Global, regional, and national quality of care and burden of ischemic heart disease, 1990 to 2017: results from the GBD study 2017

Background

Sustainable development goal (SDG) target 3.4 aims at reducing premature death from non-communicable diseases including ischemic heart disease (IHD) by one-third by 2030.

Purpose

We aimed to compare the quality of care (QoC) of IHD between countries, genders, and age groups by employing its fatal and non-fatal estimates from the Global Burden of Diseases study 2017 to guide future policy makings for achieving SDGs.

Methods

We employed three epidemiologically meaningful combinations of fatal and non-fatal estimates of IHD: 1) Mortality to incidence ratio. 2) Disability-adjusted life-years (DALYs) to prevalence ratio. 3) Years of life lost to years lived with disability ratio. In the setting of IHD, the greater these measures, the poorer the QoC of IHD. We summarized these indices by principal component analysis and taking its first principal component as the quality of care index (QCI) scaled from 0 to 100 with the bigger score indicating better QoC. Based on the mean of the socio-demographic index (SDI) of countries between 1990 and 2017, countries were divided into high- and low-SDI groups and their QCIs were compared in different maps (Figure). We defined gender disparity ratio (GDR) as the ratio of female QCI to male QCI for evaluating gender inequity. For evaluation of inequities between age groups, we categorized countries into five groups based on the quintiles of SDI in the year of interest and plotted QCI against age for each group. Statistical analyses were done by R software v3.6.0.

Results

IHD was the fourth contributor to global DALYs in 1990 and climbed to the second rank in 2017. Although all-ages DALYs of IHD increased by 0.6% and was relatively stable, its age-standardized DALYs steadily decreased by 27.7% from 1990 to 2017 worldwide. The global QCI increased by 7.4% from 71.2 in 1990 to 76.4 in 2017. In 2017, the Netherlands, France, Israel, Italy, and Japan had the highest QCI in the world, respectively, and the United States with the QCI of 84.7 was in the third quintile of the high-SDI countries (Figure 1). Peru, Iraq, Thailand, Jamaica, and Saint Lucia had the top five QCIs amongst the low-SDI countries in 2017. The global GDR steadily increased from 1.04 in 1990 to 1.08 in 2017. Most countries of Western Europe, North America, and Australasia have a GDR between 1 and 1.2 in 1990 and 2017. In 1990, the plot of QCI against age demonstrated that QCI of elderlies is lower than other age groups in high, high-middle, and middle SDI countries; nevertheless, this pattern was not evident in low-middle and low SDI countries. Although this difference was disappeared in high SDI countries in 2017, it persisted in high-middle and middle SDI countries.

Conclusions

QoC of IHD has been improved in the last decades; however, it was not consistent between countries, genders, and age groups. These results have implications for monitoring and modifying public health policies toward SDGs and health for all worldwide.

Figure 1. Comparison of QCI of Countries

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Bill and Melinda Gates Foundation

MR Elastography Demonstrates Increased Brain Stiffness in Normal Pressure Hydrocephalus

BACKGROUND AND PURPOSE

Normal pressure hydrocephalus is a reversible neurologic disorder characterized by a triad of cognitive impairment, gait abnormality, and urinary incontinence that is commonly treated with ventriculoperitoneal shunt placement. However, multiple overlapping symptoms often make it difficult to differentiate normal pressure hydrocephalus from other types of dementia, and improved diagnostic techniques would help patient management. MR elastography is a novel diagnostic tool that could potentially identify patients with normal pressure hydrocephalus. The purpose of this study was to assess brain stiffness changes in patients with normal pressure hydrocephalus compared with age- and sex-matched cognitively healthy individuals.

MATERIALS AND METHODS

MR elastography was performed on 10 patients with normal pressure hydrocephalus and 21 age- and sex-matched volunteers with no known neurologic disorders. Image acquisition was conducted on a 3T MR imaging scanner. Shear waves with 60-Hz vibration frequency were transmitted into the brain by a pillowlike passive driver. A novel postprocessing technique resistant to noise and edge artifacts was implemented to determine regional brain stiffness. The Wilcoxon rank sum test and linear regression were used for statistical analysis.

RESULTS

A significant increase in stiffness was observed in the cerebrum (P = .001), occipital lobe (P < .001), parietal lobe (P = .001), and the temporal lobe (P = .02) in the normal pressure hydrocephalus group compared with healthy controls. However, no significant difference was noted in other regions of the brain, including the frontal lobe (P = .07), deep gray and white matter (P = .43), or cerebellum (P = .20).

CONCLUSIONS

This study demonstrates increased brain stiffness in patients with normal pressure hydrocephalus compared with age- and sex-matched healthy controls; these findings should motivate future studies investigating the use of MR elastography for this condition and the efficacy of shunt therapy.

Trace determination of lead in lipsticks and hair dyes using microwave-assisted dispersive liquid-liquid microextraction and graphite furnace atomic absorption spectrometry

OBJECTIVE

A novel microwave-assisted dispersive liquid-liquid microextraction (MADLLME) technique according to the solidification of a floating organic droplet (SFO) and graphite furnace atomic absorption spectrometry (GFAAS) used for the extraction and determination of lead ions in lipsticks and hair dyes made in different countries. Lipstick and hair dye samples of different brands and colours were collected from local market in Kermanshah, Iran.

METHODS

After sample treatment with microwave-assisted acid digestion, an appropriate mixture of acetone, 1-undecanol and diethyl dithiophosphoric acid was injected rapidly into the aqueous sample containing lead ions, and as a result, cloudy mixture was formed. After centrifugation, the test tube was cooled for few minutes. The solidified 1-undecanol on top of the solution was transferred into a suitable vial and injected into the analytical instrument.

RESULTS

Under the optimum experimental conditions (extraction solvent: 30 μL of 1-undecanol; disperser solvent: 500 μL of acetone; ligand concentration: 0.15% (v/v); pH: ~1.5 and without salt added), the enhancement factor of 96 was obtained. The calibration graphs were linear in the range of 0.3-50 μg kg(-1) with a correlation coefficient (r(2) ) more than 0.995. The detection limit was 0.1 μg kg(-1) . Consequently, the developed method was successfully applied to extract and determine lead ions in the lipsticks and hair dyes, and favourable results were obtained. The proposed method which applied in cosmetics showed excellent relative recoveries (90-109.7%) with relative standard deviations <8.3% (n = 3) for all samples.

CONCLUSION

The study revealed that the concentration of lead found in lipsticks and hair dyes on the Kermanshah market is far below the recommended limits as applied in Germany (20 mg kg(-1) ) and Canada (10 mg kg(-1) ) and confirmed that very low levels of lead are technically available in the final cosmetic products.