cell apoptosis and reduce intervertebral disc degeneration. J Cell Mol Med 2017; 22:261-276. [PMID: 28805297 PMCID: PMC5742691 DOI: 10.1111/jcmm.13316] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
Although mesenchymal stem cells (MSCs) transplantation into the IVD (intervertebral disc) may be beneficial in inhibiting apoptosis of nucleus pulposus cells (NPCs) and alleviating IVD degeneration, the underlying mechanism of this therapeutic process has not been fully explained. The purpose of this study was to explore the protective effect of MSC‐derived exosomes (MSC‐exosomes) on NPC apoptosis and IVD degeneration and investigate the regulatory effect of miRNAs in MSC‐exosomes and associated mechanisms for NPC apoptosis. MSC‐exosomes were isolated from MSC medium, and its anti‐apoptotic effect was assessed in a cell and rat model. The down‐regulated miRNAs in apoptotic NPCs were identified, and their contents in MSC‐exosomes were detected. The target genes of eligible miRNAs and possible downstream pathway were investigated. Purified MSC‐exosomes were taken up by NPCs and suppressed NPC apoptosis. The levels of miR‐21 were down‐regulated in apoptotic NPCs while MSC‐exosomes were enriched in miR‐21. The exosomal miR‐21 could be transferred into NPCs and alleviated TNF‐α induced NPC apoptosis by targeting phosphatase and tensin homolog (PTEN) through phosphatidylinositol 3‐kinase (PI3K)‐Akt pathway. Intradiscal injection of MSC‐exosomes alleviated the NPC apoptosis and IVD degeneration in the rat model. In conclusion, MSC‐derived exosomes prevent NPCs from apoptotic process and alleviate IVD degeneration, at least partly, via miR‐21 contained in exosomes. Exosomal miR‐21 restrains PTEN and thus activates PI3K/Akt pathway in apoptotic NPCs. Our work confers a promising therapeutic strategy for IVD degeneration.
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Affiliation(s)
- Xiaofei Cheng
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Guoying Zhang
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Liang Zhang
- Department of Orthopedics, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Ying Hu
- Department of Toxicity Evaluation, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Kai Zhang
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaojiang Sun
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Changqing Zhao
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hua Li
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yan Michael Li
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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4424
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Lee W, Lim SS, Kim B, Won JU, Roh J, Yoon JH. Relationship between long working hours and periodontitis among the Korean workers. Sci Rep 2017; 7:7967. [PMID: 28801658 PMCID: PMC5554150 DOI: 10.1038/s41598-017-08034-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022] Open
Abstract
We aimed to investigate the association between long working hours and periodontitis, and whether such an association constitutes an exposure-response relationship. Data for this study were collected from the Korea National Health and Nutrition Examination Surveys conducted from 2007 to 2014; 17,533 workers (9,483 of men and 8,050 of women) were included. The odds ratios (OR) and 95% confidence intervals (CI) for the analysis of periodontitis defined as positive of Community Periodontal Index in relation to working hours were calculated using multiple logistic regression models with various stratifications. Compared to participants who worked ≤40 hours per week, the prevalence ratio (95% CI) for the periodontitis was 1.19 (1.14–1.24) and full adjusted OR (95% CI) was 1.09 (1.02–1.18) in participants who worked over 40 hours per week. The OR (95% CI) for periodontitis were 1.09 (0.99–1.19) in working group of 40< and ≥52 and 1.10 (1.01–1.20) in working group of >52 hours per week with a significant trend (p = 0.0233) even after adjusting for age, socioeconomic status, healthy behaviour, chronic disease, and dental care status. Long working hours are associated with periodontitis among Korean workers in an exposure-response manner.
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Affiliation(s)
- Wanhyung Lee
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea
| | - Sung-Shil Lim
- Severance Hospital, Health System, Yonsei University, Seoul, Korea
| | - Byurira Kim
- Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jong-Uk Won
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea.,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jaehoon Roh
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea.,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea. .,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea. .,Incheon Worker's Health Center, Incheon, Korea. .,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.
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4425
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Affiliation(s)
- Andrew Charles
- From the UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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4426
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Li L, Cong Y, Gao X, Wang Y, Lin P. Differential expression profiles of long non-coding RNAs as potential biomarkers for the early diagnosis of acute myocardial infarction. Oncotarget 2017; 8:88613-88621. [PMID: 29179461 PMCID: PMC5687631 DOI: 10.18632/oncotarget.20101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. The early diagnosis of AMI is crucial for deciding the course of treatment and saving lives. Long non-coding RNAs (lncRNAs) are recently discovered ncRNA class and their dysregulated expression has been implicated in cardiovascular diseases. In this study, we analyzed lncRNA expression pattern by using two microarray datasets of AMI and healthy samples from the Gene Expression Omnibus (GEO) database and tried to identify novel AMI-related lncRNAs and investigate the predictive roles of lncRNAs in the early diagnosis of AMI. From the discovery cohort, 11 differentially expressed lncRNAs were identified as candidate biomarkers that were validated in the discovery cohort, internal cohort and an independent cohort, respectively. Hierarchical clustering analysis suggested that the expression pattern of these 11 candidate lncRNA biomarkers was closely associated with disease status of samples. Then a lncRNA risk classifier was developed by integrating expression value of 11 differentially expressed lncRNAs using support vector machine (SVM) algorithm. The results of leaving one out cross-validation (LOOCV) suggested that the lncRNA risk classifier has a good discrimination between AMI patients and healthy samples with the area under ROC curve (AUC) of 0.955, 0.92 and 0.701 in three cohorts, respectively. Functional enrichment analysis suggested that these 11 candidate lncRNA biomarkers might be involved in inflammation- and immune-related biological processes. Our study indicates the potential roles in the early diagnosis of AMI and will improve our understanding of the molecular mechanism of the occurrence and recurrence of AMI.
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Affiliation(s)
- Ling Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingying Cong
- Department of Biological Sciences and Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada.,Medical Department of Breast Oncology, The Tumor Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ping Lin
- School of Nursing, Harbin Medical University, Harbin, China
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4427
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Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health 2017; 13:57. [PMID: 28789698 PMCID: PMC5549395 DOI: 10.1186/s12992-017-0283-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disparity in adult mortality (AM) with reference to social dynamics and health care has not been sufficiently examined. This study aimed to identify the gap in the understanding of AM in relation to religion, political stability, economic level, and universal health coverage (UHC). METHODS A cross-national study was performed with different sources of data, using the administrative record linkage theory. Data was created from the 2013 World Bank data catalogue by region, The Economist (Political instability index 2013), Stuckler David et al. (Universal health coverage, 2010), and religious categories of all UN country members. Descriptive statistics, a t-test, an ANOVA followed by a post hoc test, and a linear regression were used where applicable. RESULT The average AM rate for males and females was 0.20 ± 0.10 and 0.14 ± 0.10, respectively. There was high disparity of AM between countries with and without UHC and between groups with low and high income. UHC and political stability would significantly reduce AMR by >0.41 in both sexes and high economic status would reduce male AMR by 0.44, and female AMR by 0.70. CONCLUSIONS It can be concluded that effective health care; UHC and political stability significantly reduce AM.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
- Health Science Foundations and Study Center, Kathmandu, Nepal
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
| | - Myung-Bae Park
- Department of Gerontal Health and Welfare, Pai Chai University, Seo-gu, Daejeon, Republic of Korea
| | - Sambhu Acharaya
- Department of Country Cooperation and Collaboration with the UN System Office of the Director-General, World Health Organization, Geneva, Switzerland
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4428
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Nguyen QLT, Van Phan T, Tran BX, Nguyen LH, Ngo C, Phan HTT, Latkin CA. Health insurance for patients with HIV/AIDS in Vietnam: coverage and barriers. BMC Health Serv Res 2017; 17:519. [PMID: 28774340 PMCID: PMC5543590 DOI: 10.1186/s12913-017-2464-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/23/2017] [Indexed: 12/31/2022] Open
Abstract
Background Health insurance (HI) plays an important role in ensuring the financial equity by the risk pooling mechanism and reducing the economic burden of healthcare for HIV/AIDS patients. However, there is a lack of evidence to clearly understand HI coverage in regard to people living with HIV (PLWH). We conducted this study to explore the coverage and barriers of HI among PLWH in Vietnam. Methods A cross- sectional study was conducted in multi-sites including 3 hospitals and 5 outpatient clinics in Hanoi and Nam Dinh in 2013. A convenience sampling approach was used to recruit the participants. A structured questionnaire was used to examine current status of using HI, lacking information about HI, feeling difficulties in accessing, using and paying HI. Multivariate logistic regression was conducted to examine factors associated with HI use and barriers. Results Among 1133 HIV/AIDS patients, the coverage of HI was 46.0%. About 36.4% lacked information about HI, 21.0% felt difficulty in accessing HI. Meanwhile, the proportions of patients feeling difficulty in using HI and paying HI were 19.9 and 18.6%, respectively. Multivariate regression found that lacking information about HI and feeling difficulty in accessing HI were main barriers of having HI among PLWH. Conclusion This study found a high proportion of PLWH was not covered by HI. Lacking information about HI and feeling difficulty in accessing HI were primary barriers that should be resolved via timely educational campaigns and consultations as well as supports from families in order to expand effectively the HI coverage.
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Affiliation(s)
- Quyen Le Thi Nguyen
- Institute for Global Health Innovation, Duy Tan University, Da Nang, Vietnam.
| | - Tuong Van Phan
- Institute of Health Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chau Ngo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4429
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Kiadaliri AA, Kristensen LE, Englund M. Burden of rheumatoid arthritis in the Nordic region, 1990–2015: a comparative analysis using the Global Burden of Disease Study 2015. Scand J Rheumatol 2017; 47:1-101. [DOI: 10.1080/03009742.2017.1314002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- AA Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - L-E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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4430
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Rehm J, Room R. The cultural aspect: How to measure and interpret epidemiological data on alcohol-use disorders across cultures. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:330-341. [PMID: 32934495 PMCID: PMC7450835 DOI: 10.1177/1455072517704795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/24/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples. DESIGN Narrative review. RESULTS There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder. CONCLUSIONS Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Canada University of Toronto, Canada
- University of Toronto, Canada
| | - Robin Room
- La Trobe University, Australia Stockholm
- University, Sweden
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4431
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Ajayi IO, Nsungwa-Sabiiti J, Siribié M, Petzold M, Castellani J, Singlovic J, Gomes M. Reply to Brooks et al. Clin Infect Dis 2017; 65:530-531. [PMID: 28838135 DOI: 10.1093/cid/cix383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- IkeOluwapo O Ajayi
- Department of Epidemiology and Medical Statistics, Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | | | | | - Max Petzold
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, The Netherlands
| | - Joëlle Castellani
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jan Singlovic
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Melba Gomes
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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4432
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Sulkunen P. Comment on Rehm and Room. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:353-355. [PMID: 32934496 PMCID: PMC7450829 DOI: 10.1177/1455072517729786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/02/2022] Open
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4433
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Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, Marrazzo JM, Sonder GJB, Schwebke JR, Hoornenborg E, Peeling RW, Philip SS, Low N, Fairley CK. Sexually transmitted infections: challenges ahead. THE LANCET. INFECTIOUS DISEASES 2017; 17:e235-e279. [PMID: 28701272 DOI: 10.1016/s1473-3099(17)30310-9] [Citation(s) in RCA: 447] [Impact Index Per Article: 63.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
Abstract
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henry J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeanne M Marrazzo
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jane R Schwebke
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Elske Hoornenborg
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Rosanna W Peeling
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan S Philip
- Disease Prevention and Control Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
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4434
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Abstract
PURPOSE OF REVIEW We will describe the success of recent genome-wide association studies that identify genetic variants associated with depression and outline the strategies used to reduce heterogeneity and increase sample size. RECENT FINDINGS The CONVERGE consortium identified two genetic associations by focusing on a sample of Chinese women with recurrent severe depression. Three other loci have been found in Europeans by combining cohorts with clinical diagnosis and measures of depressive symptoms to increase sample size. 23andMe identified 15 loci associated with depression using self-report of clinical diagnosis in a study of over 300,000 individuals. The first genetic associations with depression have been identified, and this number is now expected to increase linearly with sample size, as seen in other polygenic disorders. These loci provide invaluable insights into the biology of depression and exciting opportunities to develop new biomarkers and therapeutic targets.
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Affiliation(s)
- Niamh Mullins
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Cathryn M Lewis
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- Division of Genetics and Molecular Medicine, King's College London, London, SE1 9RT, UK
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4435
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Abstract
OPINION STATEMENT Migraine is a very disabling disorder with severe impact on patients' lives and substantive costs to society in terms of healthcare costs and lost productivity. Prevention is a key component of migraine therapy, and while numerous preventive options exist, each is burdened by either troublesome side effects or insufficient efficacy. All migraine preventives currently in clinical use were licensed for other purposes and, by chance, have efficacy against migraine. As our understanding of migraine has evolved, calcitonin gene-related peptide (CGRP) has moved to the forefront as a neuropeptide central to migraine pathophysiology. Six small molecule CGRP receptor antagonists were shown to be effective for acute treatment of migraine; two were stopped for hepatotoxicity or one for formulation concern issues and one is now in phase III. Monoclonal antibodies against CGRP or the CGRP receptor have a longer duration of action and have been investigated for migraine prevention. Four are in development and three have completed phase II and one phase III trials; every reported study has been positive. Furthermore, no safety issues have arisen to date, including hepatic or cardiovascular effects, and initial tolerability appears to be excellent. Monoclonal antibodies antagonizing the CGRP pathway represent a novel approach to prevention: a mechanism-specific migraine-targeted therapy. While we must await the results of all the phase III trials, cautious excitement seems warranted as we enter a new era of better tolerated, well-understood, bespoke migraine treatment for this common and disabling neurological disorder.
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Affiliation(s)
- Amy R Tso
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK
| | - Peter J Goadsby
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK.
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4436
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Bailey F, Mondragon-Shem K, Hotez P, Ruiz-Postigo JA, Al-Salem W, Acosta-Serrano Á, Molyneux DH. A new perspective on cutaneous leishmaniasis-Implications for global prevalence and burden of disease estimates. PLoS Negl Trop Dis 2017; 11:e0005739. [PMID: 28796782 PMCID: PMC5552022 DOI: 10.1371/journal.pntd.0005739] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Freddie Bailey
- NTDs, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- University of Edinburgh Medical School, Edinburgh, United Kingdom
| | - Karina Mondragon-Shem
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Peter Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | | | - Waleed Al-Salem
- National Centre for Tropical Diseases, Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Álvaro Acosta-Serrano
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - David H. Molyneux
- NTDs, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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4437
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Abstract
Reductions in mortality from diarrheal diseases among young children have occurred in recent decades; however, approximately 500,000 children continue to die each year. Moreover, similar reductions in disease incidence have not been seen, episodes that impact the growth and development of young children. Two recent studies, MAL-ED and GEMS, have more clearly defined the burden and cause of diarrhea among young children, identifying four leading pathogens: rotavirus, CryptosporidiumShigella, and heat stable toxin-producing enterotoxigenic Escherichia coli. Global introduction of rotavirus vaccine is poised to substantially reduce the incidence of rotavirus infection. Interventions are needed to reduce the burden that remains.
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4438
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Abstract
Helminth infections, including soil-transmitted helminths and schistosomiasis, remain one of the most common infections in the world with over 1 billion people infected. These infections cause significant morbidity, particularly in young children, that may last a lifetime, including growth and cognitive stunting. There is an urgent need for the control and elimination of helminth infections from areas of poverty to reduce morbidity in children. Mass drug administration programs were adopted by the World Health Assembly in 2001 and have evolved to provide coverage with multiple anthelmintic medications in a single rapid impact package and more extensive coverage within a community.
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Affiliation(s)
- Jill E Weatherhead
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
| | - Peter J Hotez
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM-385, Houston, TX 77030, USA; Sabin Vaccine Institute and Texas Children's Hospital (TCH), Center for Vaccine Development, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA
| | - Rojelio Mejia
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
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4439
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Kotloff KL, Platts-Mills JA, Nasrin D, Roose A, Blackwelder WC, Levine MM. Global burden of diarrheal diseases among children in developing countries: Incidence, etiology, and insights from new molecular diagnostic techniques. Vaccine 2017; 35:6783-6789. [PMID: 28765005 DOI: 10.1016/j.vaccine.2017.07.036] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 02/02/2023]
Abstract
The Global Enteric Multicenter Study (GEMS) demonstrated that Shigella and enterotoxigenic Escherichia coli (ETEC) producing heat stable toxin (ST) (either alone or in combination with heat labile toxin) are among the most important pathogens associated with moderate-to-severe diarrhea (MSD) in children younger than 5years of age living in developing countries. To inform the design of vaccines and other interventions, we reviewed published data and new results from GEMS characterizing the burden of Shigella and ST-ETEC infections. Clinical parameters were assessed to examine the value of various case definitions as indicators of MSD associated with Shigella and ST-ETEC for use in clinical trials. We discussed advantages and disadvantages of culture-based and culture-independent molecular diagnostics for detecting clinically and epidemiologically relevant disease. Shigella serotyping data from GEMS were examined to identify desirable components of Shigella and ETEC vaccines likely to confer broad protection. These findings can inform the development and implementation of vaccines to prevent these important infections among infants and children in developing countries.
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Affiliation(s)
- Karen L Kotloff
- Departments of Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA; Departments of Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Dilruba Nasrin
- Departments of Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anna Roose
- Departments of Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William C Blackwelder
- Departments of Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Myron M Levine
- Departments of Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA; Departments of Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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4440
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Fernández-De-Las-Peñas C, Arendt-Nielsen L. Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother 2017; 17:933-939. [DOI: 10.1080/14737175.2017.1359088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- César Fernández-De-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Spain
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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4441
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Evaluating the Effectiveness of Implementing a More Severe Drunk-Driving Law in China: Findings from Two Open Access Data Sources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080832. [PMID: 28757551 PMCID: PMC5580536 DOI: 10.3390/ijerph14080832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/16/2022]
Abstract
In 2011, China implemented a more severe drunk-driving law. This study evaluated the effectiveness of the law on road traffic morbidity and mortality attributed to alcohol use. Data were from two open-access data sources, the Global Burden of Disease (GBD) 2015 update and police data. Poisson regression examined the significance of changes in morbidity and mortality. Large gaps in crude death estimates from road traffic crashes attributed to alcohol use emerged between the two data sources. For the GBD 2015 update, crude and age-standardized mortality displayed consistent trends between 1990 and 2015; age-standardized mortality per 100,000 persons increased from 5.71 in 1990 to 7.48 in 2005 and then continuously decreased down to 5.94 in 2015. Police data showed a decrease for crude mortality per 100,000 persons from 0.29 in 2006 to 0.15 in 2010 and then an increase to 0.19 in 2015. We conclude available data are inadequate to determine the effectiveness of the implementation of the more severe drunk-driving law in China since the two data sources present highly inconsistent results. Further effort is needed to tackle data inconsistencies and obtain reliable and accurate data on road traffic injury attributable to alcohol use in China.
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4442
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Lee SH, Kang Y, Cho SJ. Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality. J Headache Pain 2017; 18:77. [PMID: 28744704 PMCID: PMC5526827 DOI: 10.1186/s10194-017-0779-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023] Open
Abstract
Background Cognitive decline is a major concern in patients with migraine. Depression, anxiety, and/or poor sleep quality are well-known comorbidities of migraine, but available evidence on the subjective cognitive decline (SCD) is limited. This study aimed to investigate the presence and frequency of SCD and its relationship with anxiety, depression and sleep quality in patients with migraine. Methods We enrolled patients with migraine who scored within the normal range of the Korean-Mini Mental State Examination and the Korean-Montreal Cognitive Assessment. Using the Subjective Cognitive Decline Questionnaire (SCD-Q), participants with ≥7 were assigned to the SCD group. The Headache Impact Test-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were used and analyzed between the two groups. Results A total of 188 patients with migraine, aged 38.1 ± 9.9 years, were enrolled. The mean SCD-Q score was 6.5 ± 5.5, and 44.7% of participants were identified as SCD. Migraineurs with SCD reported higher headache pain intensity and headache impact, as well as greater prevalence of anxiety, depression, reduced quality of sleep, and shorter sleep duration during weekdays compared to migraineurs without SCD. There were no significant differences in terms of age, sex, migraine type (chronic/episodic), medication, or sleep duration during weekends between the two groups. Upon multivariate logistic analysis adjusted for age, sex, headache characteristics, and psychological variables, depression was associated with increased risk of SCD (Odds ratio 1.31, 95% confidence interval 1.16–1.49) and sleep duration during weekdays was associated with decreased risk of SCD (Odds ratio 0.66, 95% confidence interval 0.44–0.97). Conclusions A non-negligible number of patients with migraine complained of SCD. Depression and short sleep duration during weekdays were related to SCD among adult migraineurs.
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Affiliation(s)
- Sun Hwa Lee
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 445-907, South Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, Korea
| | - Soo-Jin Cho
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
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4443
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Luyckx VA, Perico N, Somaschini M, Manfellotto D, Valensise H, Cetin I, Simeoni U, Allegaert K, Vikse BE, Steegers EA, Adu D, Montini G, Remuzzi G, Brenner BM. A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group. Lancet 2017; 390:424-428. [PMID: 28284520 PMCID: PMC5884413 DOI: 10.1016/s0140-6736(17)30576-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zürich, Zürich, Switzerland
| | - Norberto Perico
- Clinical Research Center for Rare Diseases Aldo e Cele Daccò, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | | | - Dario Manfellotto
- Department of Internal Medicine, AFaR Division, Fatebenefratelli Foundation, "San Giovanni Calibita" Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Herbert Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, Hospital "L Sacco", and Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy
| | - Umberto Simeoni
- Service de Pédiatrie, Université de Lausanne, Lausanne, Switzerland
| | - Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Development and Regeneration KU Leuven, Leuven, Belgium
| | - Bjorn Egil Vikse
- Department of Medicine, Haugesund Hospital, Haugesund, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eric A Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dwomoa Adu
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Giovanni Montini
- Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases Aldo e Cele Daccò, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Centro Anna Maria Astori, Science and Technology Park Kilometro rosso, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Unit of Nephrology, Dialysis and Transplantation, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Barry M Brenner
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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4444
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Padilla J, Fadel PJ. Prolonged sitting leg vasculopathy: contributing factors and clinical implications. Am J Physiol Heart Circ Physiol 2017; 313:H722-H728. [PMID: 28733451 DOI: 10.1152/ajpheart.00326.2017] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 01/05/2023]
Abstract
Atherosclerotic peripheral artery disease primarily manifests in the medium- to large-sized conduit arteries of the lower extremities. However, the factors underlying this increased vulnerability of leg macrovasculature to disease are largely unidentified. On the basis of recent studies, we propose that excessive time spent in the sitting position and the ensuing reduction in leg blood flow-induced shear stress cause endothelial cell dysfunction, a key predisposing factor to peripheral artery disease. In particular, this review summarizes the findings from laboratory-based sitting studies revealing acute leg vascular dysfunction with prolonged sitting in young healthy subjects, discusses the primary physiological mechanisms and the potential long-term implications of such leg vasculopathy with repeated exposure to prolonged sitting, as well as identifies strategies that may be effective at evading it.
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Affiliation(s)
- Jaume Padilla
- Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; .,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri.,Child Health, University of Missouri, Columbia, Missouri; and
| | - Paul J Fadel
- Department of Kinesiology, University of Texas-Arlington, Arlington, Texas
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4445
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Misganaw A, Melaku YA, Tessema GA, Deribew A, Deribe K, Abera SF, Dessalegn M, Lakew Y, Bekele T, Haregu TN, Amare AT, Gedefaw M, Mohammed M, Yirsaw BD, Damtew SA, Achoki T, Blore J, Krohn KJ, Assefa Y, Kifle M, Naghavi M. National disability-adjusted life years (DALYs) for 257 diseases and injuries in Ethiopia, 1990-2015: findings from the global burden of disease study 2015. Popul Health Metr 2017; 15:28. [PMID: 28732542 PMCID: PMC5521136 DOI: 10.1186/s12963-017-0146-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/14/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Disability-adjusted life years (DALYs) provide a summary measure of health and can be a critical input to guide health systems, investments, and priority-setting in Ethiopia. We aimed to determine the leading causes of premature mortality and disability using DALYs and describe the relative burden of disease and injuries in Ethiopia. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for non-fatal disease burden, cause-specific mortality, and all-cause mortality to derive age-standardized DALYs by sex for Ethiopia for each year. We calculated DALYs by summing years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) for each age group and sex. Causes of death by age, sex, and year were measured mainly using Causes of Death Ensemble modeling. To estimate YLDs, a Bayesian meta-regression method was used. We reported DALY rates per 100,000 for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases, and injuries, with 95% uncertainty intervals (UI) for Ethiopia. RESULTS Non-communicable diseases caused 23,118.1 (95% UI, 17,124.4-30,579.6), CMNN disorders resulted in 20,200.7 (95% UI, 16,532.2-24,917.9), and injuries caused 3781 (95% UI, 2642.9-5500.6) age-standardized DALYs per 100,000 in Ethiopia in 2015. Lower respiratory infections, diarrheal diseases, and tuberculosis were the top three leading causes of DALYs in 2015, accounting for 2998 (95% UI, 2173.7-4029), 2592.5 (95% UI, 1850.7-3495.1), and 2562.9 (95% UI, 1466.1-4220.7) DALYs per 100,000, respectively. Ischemic heart disease and cerebrovascular disease were the fourth and fifth leading causes of age-standardized DALYs, with rates of 2535.7 (95% UI, 1603.7-3843.2) and 2159.9 (95% UI, 1369.7-3216.3) per 100,000, respectively. The following causes showed a reduction of 60% or more over the last 25 years: lower respiratory infections, diarrheal diseases, tuberculosis, neonatal encephalopathy, preterm birth complications, meningitis, malaria, protein-energy malnutrition, iron-deficiency anemia, measles, war and legal intervention, and maternal hemorrhage. CONCLUSIONS Ethiopia has been successful in reducing age-standardized DALYs related to most communicable, maternal, neonatal, and nutritional deficiency diseases in the last 25 years, causing a major ranking shift to types of non-communicable disease. Lower respiratory infections, diarrheal disease, and tuberculosis continue to be leading causes of premature death, despite major declines in burden. Non-communicable diseases also showed reductions as premature mortality declined; however, disability outcomes for these causes did not show declines. Recently developed non-communicable disease strategies may need to be amended to focus on cardiovascular diseases, cancer, diabetes, and major depressive disorders. Increasing trends of disabilities due to neonatal encephalopathy, preterm birth complications, and neonatal disorders should be emphasized in the national newborn survival strategy. Generating quality data should be a priority through the development of new initiatives such as vital events registration, surveillance programs, and surveys to address gaps in data. Measuring disease burden at subnational regional state levels and identifying variations with urban and rural population health should be conducted to support health policy in Ethiopia.
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Affiliation(s)
- Awoke Misganaw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Yohannes Adama Melaku
- School of Public Health, University of Adelaide, Adelaide, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Gizachew Assefa Tessema
- School of Public Health, University of Adelaide, Adelaide, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Amare Deribew
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Kebede Deribe
- Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Semaw Ferede Abera
- School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | | | - Yihunie Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Tolesa Bekele
- Department of Public Health, College of Medicine and Health Sciences, Madda Walabu University, Bale Robe, Ethiopia
| | | | - Azmeraw T. Amare
- School of Public Health, University of Adelaide, Adelaide, Australia
- Federal Ministry of Health, Addis Ababa, Ethiopia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | | | - Solomon Abrha Damtew
- College of Health Sciences and Medicine, Wolayta Sodo University, Addis Ababa, Ethiopia
| | - Tom Achoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Jed Blore
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Kristopher J. Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Yibeltal Assefa
- School of Public Health, University of Queensland, St Lucia, Australia
| | - Mahlet Kifle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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4446
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Pereira MG, Roios E, Pereira M. Functional disability in patients with low back pain: the mediator role of suffering and beliefs about pain control in patients receiving physical and chiropractic treatment. Braz J Phys Ther 2017; 21:465-472. [PMID: 28716365 PMCID: PMC5693431 DOI: 10.1016/j.bjpt.2017.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/03/2017] [Accepted: 01/18/2017] [Indexed: 12/26/2022] Open
Abstract
Subjective suffering mediated the relationship between depression and functional disability regardless of the type of treatment. Beliefs about chance events mediated the relationship between depression and functional disability only in the physical therapy treatment. Intervention should target cognitive and psychological factors in LBP patients.
Background Low back pain is the leading cause of disability worldwide. There is evidence that depression, anxiety, and external locus of control are negative predictors of functional disability in low back patients. Methods This study focused on the mediator role of suffering and beliefs about pain control in the relationship between psychological morbidity and functional disability in patients receiving physical therapy and chiropractic treatment for chronic low back pain. The sample included 213 patients receiving chiropractic treatment and 125 receiving physical therapy, who answered the following instruments: Beliefs about Pain Control Questionnaire; Inventory of Subjective Experiences of Suffering in Illness; Oswestry Low Back Pain Disability Questionnaire; and the Hospital Anxiety and Depression Scales. Results Suffering was a mediator in the relationship between depression and functional disability in both treatment groups. Only beliefs related to external chance events mediated the relationship between depression and functional disability in the physical therapy group, but not in the chiropratic teratment group. Conclusion Intervention should focus on suffering regardless of the type of treatment and target beliefs about pain control, in patients receiving physical therapy treatment since they seem to play a key role in functional disability in patients with low back pain.
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Affiliation(s)
- M Graça Pereira
- Universidade do Minho, Escola de Psicologia, Departamento de Psicologia Aplicada, Braga, Portugal.
| | - Edite Roios
- Universidade do Minho, Escola de Psicologia, Departamento de Psicologia Aplicada, Braga, Portugal
| | - Marta Pereira
- Universidade do Minho, Escola de Psicologia, Departamento de Psicologia Aplicada, Braga, Portugal
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4447
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Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Femia AL, Roseen EJ, Gardiner P, Gergen Barnett K, Faulkner C, Weinberg J. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med 2017; 167. [PMID: 28631003 PMCID: PMC6392183 DOI: 10.7326/m16-2579] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain. OBJECTIVE To determine whether yoga is noninferior to PT for cLBP. DESIGN 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927). SETTING Academic safety-net hospital and 7 affiliated community health centers. PARTICIPANTS 320 predominantly low-income, racially diverse adults with nonspecific cLBP. INTERVENTION Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. MEASUREMENTS Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life. RESULTS One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. LIMITATIONS Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up. CONCLUSION A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. PRIMARY FUNDING SOURCE National Center for Complementary and Integrative Health of the National Institutes of Health.
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Affiliation(s)
- Robert B Saper
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Chelsey Lemaster
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Anthony Delitto
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Karen J Sherman
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Patricia M Herman
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Ekaterina Sadikova
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Joel Stevans
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Julia E Keosaian
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Christian J Cerrada
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Alexandra L Femia
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Eric J Roseen
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Paula Gardiner
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Katherine Gergen Barnett
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Carol Faulkner
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
| | - Janice Weinberg
- From Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California
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Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abdurahman AA, Abera SF, Abraham B, Abreha GF, Adane K, Adelekan AL, Adetifa IMO, Afshin A, Agarwal A, Agarwal SK, Agarwal S, Agrawal A, Kiadaliri AA, Ahmadi A, Ahmed KY, Ahmed MB, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam N, Alam SS, Alemu ZA, Alene KA, Alexander L, Ali R, Ali SD, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amo-Adjei J, Amoako YA, Anderson BO, Androudi S, Ansari H, Ansha MG, Antonio CAT, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Astatkie A, Atey TM, Atique S, Atnafu NT, Atre SR, Avila-Burgos L, Avokpaho EFGA, Quintanilla BPA, Awasthi A, Ayele NN, Azzopardi P, Saleem HOB, Bärnighausen T, Bacha U, Badawi A, Banerjee A, Barac A, Barboza MA, Barker-Collo SL, Barrero LH, Basu S, Baune BT, Baye K, Bayou YT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Bernal OA, Beyene AS, Beyene TJ, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bose D, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Butt ZA, Cárdenas R, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Carrero JJ, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cecilio P, Cercy K, Charlson FJ, Chen AZ, Chew A, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coggeshall MS, Cooper LT, Cortinovis M, Crump JA, Dalal K, Danawi H, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, De Leo D, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dicker D, Ding EL, Dokova K, Dorsey ER, Doyle KE, Dubey M, Ehrenkranz R, Ellingsen CL, Elyazar I, Enayati A, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fürst T, Faghmous IDA, Fanuel FBB, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Fischer F, Fitzmaurice C, Fleming TD, Foigt N, Foreman KJ, Forouzanfar MH, Franklin RC, Frostad J, G/hiwot TT, Gakidou E, Gambashidze K, Gamkrelidze A, Gao W, Garcia-Basteiro AL, Gebre T, Gebremedhin AT, Gebremichael MW, Gebru AA, Gelaye AA, Geleijnse JM, Genova-Maleras R, Gibney KB, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold A, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Graetz N, Greaves F, Griswold M, Guban PI, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Habtewold TD, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Hakuzimana A, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, Hendrie D, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Htet AS, Hu G, Huang H, Huang JJ, Huntley BM, Huynh C, Iburg KM, Ileanu BV, Innos K, Irenso AA, Jahanmehr N, Jakovljevic MB, James P, James SL, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jha V, John D, Johnson C, Johnson SC, Jonas JB, Juel K, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kazanjan K, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Kerbo AA, Kereselidze M, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khan G, Khang YH, Khoja ATA, Khonelidze I, Khubchandani J, Kibret GD, Kim D, Kim P, Kim YJ, Kimokoti RW, Kinfu Y, Kissoon N, Kivipelto M, Kokubo Y, Kolk A, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar GA, Kumsa FA, Kutz M, Kyu HH, Lager ACJ, Lal A, Lal DK, Lalloo R, Lallukka T, Lan Q, Langan SM, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leinsalu M, Leshargie CT, Leung J, Leung R, Levi M, Liang X, Lim SS, Lind M, Linn S, Lipshultz SE, Liu P, Liu Y, Lo LT, Logroscino G, Lopez AD, Lorch SA, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Macarayan ERK, Mackay MT, El Razek HMA, El Razek MMA, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marcenes W, Marks GB, Marquez N, Martinez-Raga J, Marzan MB, Massano J, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McNellan C, Meaney PA, Mehari A, Mehndiratta MM, Meier T, Mekonnen AB, Meles KG, Memish ZA, Mengesha MM, Mengiste DT, Mengistie MA, Menota BG, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mezgebe HB, Micha R, Millear A, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Mock CN, Mohammad KA, Mohammed S, Mohanty SK, Mokdad AH, Mola GLD, Molokhia M, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Moses M, Mueller UO, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naheed A, Naldi L, Nangia V, Nascimento BR, Negoi I, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Ngunjiri JW, Nguyen G, Ningrum DNA, Nolte S, Nomura M, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Osman M, Owolabi MO, PA M, Pain AW, Pakhale S, Castillo EP, Pana A, Papachristou C, Parsaeian M, Patel T, Patton GC, Paudel D, Paul VK, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Polinder S, Pond CD, Prakash V, Purwar M, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rai RK, Ram U, Rana SM, Rankin Z, Rao PV, Rao PC, Rawaf S, Rego MAS, Reitsma M, Remuzzi G, Renzaho AMNN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Roba HS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy NK, Sachdev PS, Sackey BB, Saeedi MY, Safiri S, Sagar R, Sahraian MA, Saleh MM, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sandar L, Santos IS, Santos JV, Milicevic MMS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Seid AM, Seifu CN, Sepanlou SG, Serdar B, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Shamsipour M, Islam SMS, Sharma J, Sharma R, She J, Sheikhbahaei S, Shen J, Shi P, Shigematsu M, Shin MJ, Shiri R, Shoman H, Shrime MG, Sibamo ELS, Sigfusdottir ID, Silva DAS, Silveira DGA, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Sinke AH, Sinshaw AE, Skirbekk V, Sliwa K, Smith A, Sobngwi E, Soneji S, Soriano JB, Sousa TCM, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Steiner C, Steinke S, Stokes MA, Stranges S, Strong M, Stroumpoulis K, Sturua L, Sufiyan MB, Suliankatchi RA, Sun J, Sur P, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taffere GR, Talongwa RT, Tarajia M, Tavakkoli M, Taveira N, Teeple S, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Shifa GT, Terkawi AS, Tesema AG, Thakur JS, Thomson AJ, Tillmann T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Tortajada M, Troeger C, Truelsen T, Tura AK, Uchendu US, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Boven JFM, Van Dingenen R, Varughese S, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagner JA, Wakayo T, Waller SG, Walson JL, Wang H, Wang YP, Watkins DA, Weiderpass E, Weintraub RG, Wen CP, Werdecker A, Wesana J, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Won S, Workicho A, Workie SB, Wubshet M, Xavier D, Xu G, Yadav AK, Yaghoubi M, Yakob B, Yan LL, Yano Y, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zenebe ZM, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390:231-266. [PMID: 28528753 PMCID: PMC5528124 DOI: 10.1016/s0140-6736(17)30818-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING Bill & Melinda Gates Foundation.
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Yeast-expressed recombinant As16 protects mice against Ascaris suum infection through induction of a Th2-skewed immune response. PLoS Negl Trop Dis 2017; 11:e0005769. [PMID: 28708895 PMCID: PMC5529013 DOI: 10.1371/journal.pntd.0005769] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/26/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Ascariasis remains the most common helminth infection in humans. As an alternative or complementary approach to global deworming, a pan-anthelminthic vaccine is under development targeting Ascaris, hookworm, and Trichuris infections. As16 and As14 have previously been described as two genetically related proteins from Ascaris suum that induced protective immunity in mice when formulated with cholera toxin B subunit (CTB) as an adjuvant, but the exact protective mechanism was not well understood. Methodology/Principal findings As16 and As14 were highly expressed as soluble recombinant proteins (rAs16 and rAs14) in Pichia pastoris. The yeast-expressed rAs16 was highly recognized by immune sera from mice infected with A. suum eggs and elicited 99.6% protection against A. suum re-infection. Mice immunized with rAs16 formulated with ISA720 displayed significant larva reduction (36.7%) and stunted larval development against A. suum eggs challenge. The protective immunity was associated with a predominant Th2-type response characterized by high titers of serological IgG1 (IgG1/IgG2a > 2000) and high levels of IL-4 and IL-5 produced by restimulated splenocytes. A similar level of protection was observed in mice immunized with rAs16 formulated with alum (Alhydrogel), known to induce mainly a Th2-type immune response, whereas mice immunized with rAs16 formulated with MPLA or AddaVax, both known to induce a Th1-type biased response, were not significantly protected against A. suum infection. The rAs14 protein was not recognized by A. suum infected mouse sera and mice immunized with rAs14 formulated with ISA720 did not show significant protection against challenge infection, possibly due to the protein’s inaccessibility to the host immune system or a Th1-type response was induced which would counter a protective Th2-type response. Conclusions/Significance Yeast-expressed rAs16 formulated with ISA720 or alum induced significant protection in mice against A. suum egg challenge that associates with a Th2-skewed immune response, suggesting that rAS16 could be a feasible vaccine candidate against ascariasis. Roundworms (Ascaris) infect more than 700 million people living in poverty worldwide and cause malnutrition and physical and mental developmental delays in children. As an alternative or complementary approach to global deworming, a pan-anthelminthic vaccine is under development that targets ascariasis in addition to other human intestinal nematode infections. Towards this goal, two Ascaris suum antigens, As16 and As14, were expressed in Pichia pastoris as recombinant proteins. Mice immunized with rAs16 formulated with ISA720 adjuvant produced significant larva reduction (36.7%) and stunted larval development against A. suum egg challenge. The protection was associated with predominant Th2-type responses characterized by high levels of serological IgG1 (IgG1/IgG2a > 2,000) and Th2 cytokines, IL-4 and IL-5. A similar level of protection was observed in mice immunized with rAs16 formulated with alum that induces mainly a Th2-type immune response, whereas mice immunized with rAs16 formulated with MPLA or AddaVax, both inducing major Th1-type responses, were not significantly protected against A. suum infection. High-yield expression of rAs16 in yeast will allow for large-scale manufacture, and its protective efficacy when formulated with alum suggests its suitability as a vaccine candidate.
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Krug E, Cieza A. Strengthening health systems to provide rehabilitation services. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 22. [DOI: 10.1002/pri.1691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Etienne Krug
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization; Geneva Switzerland
| | - Alarcos Cieza
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization; Geneva Switzerland
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