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1. Magnetic resonance imaging brain atrophy assessment in primary age-related tauopathy (PART)

Author: Miguel Quintas-Neves, Merilee A. Teylan, Lilah Besser, João Soares-Fernandes, Charles N. Mock, Walter A. Kukull, John F. Crary, and Tiago Gil Oliveira
Subjects: Primary age-related tauopathy, Alzheimer disease, MRI, Brain imaging, Neurology. Diseases of the nervous system, RC346-429
Abstract: Abstract Alzheimer disease (AD) is a neurodegenerative disorder characterized pathologically by the accumulation of amyloid-beta (Aβ) plaques and tau neurofibrillary tangles (NFTs). Recently, primary age-related tauopathy (PART) has been described as a new anatomopathological disorder where NFTs are the main feature in the absence of neuritic plaques. However, since PART has mainly been studied in post-mortem patient brains, not much is known about the clinical or neuroimaging characteristics of PART. Here, we studied the clinical brain imaging characteristics of PART focusing on neuroanatomical vulnerability by applying a previously validated multiregion visual atrophy scale. We analysed 26 cases with confirmed PART with paired clinical magnetic resonance imaging (MRI) acquisitions. In this selected cohort we found that upon correcting for the effect of age, there is increased atrophy in the medial temporal region with increasing Braak staging (r = 0.3937, p = 0.0466). Upon controlling for Braak staging effect, predominantly two regions, anterior temporal (r = 0.3638, p = 0.0677) and medial temporal (r = 0.3836, p = 0.053), show a trend for increased atrophy with increasing age. Moreover, anterior temporal lobe atrophy was associated with decreased semantic memory/language (r = − 0.5823, p = 0.0056; and r = − 0.6371, p = 0.0019, respectively), as was medial temporal lobe atrophy (r = − 0.4445, p = 0.0435). Overall, these findings support that PART is associated with medial temporal lobe atrophy and predominantly affects semantic memory/language. These findings highlight that other factors associated with aging and beyond NFTs could be involved in PART pathophysiology.
Published: 2019
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2. Barriers and facilitators to Electronic Medical Records usage in the Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana

Author: Adwoa Gyamfi, Kofi A. Mensah, George Oduro, Peter Donkor, and Charles N. Mock
Subjects: Medicine, Medicine (General), R5-920
Abstract: Introduction: The use of paper for record keeping (or a manual system) has been the order of the day in almost all health care facilities in resource poor countries. This system has presented numerous challenges, which the use of Electronic Medical Records (EMR) seeks to address. The objectives of the study were to identify the facilitators and barriers to EMR implementation in Komfo Anokye Teaching Hospital’s (KATH) Emergency Centre (EC) and to identify lessons learned. These will help in implementation of EMR in ECs in similar settings. Methods: This was a non-interventional, descriptive cross-sectional and purely qualitative study using a semi-structured interview guide for a study population of 24. The interviews were manually recorded and analysed thematically. EMR implementation was piloted in the EC. Some of the EC staff doubled as EMR personnel. An open source EMR was freely downloaded and customised to meet the needs of the EC. The EMR database created was a hybrid one comprising of digital bio-data of patients and scanned copies of their paper EC records. Results: The facilitators for utilising the system included providing training to staff, the availability of some logistics, and the commitment of staff. The project barriers were funding, full-time information technology expertise, and automatic data and power backups. It was observed that with the provision of adequate human and financial resources, the challenges were overcome and the adoption of the EMR improved. Discussion: The EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics, and staff commitment represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation.
Published: 2017
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3. Availability of resources for emergency care at a second-level hospital in Ghana: A mixed methods assessment

Author: Kennedy B. Japiong, Godfried Asiamah, Ellis Owusu-Dabo, Peter Donkor, Barclay Stewart, Beth E. Ebel, and Charles N. Mock
Subjects: Capacity, Quality improvement, Emergency, Developing country, Global surgery, Medicine, Medicine (General), R5-920
Abstract: Emergency care is an essential component of health systems, particularly in low- and middle-income countries. We sought to assess the availability of resources to provide emergency care at a second-level hospital in Ghana. By doing so, deficits that could guide development of targeted intervention strategies to improve emergency care could be identified. Methods: A qualitative and quantitative assessment of capacity for care of emergency patients was performed at the Emergency Centre of the Police Hospital, a second-level hospital in Accra, Ghana. Direct inspection and job-specific survey of clinical, orderly, administrative and ambulance staff was performed. Responses to quantitative questions were described. Qualitative responses were examined by content analysis. Results: Assessment revealed marked deficiencies in many essential items and services. However, several successes were identified, such as laboratory capacity. Among the unavailable essential items, some were of low-cost, such as basic airway supplies, chest tubes and several emergency medications. Themes from staff responses when asked how to improve emergency care included: provide periodic training, increase bed numbers in the emergency unit, ensure availability of essential items and make personal protective equipment available for all staff caring for patients. Conclusion: This study identified opportunities to improve the care of patients with emergency conditions at the Police Hospital in Ghana. Low-cost improvements in training, organization and planning could improve item and service availability, such as: developing a continuing education curriculum for staff in all areas of the emergency centre; holding in-service training on existing protocols for triage and emergency care; adding checklists to guide appropriate triage and safe transfer of patients; and perform a root cause analysis of item non-availability to develop targeted interventions.
Published: 2016
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4. The need for ventilators in the developing world: An opportunity to improve care and save lives

Author: Vijay Krishnamoorthy, Monica S. Vavilala, and Charles N. Mock
Subjects: Ventilators, developing countries, improve care, save lives, Medicine, Public aspects of medicine, RA1-1270
Abstract: The drive to breathe is a fundamental human and biologic behavior, regulated by a complex system of checks and balances in the body. When respiratory mechanics are deregulated by injury, infection, coma, or a host of other conditions, the biologic equilibrium shifts into a state of respiratory failure. When this occurs, mechanical ventilation can be a life saving therapy. While commonplace in developed countries, critical care is at its infancy in many developing countries, where basic technology is often not available. Thus, while many lives are saved in developed nations through the provision of mechanical ventilation, patients in many developing nations often die from otherwise reversible causes due to lack of resources, education, and training.
Published: 2014
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5. Standardization of Trauma, General Surgical Morbidity and Mortality Conferences: Development and Dissemination of a 'Toolkit' in Peru

Author: Gabriela Zavala Wong, Manuel J. Rodriguez Castro, Eduardo Huaman Egoavil, Roberto Valderrama, Charles N. Mock, Juan J. Herrera-Matta, Gianni Aragon, Ryan Peterson, Ying Jin, and Lacey N. LaGrone
Subjects: Peru, Humans, Surgery, Trauma, General Surgica Mortality, General Surgical Morbidity
Abstract: Background Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them. Methods The present study aims to gather general surgeons representing most of Peru’s urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices. Results A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described “improve the system” as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p Conclusion We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of “system improvement” as the goal of M&M conferences.
Published: 2022

6. Divergent magnetic resonance imaging atrophy patterns in Alzheimer's disease and primary age-related tauopathy

Author: Miguel Quintas-Neves, Merilee A. Teylan, Rafaela Morais-Ribeiro, Francisco Almeida, Charles N. Mock, Walter A. Kukull, John F. Crary, and Tiago Gil Oliveira
Subjects: Aging, General Neuroscience, Brain, Plaque, Amyloid, Neuropsychological Tests, Magnetic Resonance Imaging, Tauopathies, Alzheimer Disease, Humans, Cognitive Dysfunction, Neurology (clinical), Atrophy, Geriatrics and Gerontology, Developmental Biology
Abstract: Our study compared brain MRI with neuropathological findings in patients with primary age-related tauopathy (PART) and Alzheimer's disease (AD), while assessing the relationship between brain atrophy and clinical impairment. We analyzed 233 participants: 32 with no plaques ("definite" PART-BRAAK stage higher than 0 and CERAD 0), and 201 cases within the AD spectrum, with 25 with sparse (CERAD 1), 76 with moderate (CERAD 2), and 100 with severe (CERAD 3) degrees of neuritic plaques. Upon correcting for age, sex, and age difference at MRI and death, there were significantly higher levels of atrophy in CERAD 3 compared to CERAD 1-2 and a trend compared to PART (p = 0.06). In the anterior temporal region, there was a trend for higher levels of atrophy in PART compared to Alzheimer's disease spectrum cases with CERAD 1 (p = 0.08). We then assessed the correlation between regional brain atrophy and CDR sum of boxes score for PART and AD, and found that overall cognition deficits are directly correlated with regional atrophy in the AD continuum, but not in definite PART. We further observed correlations between regional brain atrophy with multiple neuropsychological metrics in AD, with PART showing specific correlations between language deficits and anterior temporal atrophy. Overall, these findings support PART as an independent pathologic process from AD.
Published: 2022

7. Disease Control Priorities, Third Edition: Volume 9. Improving Health and Reducing Poverty

Author: Dean T. Jamison, Hellen Gelband, Susan Horton, Prabhat Jha, Ramanan Laxminarayan, Charles N. Mock, Rachel Nugent
Published: 2017

8. Disease Control Priorities, Third Edition: Volume 7. Injury Prevention and Environmental Health

Author: Charles N. Mock, Rachel Nugent, Olive Kobusingye, Kirk R. Smith
Published: 2017

9. Disease Control Priorities, Third Edition: Volume 1. Essential Surgery

Author: Haile T. Debas, Peter Donkor, Atul Gawande, Dean T. Jamison, Margaret E. Kruk, Charles N. Mock
Published: 2015

10. Effect of different helmet types in head injuries: a case-control study in northern Ghana

Author: Anthony Baffour Appiah, Patricia Akweongo, Samuel Oko Sackey, Martin Tangnaa Morna, Ernest Kenu, Alexis Dun Bo-ib Buunaaim, Samual Akobour Yaw Debrah, Thomas K Ojo, Peter Donkor, and Charles N Mock
Subjects: Public Health, Environmental and Occupational Health
Abstract: BackgroundMotorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana.MethodsA prospective unmatched case–control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury.ResultsAfter adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35).ConclusionEven in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.
Published: 2022

11. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries

Author: Alicia G, Sykes, Justina, Seyi-Olajide, Emmanuel A, Ameh, Doruk, Ozgediz, Alizeh, Abbas, Simone, Abib, Adesoji, Ademuyiwa, Abdelbasit, Ali, Tasmiah Tahera, Aziz, Tanvir Kabir, Chowdhury, Hafeez, Abdelhafeez, Romeo C, Ignacio, Benjamin, Keller, Greg, Klazura, Karen, Kling, Benjamin, Martin, Godfrey Sama, Philipo, Hariharan, Thangarajah, Ava, Yap, John G, Meara, Donald A P, Bundy, Dean T, Jamison, Charles N, Mock, and Stephen W, Bickler
Subjects: Adolescent, Child, Preschool, Income, Infant, Newborn, Humans, Child, Global Health, Developing Countries, Hospitals
Abstract: Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life.Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries.An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year.Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.
Published: 2022

12. Availability of Oxygen and Other Essential Medical Products in COVID-19 Treatment Facilities of Nepal

Author: Charles N Mock, Suraj Bhattarai, Arun Neopane, Bikal Shrestha, and Barclay T. Stewart
Subjects: Government, Surge Capacity, business.industry, Oxygen concentrator, Public Health, Environmental and Occupational Health, Context (language use), medicine.disease, Private sector, Health Services Accessibility, COVID-19 Drug Treatment, Oxygen, Procurement, Nepal, Health care, medicine, Infection control, Humans, Medical emergency, business
Abstract: Background: There is paucity of data globally regarding availability of essential medical products and oxygen supply in healthcare facilities to inform surge capacity and strategic healthcare development. Due to continued waves of COVID-19 pandemic caused by virus variants with increased transmissibility, many facilities worldwide, particularly in the Indian subcontinent, have reported sudden increase in demand for oxygen and its delivery systems to treat patients with COVID pneumonia. Therefore, we aimed to assess the status of essential medical products, oxygen supply, and methods of procurement in COVID-19 treatment facilities across Nepal. Methods: We performed cross-sectional survey among 120 COVID-19 treatment facilities designated by the Government of Nepal in June 2020. Data were collected via an online semi-structured questionnaire based on validated healthcare capacity assessments. responded (49 clinics, 20 level hospitals). Findings: Sixty-nine facilities responded (49 clinics, 20 hospitals). All 69 facilities reported at least one form of oxygen availability: 25 facilities (36%) had their own oxygen plant, 65% had oxygen concentrators, and 88% had portable oxygen cylinders. Majority (38/49; 77%) of clinics and 60% (12/20) of hospitals had sufficient stock (³5 pieces in clinics, >20 pieces in hospitals) of functional oxygen cylinders, which were generally procured through the private sector (78% of facilities with oxygen cylinders). Almost all clinics had at least one piece of pulse oximeter device, blood pressure measuring set, thermometer, thermal gun, and resuscitation kit (oral or nasal airway, suction), compared to approximately a half of hospitals which had sufficient quantity (>10 pieces) of these products. Interpretation: It is crucial for hard-hit countries to timely map the availability and usage of essential medical products including oxygen in COVID-19 care hospitals. If needed, relevant policies and processes around oxygen production and supply should be revised. Furthermore, countries should not delay in adopting innovation for quicker, safer and sustainable production of medical oxygen to ensure continuous supply to the needy. Funding Information: No funding was received to conduct this study. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was approved by the Ethical Review Board (ERB) of Nepal Health Research Council ((Ref: NHRC-ERB Reg. No. 267/2020P), and utilizes specific data collected from a larger study done “to assess the service availability and infection prevention status of hospitals in Nepal in the context of possible COVID-19 case management need”.
Published: 2021

13. Traditional bonesetters in northern Ghana: opportunities for engagement with the formal health sector

Author: Charles N Mock, Peter Donkor, Anthony Edusei, Alexis D. B. Buunaaim, and Tolgou Yempabe
Subjects: Record keeping, Adult, Male, Modern medicine, Health Knowledge, Attitudes, Practice, Injury, Ghana, Fractures, Bone, Young Adult, Formal education, Surveys and Questionnaires, Medicine, Humans, Health sector, Medicine, African Traditional, Aged, Medical education, business.industry, Research, General Medicine, Pain management, traditional bonesetter, Middle Aged, Africa, business, Delivery of Health Care
Abstract: Introduction:we sought to explore the knowledge and practices among traditional bonesetters (TBSs) in the Northern Region of Ghana and to assess opportunities for their engagement with the formal health sector. Methods:we identified 28 TBSs widely distributed in the Northern Region. They were interviewed using qualitative and quantitative methods, regarding their background, training, current practices, opinions regarding orthodox care, and interests in future linkages with the formal health sector. Results:most TBSs (67.9%) had no formal education and most (85.7%) learned their skills from older family members. Their treatments included reasonable versions of closed reduction and immobilization, but also use of locally-derived concoctions and spiritual aspects, such as incantations. Only 21.4% regularly referred complications to hospital. Nonetheless, all endorsed advantages to orthodox care, such as X-rays (100%), record keeping (100%), and pain management (85.7%). Almost all (96.4%) expressed an interest in training courses or other engagement with the formal health sector. Topics in which they were interested for training included record keeping (100%), pain management (85.7%), and management of open fractures and complications (82.1%). Conclusion:factors making linkage between TBSs and the formal health sector difficult included low levels of formal education, training through secretive in-family methods, and spiritual and mystical aspects of their practice that might make communications about modern medicine difficult. Nonetheless, most indicated interest in linking with modern care, especially through training courses. Topics they suggested for such courses provide a foundation to build on in future efforts to engage TBSs with the formal health sector.
Published: 2020

14. Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Author: Maxwell Osei-Ampofo, Ossei Sampen, Augustus Okleme, Kusi Kwasi, Charles N Mock, Frank Nketiah Boakye, Peter Donkor, Senyo Gudugbe, Dominic Konadu-Yeboah, and Helena Okrah
Subjects: Adult, Male, medicine.medical_specialty, Resuscitation, Emergency Medical Services, Adolescent, Ghana, Article, Teaching hospital, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, Preventable death, Child, Hospitals, Teaching, business.industry, Potential effect, Infant, Newborn, Infant, Vascular surgery, Middle Aged, Trauma care, Quality Improvement, Cardiac surgery, 030220 oncology & carcinogenesis, Child, Preschool, Emergency medicine, Wounds and Injuries, 030211 gastroenterology & hepatology, Surgery, Female, Autopsy, business, Abdominal surgery
Abstract: OBJECTIVE: To determine the rate of preventable trauma deaths in an African hospital; identify the potential effect of improvements in trauma care over the past decade; and identify deficiencies in care that still need to be addressed. METHODS: A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive in-hospital trauma deaths over 5-months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care. RESULTS: Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison to a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p=0.07) There was a notable change in the pattern of deficiency (p=0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17% to 8%), but an increase in delay in treatment at the hospital (23% to 40%). CONCLUSIONS: Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.
Published: 2020

15. Intersectoral Policy Priorities for Health

Author: David A. Watkins, Rachel Nugent, Helen Saxenian, Gavin Yamey, Kristen Danforth, Eduardo González-Pier, Charles N. Mock, Prabhat Jha, Ala Alwan, and Dean T. Jamison
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology
Published: 2017

16. Universal Health Coverage and Intersectoral Action for Health

Author: Dean T. Jamison, Ala Alwan, Charles N. Mock, Rachel Nugent, David A. Watkins, Olusoji Adeyi, Shuchi Anand, Rifat Atun, Stefano Bertozzi, Zulfiqar Bhutta, Agnes Binagwaho, Robert Black, Mark Blecher, Barry R. Bloom, Elizabeth Brouwer, Donald A. P. Bundy, Dan Chisholm, Alarcos Cieza, Mark Cullen, Kristen Danforth, Nilanthi de Silva, Haile T. Debas, Peter Donkor, Tarun Dua, Kenneth A. Fleming, Mark Gallivan, Patricia Garcia, Atul Gawande, Thomas Gaziano, Hellen Gelband, Roger Glass, Amanda Glassman, Glenda Gray, Demissie Habte, King K. Holmes, Susan Horton, Guy Hutton, Prabhat Jha, Felicia Knaul, Olive Kobusingye, Eric Krakauer, Margaret E. Kruk, Peter Lachmann, Ramanan Laxminarayan, Carol Levin, Lai Meng Looi, Nita Madhav, Adel Mahmoud, Jean-Claude Mbanya, Anthony R. Measham, María Elena Medina-Mora, Carol Medlin, Anne Mills, Jody-Anne Mills, Jaime Montoya, Ole Norheim, Zachary Olson, Folashade Omokhodion, Ben Oppenheim, Toby Ord, Vikram Patel, George C. Patton, John Peabody, Dorairaj Prabhakaran, Jinyuan Qi, Teri Reynolds, Sevket Ruacan, Rengaswamy Sankaranarayanan, Jaime Sepúlveda, Richard Skolnik, Kirk R. Smith, Marleen Temmerman, Stephen Tollman, Stéphane Verguet, Damian Walker, Neff Walker, Yangfeng Wu, and Kun Zhao
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030503 health policy & services, 030212 general & internal medicine, 0305 other medical science
Published: 2017

17. Disease Control Priorities, Third Edition (Volume 9) : Improving Health and Reducing Poverty

Author: Dean T. Jamison, Hellen Gelband, Susan Horton, Prabhat Jha, Charles N. Mock, Rachel Nugent, Dean T. Jamison, Hellen Gelband, Susan Horton, Prabhat Jha, Charles N. Mock, and Rachel Nugent
Subjects: World health--Developing countries, Medicine, Preventive--Developing countries, Health planning--Developing countries, Poverty--International cooperation
Abstract: As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a'highest-priority'essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.
Published: 2018

18. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013

Author: Meghan D. Mooney, Ken Takahashi, Andrea Stewart, Jonathan C Brown, Shireen Sindi, Amany H Refaat, Ruben Castro, Sara Sheikhbahaei, Kyle R. Heuton, Gillian M. Hansen, Chante Karimkhani, Bryan K. Phillips, Ibrahim Abubakar, Yohannes Kinfu, Victoria F Bachman, Konstantinos Stroumpoulis, Megan Coggeshall, Lucía Cuevas-Nasu, Yichong Li, Vineet K. Chadha, Andrew G. M. Bulloch, Takayoshi Ohkubo, Don C. Des Jarlais, Giancarlo Logroscino, Francis Apolinary Mhimbira, Jefferson G Fernandes, Cheng Huang, Ejaz Ahmad Khan, Fortuné Gbètoho Gankpé, Roderick J Hay, Itamar S. Santos, Zanfina Ademi, Fiona J Charlson, Norlinah Mohamed Ibrahim, Anwar Rafay, Andrew L. Thorne-Lyman, Juanita A. Haagsma, Emmanuel A. Ameh, John J. McGrath, Massimo Cirillo, Wubegzier Mekonnen, Holly Hagan, Naohiro Yonemoto, Frida Namnyak Ngalesoni, Dietrich Plass, Matias Trillini, David Phillips, Braden Te Ao, Wanqing Chen, Yun Jin Kim, David Rojas-Rueda, Christina Papachristou, Andrew E. Moran, Richard A. Gosselin, Maziar Moradi-Lakeh, Soraya Seedat, Janet L Leasher, Belinda K Lloyd, Lorenzo Monasta, Bruno F. Sunguya, Eun-Kee Park, Eduardo A. Undurraga, Mohammad A. AlMazroa, Mohammad H. Forouzanfar, Young-Ho Khang, Vasiliki Stathopoulou, Dima M. Qato, James Scott, Ileana Heredia-Pi, Luca Ronfani, Haidong Kan, Tasara T. Mazorodze, Murugesan Raju, Saeid Shahraz, Taavi Tillmann, Wang Wenzhi, Neil Pearce, Eric Y. Tenkorang, Aliya Naheed, Ferrán Catalá-López, Sudan Prasad Neupane, Emily Dansereau, Michael McKee, Derrick A Bennett, Mazeda Hossain, Paul S. F. Yip, Grant Nguyen, Norberto Perico, Miguel Angel Alegretti, Babak Eshrati, Boris Bikbov, Palwasha Anwari, Guoqing Hu, Amelia Bertozzi-Villa, Peter A. Meaney, Farshad Farzadfar, Svetlana Popova, Tara Templin, Hmwe H Kyu, Uche S. Uchendu, Kebede Deribe, Sergey Soshnikov, Nobhojit Roy, Daniel Kim, Ilana N. Ackerman, Homie Razavi, Leslie T. Cooper, Sandra Nolte, David T. Felson, John J Huang, Yang Liu, Fiorella Cavalleri, Adrian Davis, Héctor Gómez Dantés, Klara Dokova, Yuantao Hao, Catalina Medina, Austin E Schumacher, Stan Biryukov, Jane Rowley, Arindam Basu, Jose C. Adsuar, Rosana E. Norman, Yousef Khader, Rafael Alfonso-Cristancho, Sukanta Saha, Simón Barquera, Diego Gonzalez-Medina, Philip B. Mitchell, Lars Barregard, Haidong Wang, Yongmei Li, Ami R. Moore, Marie Ng, Raghib Ali, Peter T. Serina, Lijing L Yan, Ayse Abbasoglu Ozgoren, Ricky Leung, Michelle L. Bell, Tim Driscoll, Azmeraw T. Amare, Farshad Pourmalek, Tea Lallukka, Benjamin O Anderson, Raimundas Lunevicius, Corine Karema, Robert G. Weintraub, Erin C Mullany, Anders Larsson, Glen Mola, Paulo A. Lotufo, Luke Nyakarahuka, Sayed Saidul Alam, Louisa Degenhardt, Hugh R. Taylor, E. Ray Dorsey, Suzanne Polinder, Hilton Lam, Urbano Fra Paleo, David Zonies, Rahman Shiri, Marco A Avila, Alicia Elena Beatriz Lawrynowicz, Katya Anne Shackelford, Lynne Gaffikin, Konstantin Kazanjan, Mark T Mackay, Jasvinder A. Singh, Bryan L. Sykes, Sadaf G. Sepanlou, Chantal Huynh, Rakhi Dandona, Logan Sandar, Lavanya Singh, Dietrich Rothenbacher, Theo Vos, Steven E. Lipshultz, Coen H. Van Gool, Peggy P. Chiang, Mark G. Shrime, Christopher J L Murray, Scott Weichenthal, Jae-Hyun Park, Samia Alhabib, Philimon Gona, Christian Kieling, Yuichiro Yano, Ronny Westerman, Thomas Truelsen, Rajeev Gupta, Megan Bohensky, Abdullatif Husseini, Qing Lan, Luke D. Knibbs, Yousef M. Elshrek, H. Ross Anderson, Guohong Jiang, Madeline L. Moyer, Vinod K. Paul, Wim H. van Brakel, Emin Murat Tuzcu, Kara Estep, Lalit Dandona, Uchechukwu K.A. Sampson, Mohammad Tavakkoli, Ying Jiang, Joseph A Wagner, Mitsuru Mukaigawara, In-Hwan Oh, Siyi Shangguan, Noela M. Prasad, Charles D.A. 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A., Sanabria, Juan R., Sandar, Logan, Santos, Itamar S., Satpathy, Maheswar, Sawhney, Monika, Scarborough, Peter, Schneider, Ione J., Schöttker, Ben, Schumacher, Austin E., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Serina, Peter T., Servan-Mori, Edson E., Shackelford, Katya A., Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga D., Silberberg, Donald H., Simard, Edgar P., Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A., Singh, Lavanya, Skirbekk, Vegard, Slepak, Erica Leigh, Sliwa, Karen, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stanaway, Jeffrey D., Stathopoulou, Vasiliki, Stein, Dan J., Stein, Murray B., Steiner, Caitlyn, Steiner, Timothy J., Stevens, Antony, Stewart, Andrea, Stovner, Lars J., Stroumpoulis, Konstantino, Sunguya, Bruno F., Swaminathan, Soumya, Swaroop, Mamta, Sykes, Bryan L., Tabb, Karen M., Takahashi, Ken, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R., Te Ao, Braden J., Tediosi, Fabrizio, Temesgen, Awoke M., Templin, Tara, Ten Have, Margreet, Tenkorang, Eric Y., Terkawi, Abdullah S., Thomson, Blake, Thorne-Lyman, Andrew L., Thrift, Amanda G., Thurston, George D., Tillmann, Taavi, Tonelli, Marcello, Topouzis, Foti, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X., Trillini, Matia, Truelsen, Thoma, Tsilimbaris, Miltiadi, Tuzcu, Emin M., Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen B., Van Brakel, Wim H., Van De Vijver, Steven, Van Gool, Coen H., Van Os, Jim, Vasankari, Tommi J., Venketasubramanian, N, Violante, Francesco S., Vlassov, Vasiliy V., Vollset, Stein Emil, Wagner, Gregory R., Wagner, Joseph, Waller, Stephen G., Wan, Xia, Wang, Haidong, Wang, Jianli, Wang, Linhong, Warouw, Tati S., Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Wenzhi, Wang, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wilkinson, James D., Williams, Thomas N., Wolfe, Charles D., Wolock, Timothy M., Woolf, Anthony D., Wulf, Sarah, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L., Yano, Yuichiro, Ye, Pengpeng, Yentür, Gökalp K., Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaki, Maysaa E., Zhao, Yong, Zheng, Yingfeng, Zonies, David, Zou, Xiaonong, Salomon, Joshua A., Lopez, Alan D., Vos, Theo, Medische Sociologie, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Psychiatrie (3), Psychiatrie & Neuropsychologie, Barber, Ryan M, Foreman, Kyle J, Abd Allah, Foad, Abera, Semaw F, Abraham, Jerry P, Abu Raddad, Laith J, Abu Rmeileh, Niveen M, Ackerman, Ilana N, Adou, Arsène K, Adsuar, José C, Agardh, Emilie E, Albittar, Mohammed I, Alegretti, Miguel A, Alemu, Zewdie A, Alfonso Cristancho, Rafael, Almazroa, Mohammad A, Alvis Guzman, Nelson, Amare, Azmeraw T, Ameh, Emmanuel A, Anderson, Benjamin O, Antonio, Carl Abelardo T, Asghar, Rana J, Atkins, Lydia S, Avila, Marco A, Bachman, Victoria F, Bahit, Maria C, Barker Collo, Suzanne L, Barrero, Lope H, Basulaiman, Mohammed O, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Bertozzi Villa, Amelia, Beyene, Tariku J, Bhutta, Zulfiqar A, Blore, Jed D, Blosser, Christopher D, Blyth, Fiona M, Bohensky, Megan A, Bolliger, Ian W, Bornstein, Natan M, Bourne, Rupert R. A, Boyers, Lindsay N, Brayne, Carol E, Breitborde, Nicholas J. K, Briggs, Adam D, Brooks, Peter M, Brown, Jonathan C, Brugha, Traolach S, Buckle, Geoffrey C, Budke, Christine M, Bulloch, Andrew G, Campos Nonato, Ismael R, Carapetis, Jonathan R, Carpenter, David O, Castañeda Orjuela, Carlos A, Castro, Ruben E, Catalá López, Ferrán, Chadha, Vineet K, Chang, Jung Chen, Charlson, Fiona J, Chiang, Peggy P, Chimed Ochir, Odgerel, Christophi, Costas A, Coates, Matthew M, Coffeng, Luc E, Coggeshall, Megan S, Colquhoun, Samantha M, Cooke, Graham S, Cooper, Leslie T, Coppola, Luis M, Criqui, Michael H, Crump, John A, Cuevas Nasu, Lucia, Dargan, Paul I, Davitoiu, Dragos V, Del Pozo Cruz, Borja, Dellavalle, Robert P, Jarlais, Don C. De, Dharmaratne, Samath D, Dherani, Mukesh K, Diaz Torné, Cesar, Ding, Eric L, Dorsey, E. Ray, Driscoll, Tim R, Duber, Herbert C, Ebel, Beth E, Edmond, Karen M, Elshrek, Yousef M, Ermakov, Sergey P, Erskine, Holly E, Faraon, Emerito Jose A, Fay, Derek F, Feigin, Valery L, Felson, David T, Fereshtehnejad, Seyed Mohammad, Fernandes, Jefferson G, Ferrari, Alize J, Flaxman, Abraham D, Fleming, Thomas D, Forouzanfar, Mohammad H, Fowkes, F. Gerry R, Paleo, Urbano Fra, Franklin, Richard C, Gankpé, Fortuné G, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, González Medina, Diego, Gosselin, Richard A, Gotay, Carolyn C, Gouda, Hebe N, Gugnani, Harish C, Gutiérrez, Reyna A, Hafezi Nejad, Nima, Halasa, Yara A, Hamadeh, Randah R, Hankey, Graeme J, Hansen, Gillian M, Harb, Hilda L, Hay, Simon I, Hay, Roderick J, Heredia Pi, Ileana B, Heuton, Kyle R, Hoek, Hans W, Hoffman, Howard J, Hosgood, H. Dean, Hotez, Peter J, Hoy, Damian G, Huang, John J, Iannarone, Marissa L, Iburg, Kim M, Jacobsen, Kathryn H, Jarvis, Deborah L, Jassal, Simerjot K, Jensen, Paul N, Jonas, Jost B, Karema, Corine K, Kassebaum, Nicholas J, Kemp, Andrew H, Kengne, Andre P, Khader, Yousef S, Khalifa, Shams Eldin A, Khan, Ejaz A, Khang, Young Ho, Kinge, Jonas M, Knibbs, Luke D, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G. Anil, Kyu, Hmwe H, Lansingh, Van C, Lawrynowicz, Alicia E. B, Leasher, Janet L, Levitz, Carly E, Lim, Stephen S, Lipshultz, Steven E, Lloyd, Belinda K, Lofgren, Katherine T, Looker, Katharine J, Lortet Tieulent, Joannie, Lotufo, Paulo A, Lucas, Robyn M, Lyons, Ronan A, Macintyre, Michael F, Mackay, Mark T, Margolis, David J, Marzan, Melvin B, Masci, Joseph R, Mashal, Mohammad T, Mayosi, Bongani M, Mazorodze, Tasara T, Mcgill, Neil W, Mcgrath, John J, Meaney, Peter A, Melaku, Yohannes A, Memish, Ziad A, Mensah, George A, Mhimbira, Francis A, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L. D, Montine, Thomas J, Mooney, Meghan D, Moore, Ami R, Moradi Lakeh, Maziar, Moran, Andrew E, Moturi, Wilkister N, Moyer, Madeline L, Msemburi, William T, Mueller, Ulrich O, Mullany, Erin C, Murdoch, Michele E, Murthy, Kinnari S, Naidoo, Kovin S, Narayan, K. M. Venkat, Neupane, Sudan P, Newton, Charles R, Ngalesoni, Frida N, Nisar, Muhammad I, Norheim, Ole F, Norman, Rosana E, Oh, In Hwan, Ohno, Summer L, Olusanya, Bolajoko O, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Park, Eun Kee, Park, Jae Hyun, Patten, Scott B, Patton, George C, Paul, Vinod K, Pavlin, Boris I, Pereira, David M, Perez Padilla, Rogelio, Perez Ruiz, Fernando, Peterson, Carrie B, Phillips, Michael R, Phillips, Bryan K, Phillips, David E, Piel, Frédéric B, Poulton, Richie G, Prasad, Noela M, Pullan, Rachel L, Qato, Dima M, Quistberg, D. Alex, Rahman, Sajjad U, Rana, Saleem M, Reddy, K. Srinath, Ribeiro, Antonio L, Roberts, D. Allen, Rojas Rueda, David, Roth, Gregory A, Rothstein, David H, Rowley, Jane T, Ruhago, George M, Saeedi, Mohammad Y, Sampson, Uchechukwu K. A, Sanabria, Juan R, Santos, Itamar S, Schneider, Ione J, Schumacher, Austin E, Schwebel, David C, Scott, James G, Sepanlou, Sadaf G, Serina, Peter T, Servan Mori, Edson E, Shackelford, Katya A, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Singh, Jasvinder A, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stanaway, Jeffrey D, Stein, Dan J, Stein, Murray B, Steiner, Timothy J, Stovner, Lars J, Sunguya, Bruno F, Sykes, Bryan L, Tabb, Karen M, Taylor, Hugh R, Ao, Braden J. Te, Temesgen, Awoke M, Tenkorang, Eric Y, Terkawi, Abdullah S, Thorne Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tran, Bach X, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, van Gool, Coen H, Vasankari, Tommi J, Violante, Francesco S, Vlassov, Vasiliy V, Wagner, Gregory R, Waller, Stephen G, Warouw, Tati S, Weintraub, Robert G, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Yan, Lijing L, Yentür, Gökalp K, Yoon, Seok Jun, Younis, Mustafa Z, Zaki, Maysaa E, Salomon, Joshua A, Lopez, Alan D, Computational Science and Engineering Department [Daresbury] ( STFC ), Science & Technologie Facilities Council, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Weill Cornell Medical College - Qatar, Qatar Foundation - Education City, Doha, Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Karolinska Institute, karolinska institute, Centro de Estudios Avanzados en Zonas Aridas ( CEAZA ), Ecole Polytechnique Fédérale de Lausanne ( EPFL ), Wisconsin Division of Public Health, Regional Genetic Service, St Mary's Hospital, Manchester, Laboratoire d'Ingénierie des Matériaux ( LIM ), Centre National de la Recherche Scientifique ( CNRS ), Computer Science Department [Bristol], University of Bristol [Bristol], Lawrence Berkeley National Laboratory [Berkeley] ( LBNL ), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) ( SRI-B ), Multimedia Research Center ( MRC ), University of Alberta [Edmonton], Division of Biostatistics ( Biostat - MINNEAPOLIS ), University of Minnesota [Minneapolis], Laboratory of Neurologic Diseases, Mario Negri Institute, Milan, University of Southampton [Southampton], Imperial College London, Neurology Department, Ichilov Medical Center, Department of Public Health and Primary Care, Cambridge University, Interactions, transferts, ruptures artistiques et culturels - EA 6301 ( InTRu ), Université de Tours, Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Institute of Parasitology, STAR laboratory, Stanford University [Stanford], Unité de recherche Virologie et Immunologie Moléculaires ( VIM ), Institut National de la Recherche Agronomique ( INRA ), Tennent Institute of Ophthalmology, National University of Singapore ( NUS ), Multidisciplinary Nanotechnology Centre, Swansea University, Department of Computer Sciences [Scheffield], University of Sheffield [Sheffield], Cyprus International Institute for the Environment and Public Health, Harvard School of Public Health, Glasgow Centre for Physical Organic Chemistry, University of Glasgow, King‘s College London, Université Panthéon-Sorbonne - UFR Science Politique ( UP1 UFR11 ), Université Panthéon-Sorbonne ( UP1 ), National Diagnostics Centre ( NDC ), National University of Ireland [Galway] ( NUI Galway ), Arthritis Research UK Epidemiology Unit ( MANCHESTER - Arthritis Research ), University of Manchester [Manchester], CEGOT - Porto, Universidade do Porto [Porto], Advanced Laboratories on Embedded Systems [Roma] ( ALES ), Department of Biology [Miami], University of Miami [Coral Gables], Division of Human Nutrition, Wageningen University and Research Centre [Wageningen] ( WUR ), Spatial Ecology and Epidemiology Group, University of Oxford [Oxford], Department of Civil Engineering [Hamirpur], National Institute of Technology [Hamirpur], GEMMA — Environmental Engineering and Microbiology Research Group, Department of Hydraulic, Maritime and Environmental Engineering, Universitat Politècnica de Catalunya [Barcelona] ( UPC ), Institut National de Recherche et d'Analyse Physico-Chimique ( INRAP ), Institut National de Recherche et d'Analyse Physico-chimique (INRAP-Tunisie), University of Connecticut ( UCONN ), Norwegian Institute for Air Research ( NILU ), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) ( FEMTO-ST ), Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Ecole Nationale Supérieure de Mécanique et des Microtechniques ( ENSMM ) -Université de Technologie de Belfort-Montbeliard ( UTBM ), Tehran University, Friedrich-Alexander Universität Erlangen-Nürnberg ( FAU ), Secretariat of the Pacific Community, Public Health Division, Sociétés, Acteurs, Gouvernement en Europe ( SAGE ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Physics and Astronomy, Washington State University ( WSU ), Laboratoire de Physique de l'ENS Lyon ( Phys-ENS ), École normale supérieure - Lyon ( ENS Lyon ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en informatique de Toulouse ( IRIT ), Institut National Polytechnique [Toulouse] ( INP ) -Université Toulouse 1 Capitole ( UT1 ) -Université Toulouse - Jean Jaurès ( UT2J ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique ( CNRS ), School of Computer Science - China University of Geosciences (China University of Geosciences (East Area)), Université Catholique de Louvain ( UCL ), Div Cyclotron & Radiopharmaceut Sci ( DRDO, INMAS ), Univ New Delhi, University of St Andrews [Scotland], University of Cape Town, Department of Neuroscience, Karolinska Institutet [Stockholm], Institut de Physique Nucléaire d'Orsay ( IPNO ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Department of Computer Science and Engineering [Daejeon] (Chungnam National University), Lawrence University, Gastroenterology & Hepatology, Tata Research Development and Design Center ( TRDDC ), TCS Innovation Labs, Laboratoire MOLTECH-Anjou [Angers] ( MOLTECH ANJOU ), Université d'Angers ( UA ) -Centre National de la Recherche Scientifique ( CNRS ), University of Helsinki [Helsinki], Google Inc [Mountain View], Research at Google, Swedish Defense Research Agency ( FOI ), Centre de Recherche en Information Biomédicale sino-français ( CRIBS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratory of Image Science and Technology [Nanjing] ( LIST ), Southeast University [Jiangsu]-School of Computer Science and Engineering, Laboratoire de glaciologie et géophysique de l'environnement ( LGGE ), Observatoire des Sciences de l'Univers de Grenoble ( OSUG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Business and Informatics, University of Boras, Department of Mechanical and Automation Engineering ( CAD Laboratory ), The Chinese University of Hong Kong [Hong Kong], Università degli studi di Bari, Heuristique et Diagnostic des Systèmes Complexes [Compiègne] ( Heudiasyc ), Université de Technologie de Compiègne ( UTC ) -Centre National de la Recherche Scientifique ( CNRS ), Department of plant pathology and microbiology - centre for sustainable pest and disease management, Rothamsted Research, RGU, Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Barts and The London School of Medicine and Dentistry, Queen Mary University of London ( QMUL ), Centre d'économie de la Sorbonne ( CES ), Université Panthéon-Sorbonne ( UP1 ) -Centre National de la Recherche Scientifique ( CNRS ), Paris School of Economics ( PSE ), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale ( IDSIA ), Università della Svizzera italiana ( USI ) -Scuola universitaria professionale della Svizzera italiana [Manno] ( SUPSI ), Anaesthetics, Southampton University Hospital, Department of Mathematics, University of Iowa [Iowa City], College of Medicine, Alfaisal University, Saudi Ministry of Health, Institut national des recherches agricoles du Bénin, Centre de Recherches agricoles du Sud, Departments of Epidemiology and Nutrition, Unit of Human Nutrition, Agricultural University of Athens, Department of Animal Science, PennState University [Pennsylvania] ( PSU ), University of Virginia, University of Virginia [Charlottesville], Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS ‘‘Burlo Garofolo', Jet Propulsion Laboratory ( JPL ), NASA-California Institute of Technology ( CALTECH ), Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital [Boston], Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Department of Chemistry, Scientific Computing Research Unit, Department of dermatology, Milano University-Azienda Ospedaleria Ospedali Riuniti di Bergamo, Department of epidemiology and Public Health, Faculty of Medicine, Hong Kong Baptist University ( HKBU ), Département Optique ( OPT ), Université européenne de Bretagne ( UEB ) -Télécom Bretagne-Institut Mines-Télécom [Paris], Department of Neurology Lunds University Hospital Lund, Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux ( SAMOVAR ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ) -Centre National de la Recherche Scientifique ( CNRS ), Département Réseaux et Services Multimédia Mobiles ( RS2M ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ), Electrical Engineering and Computer Science Department - Case Western Reserve University, Case Western Reserve University [Cleveland], Institut Lumière Matière [Villeurbanne] ( ILM ), Université Claude Bernard Lyon 1 ( UCBL ), World Health Organization, Nordic School of Public Health, The James Hutton Institute, Sero, Sero consulting, Evolutionary Ecology of Infectious Disease Group, Department of Zoology, Horia Hulubei National Institute for Physics and Nuclear Engineering, Dunedin School of Medicine, University of Otago, Department of Physics, Clarendon Laboratory, Center for TeleInFrastruktur ( CTIF ), Aalborg University [Denmark] ( AAU ), Physikalisches Institut [Freiburg], Albert-Ludwigs-Universität Freiburg, Savoirs, Textes, Langage (STL) - UMR 8163 ( STL ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Dept.of Computer Science, Indian Institute of Technology Madras ( IIT Madras ), Istituto Mario Negri Bergamo, Centro Ricerche e Trapianti Villa Camozzi, Universidade Estadual Paulista Júlio de Mesquita ( UNESP ), Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Clinical Epidemiology and Aging Research, German Cancer Research Center, Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Symantec, European Microsoft Innovation Center ( EMIC ), Microsoft Corporation [Redmond, Wash.], Laboratoire de Mécanique, Physique et Géosciences ( LMPG ), Université Le Havre Normandie ( ULH ), Normandie Université ( NU ) -Normandie Université ( NU ), Novartis institute for tropical diseases, Institut de Génétique et de Biologie Moléculaire et Cellulaire ( IGBMC ), Université de Strasbourg ( UNISTRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Departments of Anatomy and Cell Biology, Wayne State University School of Medicine, Departments of Ophthalmology, Departments of Applied Physics [New Haven], Yale University [New Haven], Center for Mathematical Modeling ( CMM ), Universidad de Santiago de Chile [Santiago] ( USACH ), Laboratory for Atmospheric and Space Physics [Boulder] ( LASP ), University of Colorado Boulder [Boulder], University of Occupational and Environmental Health [Kitakyushu] ( UEOH ), Department of Computer Science and Engineering [New Delhi], Indian Institute of Technology Delhi ( IIT Delhi ), Institut de Recherche sur les Phénomènes Hors Equilibre ( IRPHE ), Aix Marseille Université ( AMU ) -Ecole Centrale de Marseille ( ECM ) -Centre National de la Recherche Scientifique ( CNRS ), GlaxoSmithKline, Imperial College London-Clinical Imaging Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale School of Medicine-Yale School of Medicine-Yale Stem Cell Center, Maclean Building, Benson Lane, Crowmarsh Gifford, Centre for Ecology and Hydrology, Nanoscience Institute ( NEST ), Dipartimento di Fisica, Università di Pisa, Aristotle University of Thessaloniki, Laboratory Of Immune Cell Biology ( LICB ), National Institutes of Health ( NIH ), Institute of Human Genetics, Bonn Universität [Bonn], Occupational Health Unit, Bologna University Hospital-Sant'Orsola-Malpighi Polyclinic, Royal Institute of Technology [Stockholm] ( KTH ), Institut für Informatik [München/Munich] ( LMU ), Ludwig-Maximilians-Universität München, NICTA [Eveleigh], National ICT Australia [Sydney] ( NICTA ), Manchester Academic Health Sciences Centre, Institut d'Histoire et de Philosophie des Sciences et des Techniques ( IHPST ), Université Panthéon-Sorbonne ( UP1 ) -Département d'Etudes Cognitives - ENS Paris ( DEC ), École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ), Ghent University [Belgium] ( UGENT ), German Research Centre for Geosciences - Helmholtz-Centre Potsdam ( GFZ ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique ( LHEEA ), École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Génie Civil et Mécanique ( GeM ), Université de Nantes ( UN ) -École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Neurorestoration Group, King‘s College London-Wolfson Centre for Age-related Diseases, Department of Computer Science [KAIST] ( CS ), Korea Advanced Institute of Science and Technology ( KAIST ), Laboratoire de l'Accélérateur Linéaire ( LAL ), Natl Engn Res Ctr Vegetables, Key Lab Biol & Genet Improvement Hort Crops N Chi, Beijing Acad Agr & Forestry Sci, University Hospital Puerta de Hierro, Madrid, Computational Science and Engineering Department [Daresbury] (STFC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Weill Cornell Medicine [Qatar], Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centro de Estudios Avanzados en Zonas Aridas (CEAZA), Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratoire d'Ingénierie des Matériaux (LIM), Centre National de la Recherche Scientifique (CNRS), Lawrence Berkeley National Laboratory [Berkeley] (LBNL), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) (SRI-B), Multimedia Research Center (MRC), University of Alberta, Division of Biostatistics (Biostat - MINNEAPOLIS), University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System, University of Southampton, University of Cambridge [UK] (CAM), Interactions, transferts, ruptures artistiques et culturels - EA 6301 (InTRu), Université de Tours (UT), Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Stanford University, Unité de recherche Virologie et Immunologie Moléculaires (VIM (UR 0892)), Institut National de la Recherche Agronomique (INRA), National University of Singapore (NUS), Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Paris 1 Panthéon-Sorbonne (UP1), National Diagnostics Centre (NDC), National University of Ireland [Galway] (NUI Galway), Arthritis Research UK Epidemiology Unit (MANCHESTER - Arthritis Research), Universidade do Porto = University of Porto, Advanced Laboratories on Embedded Systems [Roma] (ALES), Wageningen University and Research [Wageningen] (WUR), University of Oxford, Universitat Politècnica de Catalunya [Barcelona] (UPC), Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), University of Connecticut (UCONN), Norwegian Institute for Air Research (NILU), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Tehran, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Sociétés, Acteurs, Gouvernement en Europe (SAGE), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), The George Washington University (GW), Washington State University (WSU), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université Catholique de Louvain = Catholic University of Louvain (UCL), Div Cyclotron & Radiopharmaceut Sci (DRDO, INMAS), School of Physics and Astronomy [St Andrews], Tata Research Development and Design Center (TRDDC), MOLTECH-Anjou, Université d'Angers (UA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Swedish Defense Research Agency (FOI), Centre de Recherche en Information Biomédicale sino-français (CRIBS), Université de Rennes (UR)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Image Science and Technology [Nanjing] (LIST), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Department of Mechanical and Automation Engineering (CAD Laboratory), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] (Heudiasyc), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), Biotechnology and Biological Sciences Research Council (BBSRC)-Biotechnology and Biological Sciences Research Council (BBSRC), Queen Mary University of London (QMUL), Centre d'économie de la Sorbonne (CES), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana = University of Applied Sciences and Arts of Southern Switzerland [Manno] (SUPSI), Pennsylvania State University (Penn State), Penn State System-Penn State System, Jet Propulsion Laboratory (JPL), NASA-California Institute of Technology (CALTECH), Hong Kong Baptist University (HKBU), Département Optique (OPT), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT), Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux (SAMOVAR), Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP), Département Réseaux et Services Multimédia Mobiles (TSP - RS2M), University of Melbourne, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Otago [Dunedin, Nouvelle-Zélande], Center for TeleInFrastruktur (CTIF), Aalborg University [Denmark] (AAU), Savoirs, Textes, Langage (STL) - UMR 8163 (STL), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Indian Institute of Technology Madras (IIT Madras), Universidade Estadual Paulista Júlio de Mesquita Filho = São Paulo State University (UNESP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), European Microsoft Innovation Center (EMIC), Laboratoire de Mécanique, Physique et Géosciences (LMPG), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU), Novartis Institute for Tropical Diseases (NITD), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Center for Mathematical Modeling (CMM), Universidad de Chile = University of Chile [Santiago] (UCHILE), Laboratory for Atmospheric and Space Physics [Boulder] (LASP), University of Colorado [Boulder], University of Occupational and Environmental Health [Kitakyushu] (UEOH), Indian Institute of Technology Delhi (IIT Delhi), Institut de Recherche sur les Phénomènes Hors Equilibre (IRPHE), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Yale University [New Haven]-Yale School of Medicine [New Haven, Connecticut] (YSM), Nanoscience Institute (NEST), University of Pisa - Università di Pisa, Laboratory Of Immune Cell Biology (LICB), National Institutes of Health [Bethesda] (NIH), Rheinische Friedrich-Wilhelms-Universität Bonn, Royal Institute of Technology [Stockholm] (KTH ), Institut für Informatik [München/Munich] (LMU), Ludwig-Maximilians-Universität München (LMU), National ICT Australia [Sydney] (NICTA), Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Paris 1 Panthéon-Sorbonne (UP1)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Universiteit Gent = Ghent University (UGENT), German Research Centre for Geosciences - Helmholtz-Centre Potsdam (GFZ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Génie Civil et Mécanique (GeM), Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Department of Computer Science [KAIST] (CS), Korea Advanced Institute of Science and Technology (KAIST), Kardiyoloji, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Minnesota [Twin Cities], Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Unité de recherche Virologie et Immunologie Moléculaires (VIM), Université Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Panthéon-Sorbonne (UP1), Wageningen University and Research Centre [Wageningen] (WUR), Institut National de Recherche et d'Analyse Physico-chimique (Ariana, Tunisie) (INRAP), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), George Washington University (GW), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université Toulouse 1 Capitole (UT1)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Université Catholique de Louvain (UCL), MOLTECH-ANJOU (MOLTECH-ANJOU), Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Università della Svizzera italiana (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), California Institute of Technology (CALTECH)-NASA, Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP)-Centre National de la Recherche Scientifique (CNRS), Département Réseaux et Services Multimédia Mobiles (RS2M), Universidade Estadual Paulista Júlio de Mesquita Filho [São José do Rio Preto] (UNESP), Université Grenoble Alpes (UGA), Universidad de Santiago de Chile [Santiago] (USACH), Yale University [New Haven]-Yale University School of Medicine, Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), Ghent University [Belgium] (UGENT), Université de Nantes - Faculté des Sciences et des Techniques, Grelier, Elisabeth, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Universidade do Porto, Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université Toulouse 1 Capitole (UT1), Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire des Sciences de l'Univers de Grenoble (OSUG), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Università degli studi di Bari Aldo Moro (UNIBA), École des Ponts ParisTech (ENPC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), Institut Mines-Télécom [Paris] (IMT)-Télécom Bretagne-Université européenne de Bretagne - European University of Brittany (UEB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Universiteit Gent = Ghent University [Belgium] (UGENT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-CHU Limoges-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Technologie de Belfort-Montbeliard (UTBM), Institut de Chimie du CNRS (INC)-Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Nantes (ECN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Wolfson Centre for Age-related Diseases-King‘s College London, Cell biology, Public Health, Epidemiology, Health Technology Assessment (HTA), Erasmus MC other, Pathology, and Cardiothoracic Surgery
Subjects: Gerontology, Male, CHANGING RELATION, Nutrition and Disease, MESH : Life Expectancy, MESH : Aged, ECONOMIC-DEVELOPMENT, Poison control, MESH: Global Health, Global Health, Socioeconomic Factor, Communicable Disease, MESH : Chronic Disease, Health Transition, Voeding en Ziekte, Quality-Adjusted Life Year, SELF-RATED HEALTH, MESH : Socioeconomic Factors, Medicine, MESH : Female, MESH: Mortality, Premature, 2. Zero hunger, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Medicine (all), GBD2013 diseases, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Middle Aged, 3. Good health, MESH : Wounds and Injuries, Epidemiological transition, MESH: Quality-Adjusted Life Years, MESH: Communicable Diseases, NONCOMMUNICABLE DISEASES, Female, Quality-Adjusted Life Years, MESH: Life Expectancy, MESH: Health Transition, Human, MESH: Socioeconomic Factors, ACUTE MYOCARDIAL-INFARCTION, MESH : Male, MORTALITY TRENDS, Population, MESH : Health Transition, Communicable Diseases, Article, Life Expectancy, EUROPEAN-UNION, SDG 3 - Good Health and Well-being, General & Internal Medicine, SYSTEMATIC ANALYSIS, Disability-adjusted life year, Humans, Life Science, MESH : Middle Aged, Mortality, education, Premature, MESH : Mortality, Premature, VLAG, Aged, MESH: Humans, business.industry, Mortality, Premature, MESH: Chronic Disease, MESH : Communicable Diseases, Wounds and Injurie, MESH : Humans, MESH : Quality-Adjusted Life Years, Non-communicable disease, Chronic Disease, Socioeconomic Factors, Wounds and Injuries, medicine.disease, MESH: Male, LOW SOCIOECONOMIC-STATUS, Years of potential life lost, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Wounds and Injuries, Life expectancy, RISK-FACTORS, MESH : Global Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract: Summary Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Funding Bill & Melinda Gates Foundation. BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
Published: 2015

19. Trends in Morbidity and Mortality Attributable to Injuries and Selected Environmental Hazards

Author: David A. Watkins, Nazila Dabestani, Charles N. Mock, Mark R. Cullen, Kirk R. Smith, and Rachel Nugent
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, 030212 general & internal medicine
Published: 2017

20. The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013

Author: Juanita A Haagsma, Nicholas Graetz, Ian Bolliger, Mohsen Naghavi, Hideki Higashi, Erin C Mullany, Semaw Ferede Abera, Jerry Puthenpurakal Abraham, Koranteng Adofo, Ubai Alsharif, Emmanuel A Ameh, Walid Ammar, Carl Abelardo T Antonio, Lope H Barrero, Tolesa Bekele, Dipan Bose, Alexandra Brazinova, Ferrán Catalá-López, Lalit Dandona, Rakhi Dandona, Paul I Dargan, Diego De Leo, Louisa Degenhardt, Sarah Derrett, Samath D Dharmaratne, Tim R Driscoll, Leilei Duan, Sergey Petrovich Ermakov, Farshad Farzadfar, Valery L Feigin, Richard C Franklin, Belinda Gabbe, Richard A Gosselin, Nima Hafezi-Nejad, Randah Ribhi Hamadeh, Martha Hijar, Guoqing Hu, Sudha P Jayaraman, Guohong Jiang, Yousef Saleh Khader, Ejaz Ahmad Khan, Sanjay Krishnaswami, Chanda Kulkarni, Fiona E Lecky, Ricky Leung, Raimundas Lunevicius, Ronan Anthony Lyons, Marek Majdan, Amanda J Mason-Jones, Richard Matzopoulos, Peter A Meaney, Wubegzier Mekonnen, Ted R Miller, Charles N Mock, Rosana E Norman, Ricardo Orozco, Suzanne Polinder, Farshad Pourmalek, Vafa Rahimi-Movaghar, Amany Refaat, David Rojas-Rueda, Nobhojit Roy, David C Schwebel, Amira Shaheen, Saeid Shahraz, Vegard Skirbekk, Kjetil Søreide, Sergey Soshnikov, Dan J Stein, Bryan L Sykes, Karen M Tabb, Awoke Misganaw Temesgen, Eric Yeboah Tenkorang, Alice M Theadom, Bach Xuan Tran, Tommi J Vasankari, Monica S Vavilala, Vasiliy Victorovich Vlassov, Solomon Meseret Woldeyohannes, Paul Yip, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Christopher J L Murray, Theo Vos, Shivanthi Balalla, Michael R Phillips, and Public Health
Subjects: Gerontology, Adult, Male, Adolescent, Poison control, Developing country, Global Health, Occupational safety and health, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Cost of Illness, Risk Factors, Cause of Death, Injury prevention, Global health, Medicine, Humans, Disabled Persons, 030212 general & internal medicine, Mortality, Child, Cause of death, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Public Health, Environmental and Occupational Health, Infant, 030208 emergency & critical care medicine, Middle Aged, Quality-adjusted life year, Child, Preschool, Wounds and Injuries, Original Article, Female, Quality-Adjusted Life Years, business, Demography
Abstract: © 2016 BMJ Publishing Group. All rights reserved. Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disabilityadjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for illdefined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.
Published: 2016

21. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Author: Vasiliki Stathopoulou, Kiran Thapa, Vesper Hichilombwe Chisumpa, Azeem Majeed, Hjalte Holm Andersen, Devasahayam J. Christopher, Alireza Mohammadi, John J. McGrath, Konstantin Kazanjan, Naohiro Yonemoto, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Frida Namnyak Ngalesoni, Jennifer O Lam, Laetitia Huiart, Xiaofeng Liang, Amanuel Tesfay Gebremedhin, Lalit Dandona, Felix Masiye, Joseph R Fitchett, Derrick A Bennett, Rosana E. Norman, Theo Vos, Tuomo J. Meretoja, Rahman Shiri, Melvin Barrientos Marzan, Charles R. Newton, Kelly Cercy, Masoud Vaezghasemi, Elena Alvarez Martin, Christopher Troeger, Ismael R. Campos-Nonato, Amany H Refaat, Ruben Castro, Amiran Gamkrelidze, Michael R. Phillips, Samath D Dharmaratne, Reed J D Sorensen, Roderick J. Hay, Johan Ärnlöv, Ivo Rakovac, Alexandra Brazinova, Nancy Fullman, Sara Sheikhbahaei, Liliana G Ciobanu, Nader Jahanmehr, Yuming Guo, Luigi Naldi, Rana Jawad Asghar, Tsegaye Tewelde Gebrehiwot, Corine Karema, Biju Abraham, Rynaz H S Rabiee, Emerito Jose A. Faraon, Philimon Gona, Jonathan I. Silverberg, Alexandria Brown, Kovin Naidoo, Suleman Atique, Yun Jin Kim, Benn Sartorius, Hwashin Hyun Shin, George Mugambage Ruhago, Adugnaw Berhane, Tesfaye Tekle, Abdur Rahman Khan, Vipin Gupta, Nima Hafezi-Nejad, Héctor Gómez-Dantés, Jun She, Ted R. Miller, Tolesa Bekele, Yohannes Kinfu, Srinivas Murthy, Alaa Badawi, Mahfuzar Rahman, Raghib Ali, Robert G. Weintraub, Nicholas Steel, Khalid A Altirkawi, Muhammad Imran Nisar, Man Mohan Mehndiratta, Thomas N. Williams, Adrian Davis, Usha Ram, Nobuyuki Horita, Qingyang Xiao, Bishal Gyawali, Burcu Kucuk Bicer, Eun-Kee Park, Subas Neupane, Mohammad Tavakkoli, Lorenzo Monasta, Roman Topor-Madry, Marc-Alain Widdowson, James Leigh, Padukudru Anand Mahesh, Stephen M. Amrock, Stefan Ma, Virendra Singh, Amir Kasaeian, Mahdi Mahdavi, Shahrzad Bazargan-Hejazi, Kim Moesgaard Iburg, Vafa Rahimi-Movaghar, Julio Cesar Campuzano, Maria Dolores Sanchez-Niño, Jean B. Nachega, Hamid Asayesh, Pratik Pinal Doshi, Charles Shey Wiysonge, Peter J. Hotez, Ying Jiang, Girma Temam Shifa, Warren D. Lo, Francis Apolinary Mhimbira, Joan B. Soriano, Ritul Kamal, Young-Ho Khang, Isaac Akinkunmi Adedeji, Daniel C Casey, Adeladza Kofi Amegah, Demewoz Haile, Tomi Akinyemiju, Andrew L. Thorne-Lyman, Achala Upendra Jayatilleke, Rajeev Gupta, Rosario Cárdenas, Peter W. Gething, Ami R. Moore, Marie Ng, Maigeng Zhou, Ferrán Catalá-López, Anders Larsson, Ratilal Lalloo, Panniyammakal Jeemon, Bach Xuan Tran, Chigozie Jesse Uneke, Marina Shakh-Nazarova, Jamie Hancock, Yohannes Adama Melaku, Jasvinder A. Singh, Isabela M. Benseñor, Shafiu Mohammed, Rajiv Chowdhury, Hedyeh Ebrahimi, Yoshihiro Kokubo, Belinda K Lloyd, Samir Bhatt, Geoffrey Buckle, Tissa Wijeratne, Giuseppe Remuzzi, Robert W Aldridge, Luca Ronfani, Raj Kumar Verma, Jagdish Khubchandani, Irma Khonelidze, Ai Koyanagi, Teshome Gebre, Michael Kutz, Om Prakash Singh, Ana Maria Nogales Vasconcelos, Margaret Lind, Svetlana Popova, Hmwe H Kyu, Tom Achoki, Laith J. Abu-Raddad, Zacharie Tsala Dimbuene, Henock Yebyo, Mehdi Yaseri, Max Petzold, Sungho Won, Semaw Ferede Abera, Devina Nand, Rafael Tabarés-Seisdedos, Abdishakur M. Abdulle, Yingfeng Zheng, Soewarta Kosen, Aleksandra Barac, Mahboubeh Parsaeian, Yuichiro Yano, Charles D.A. Wolfe, Simon I. Hay, Luke D. Knibbs, Balem Demtsu Betsu, Solomon Abrha Damtew, Ileana Heredia-Pi, Boris Bikbov, Bemnet Amare Tedla, Daniel Kim, Ulrich O Mueller, Khurshid Alam, Andrew H. Kemp, Austin Carter, Chuanhua Yu, Ibrahim A Khalil, João Mário Pedro, Atsushi Goto, Arsène Kouablan Adou, Scott B. Patten, Nicola Low, Julio Cesar Montañez Hernandez, Heidi J. Larson, Worku Tefera, Sanjay Zodpey, Kalpana Balakrishnan, Hsing-Yi Chang, Jacqueline Castillo Rivas, Donal Bisanzio, Hilda L Harb, Meghan D. Mooney, John N Newton, Vasiliy Victorovich Vlassov, Marcella Montico, Mojde Mirarefin, Vinay Nangia, Edgar P. Simard, Ben Schöttker, Michael Brainin, Ziad A. Memish, Rafael Lozano, Damian G Hoy, Gebre Yitayih Abyu, Alexis J Handal, Saleem M Rana, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Iqbal R. F. Elyazar, Oluremi N Ajala, Christopher J L Murray, Chioma Ezinne Chibueze, Rupert R A Bourne, Euripide Frinel G Arthur Avokpaho, Andreas A Kudom, Hilton Lam, Aman Yesuf Endries, Farshad Pourmalek, Andre Pascal Kengne, Gholamreza Roshandel, Chandrashekhar T Sreeramareddy, Bolajoko O. Olusanya, Tommi Vasankari, Zahid A Butt, Alemseged Aregay Gebru, Samer Hamidi, Soraya Seedat, Xie Rachel Kulikoff, Maziar Moradi-Lakeh, Gelin Xu, Shireen Sindi, Ruoyan Tobe-Gai, Haidong Wang, Johanna M. Geleijnse, Rajesh Kumar Rai, Ryan M Barber, André Karch, Ione Jayce Ceola Schneider, Hebe N. Gouda, Sibhatu Biadgilign, Erika Ota, Kerrie E. Doyle, Olalekan A. Uthman, Jed D. Blore, Walid Ammar, Guohong Jiang, Carlos A Castañeda-Orjuela, Ibrahim Abubakar, Konstantinos Stroumpoulis, Megan Coggeshall, Charles N Mock, Ronan A Lyons, Jose Martinez-Raga, Thomas Fürst, Ambuj Roy, Mustafa Z. Younis, Harish Chander Gugnani, Mohammad Hifz Ur Rahman, Lidia Morawska, Noore Alam, Paul S. F. Yip, Grant Nguyen, Randah R. Hamadeh, Victor Aboyans, Miloje Savic, Ketevan Gambashidze, Graeme J. Hankey, David M. Pereira, Cho-il Kim, Peter A. Meaney, Haidong Kan, Sameer Vali Gopalani, Murugesan Raju, Saeid Shahraz, Ibrahim Abdelmageem Mohamed Ginawi, Kenji Shibuya, Raimundas Lunevicius, Sun Ha Jee, Prashant Singh, Atte Meretoja, Suzanne Polinder, Alex Reynolds, Joseph Mikesell, David O. Carpenter, Carla Sofia e Sa Farinha, Miguel Angel Alegretti, Nataliya Foigt, Naris Silpakit, Amare Deribew, Gessessew Bugssa Hailu, Mohammed Magdy Abd El Razek, Reza Assadi, Yichong Li, Georgina A. V. Murphy, Babak Eshrati, Rintaro Mori, Scott Weichenthal, Andre Keren, Van C. Lansingh, Kebede Deribe, Bulat Idrisov, François Alla, Maaya Kita, Ala'a Alkerwi, Maia Kereselidze, Yanping Wang, Rajesh Sharma, Florian Fischer, Foluke Adetola Ojelabi, Maya S Fraser, Kingsley N. Ukwaja, H. Dean Hosgood, Puja Rao, Deena Alasfoor, Muhammad Muhammad Saleh, Bryan L. 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Ding, Narayanaswamy Venketasubramanian, Stephen S Lim, Barthelemy Kuate Defo, Alan D. Lopez, G Anil Kumar, João C. Fernandes, In-Hwan Oh, Rasmus Havmoeller, Amanuel Alemu Abajobir, Pengpeng Ye, Gabrielle deVeber, Espen Bjertness, Hao Zhang, Ali H. Mokdad, Yogeshwar Kalkonde, Peter Memiah, Rodrigo Sarmiento-Suarez, Konrad Pesudovs, Yong Zhao, Joseph Friedman, Abdullah Sulieman Terkawi, Hadi Danawi, André Faro, Kevin N. Sheth, Abera Kenay Tura, Sajjad Ur Rahman, Sergey Soshnikov, Ajit Kumar Yadav, Michelle L. Bell, Nelson Alvis-Guzman, Miia Kivipelto, Pieter de Jager, Yongmei Li, Giancarlo Logroscino, Sivadasanpillai Harikrishnan, Talha Farid, Zewdie Aderaw Alemu, Alemayehu Amberbir, Niveen M E Abu-Rmeileh, Beatriz Paulina Ayala Quintanilla, Parvaiz A Koul, Edson Serván-Mori, Anil Kaul, Cheng Huang, Kalkidan Hassen Abate, Hsiang Huang, Foad Abd-Allah, Marek Majdan, Sait Mentes Birlik, Jung-Chen Chang, Rahul Gupta, Luciano A. Sposato, Sergey Petrovich Ermakov, Ejaz Ahmad Khan, Yibeltal Tebekaw Bayou, Christian Lycke Ellingsen, Ole Frithjof Norheim, Zulfiqar A Bhutta, Hajo Zeeb, Norberto Perico, Jun Zhu, Bruno F. Sunguya, Parthasarathi Ganguly, Fisaha Haile Tesfay, Min-Jeong Shin, Ashish Awasthi, Felix Akpojene Ogbo, Alan J Thomson, Mostafa Qorbani, Ye Jin, Don C. Des Jarlais, Itamar S. Santos, Juanita A. Haagsma, Anwar Rafay, Jacob Olusegun Olusanya, José Neves, Gregory M Anderson, Amador Goodridge, Bolanle F Banigbe, David Rojas-Rueda, Pedro R. Olivares, Rakhi Dandona, Stefanos Tyrovolas, Peter Njenga Keiyoro, Stein Emil Vollset, Andrea Werdecker, Mohamed Hsairi, Chandrasekharan Nair Kesavachandran, Jeanne Françoise Kayibanda, Alemayehu B. Mekonnen, Addisu Shunu Beyene, Lela Sturua, Inga Dora Sigfusdottir, Amber Sligar, Maysaa El Sayed Zaki, Shiwei Liu, Melkamu Dedefo Gishu, Chantal Huynh, Lope H Barrero, Linhong Wang, Neeraj Bedi, Masood Ali Shaikh, Ricky Leung, Mehdi Javanbakht, Alemayehu Hailu, Kimani M Harun, Ubai Alsharif, Richard C. Franklin, Zoubida Zaidi, Hassan Magdy Abd El Razek, Masako Horino, Karzan Abdulmuhsin Mohammad, Diego Augusto Santos Silva, Marcello Tonelli, Juan Jesus Carrero, Cyrus Cooper, Rajaa Al-Raddadi, Juan Liang, Leslie Cornaby, Awoke Misganaw, Norito Kawakami, Carl Abelardo T. Antonio, Daniel J. Weiss, Abhishek Singh, Vivekanand Jha, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Gizachew Assefa Tessema, Alem Mehari, Wagner Marcenes, Chabila C Mapoma, Ababi Zergaw Giref, Farhad Pishgar, Khassoum Diallo, Nicholas J K Breitborde, Emmanuel A. Ameh, Justin Beardsley, Ademola Lukman Adelekan, Joshua A. Salomon, Mamo Wubshet, Diego De Leo, Daniel Pope, Elisabete Weiderpass, Gregory A. 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Colquhoun, Eduardo Bernabé, Nadia Akseer, Maheswar Satpathy, Fotis Topouzis, Health Services Management & Organisation (HSMO), Public Health, Psychiatry, Neurology, Wang, Haidong, Bhutta, Zulfiqar A, Coates, Matthew M, Coggeshall, M, Ciobanu, Liliana G, Murray, Christopher JL, Coggeshall, Megan, Dandona, Lalit, Diallo, Khassoum, Franca, Elisabeth Barboza, Fraser, Maya, Fullman, Nancy, Gething, Peter W, Hay, Simon I, Kinfu, Yohanne, Kita, Maaya, Kulikoff, Xie Rachel, Larson, Heidi J, Liang, Juan, Liang, Xiaofeng, Lind, Margaret, Lopez, Alan D, Lozano, Rafael, Mensah, George A, Mikesell, Joseph B, Mokdad, Ali H, Mooney, Meghan D, Nguyen, Grant, Rakovac, Ivo, Salomon, Joshua A, Silpakit, Nari, Sligar, Amber, Sorensen, Reed J D, Vos, Theo, Zhu, Jun, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Adelekan, Ademola Lukman, Adou, Arsène Kouablan, Agarwal, Arnav, Ajala, Oluremi N, Akinyemiju, Tomi F, Akseer, Nadia, Alam, Khurshid, Alam, Noore K M, Alasfoor, Deena, Aldridge, Robert William, Alegretti, Miguel Angel, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'A, Alla, Françoi, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Ameh, Emmanuel A, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Gregory M, Antonio, Carl Abelardo T, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Banigbe, Bolanle F, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barrero, 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Cooper, Cyru, Cornaby, Leslie, Damtew, Solomon Abrha, Danawi, Hadi, Dandona, Rakhi, das Neves, José, Davis, Adrian C, de Jager, Pieter, De Leo, Diego, Degenhardt, Louisa, Deribe, Kebede, Deribew, Amare, Jarlais, Don C De, Deveber, Gabrielle A, Dharmaratne, Samath D, Dhillon, Preet K, Ding, Eric L, Doshi, Pratik Pinal, Doyle, Kerrie E, Duan, Leilei, Dubey, Manisha, Ebrahimi, Hedyeh, Ellingsen, Christian Lycke, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Esteghamati, Alireza, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Fereshtehnejad, Seyed-Mohammad, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Foigt, Nataliya, Franklin, Richard C, Friedman, Joseph, Fürst, Thoma, Gambashidze, Ketevan, Gamkrelidze, Amiran, Ganguly, Parthasarathi, Gebre, Teshome, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Geleijnse, Johanna M, Gessner, Bradford D, Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Gishu, Melkamu Dedefo, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Goto, Atsushi, Gouda, Hebe N, Gugnani, Harish Chander, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gyawali, Bishal, Haagsma, Juanita A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Harun, Kimani M, Havmoeller, Rasmu, Hay, Roderick J, Heredia-Pi, Ileana Beatriz, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Hu, Guoqing, Huang, Cheng, Huang, John J, Huang, Hsiang, Huiart, Laetitia, Iburg, Kim Moesgaard, Idrisov, Bulat T, Innos, Kaire, Jacobsen, Kathryn H, Jahanmehr, Nader, Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Kang, Gagandeep, Karch, André, Karema, Corine Kakizi, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Kazanjan, Konstantin, Keiyoro, Peter Njenga, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khonelidze, Irma, Khubchandani, Jagdish, Kim, Cho-il, Kim, Daniel, Kim, Yun Jin, Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D, Kokubo, Yoshihiro, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kumar, G Anil, Kyu, Hmwe H, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lam, Jennifer O, Lansingh, Van C, Larsson, Ander, Leigh, Jame, Leung, Ricky, Li, Yichong, Li, Yongmei, Lindsay, M Patrice, Liu, Patrick Y, Liu, Shiwei, Lloyd, Belinda K, Lo, Warren D, Logroscino, Giancarlo, Low, Nicola, Lunevicius, Raimunda, Lyons, Ronan A, Ma, Stefan, Razek, Hassan Magdy Abd El, Razek, Mohammed Magdy Abd El, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Mapoma, Chabila C, Marcenes, Wagner, Martinez-Raga, Jose, Marzan, Melvin Barriento, Masiye, Felix, Mcgrath, John J, Meaney, Peter A, Mehari, Alem, Mehndiratta, Man Mohan, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Miller, Ted R, Mills, Edward J, Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Moore, Ami R, Moradi-Lakeh, Maziar, Morawska, Lidia, Mori, Rintaro, Mueller, Ulrich O, Murphy, Georgina A V, Murthy, Sriniva, Nachega, Jean B, Naheed, Aliya, Naidoo, Kovin S, Naldi, Luigi, Nand, Devina, Nangia, Vinay, Neupane, Suba, Newton, Charles R, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, Nguhiu, Peter, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Norheim, Ole F, Norman, Rosana E, Ogbo, Felix Akpojene, Oh, In-Hwan, Ojelabi, Foluke Adetola, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Oren, Eyal, Ota, Erika, Pa, Mahesh, Park, Eun-Kee, Park, Hye-Youn, Parsaeian, Mahboubeh, Caicedo, Angel J Paternina, Patten, Scott B, Pedro, João Mário, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Pillay, Julian David, Pishgar, Farhad, Polinder, Suzanne, Pope, Daniel, Popova, Svetlana, Pourmalek, Farshad, Qorbani, Mostafa, Rabiee, Rynaz H S, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Raju, Murugesan, Ram, Usha, Rana, Saleem M, Ranabhat, Chhabi Lal, Rao, Puja, Refaat, Amany H, Remuzzi, Giuseppe, Resnikoff, Serge, Reynolds, Alex, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Roy, Ambuj, Ruhago, George Mugambage, Sagar, Rajesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Santos, Itamar S, Santos, João Vasco, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schneider, Ione J C, Schöttker, Ben, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Setegn, Tesfaye, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N, Shibuya, Kenji, Shin, Hwashin Hyun, Shin, Min-Jeong, Shiri, Rahman, Shuie, Ivy, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silverberg, Jonathan, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Soriano, Joan B, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steel, Nichola, Stroumpoulis, Konstantino, Sturua, Lela, Sunguya, Bruno F, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tavakkoli, Mohammad, Taye, Bineyam, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Tekle, Tesfaye, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tesfay, Fisaha Haile, Tessema, Gizachew Assefa, Thapa, Kiran, Thomson, Alan J, Thorne-Lyman, Andrew L, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tran, Bach Xuan, Troeger, Christopher, Truelsen, Thoma, Dimbuene, Zacharie Tsala, Tura, Abera Kenay, Tyrovolas, Stefano, Ukwaja, Kingsley N, Uneke, Chigozie Jesse, Uthman, Olalekan A, Vaezghasemi, Masoud, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wang, Linhong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Widdowson, Marc-Alain, Wijeratne, Tissa, Williams, Thomas Neil, Wiysonge, Charles Shey, Wolfe, Charles D A, Wolfe, Ingrid, Won, Sungho, Wubshet, Mamo, Xiao, Qingyang, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zeeb, Hajo, Zhang, Hao, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zodpey, Sanjay, and Murray, Christopher J L
Subjects: Pediatrics, Nutrition and Disease, Global Health, Communicable Disease, 0302 clinical medicine, Voeding en Ziekte, Infant Mortality, Compensation law of mortality, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, DEVELOPING-COUNTRIES, 10. No inequality, Medicine(all), NEWBORN BABIES, Medicine (all), Mortality rate, 1. No poverty, DEATH, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, 11 Medical And Health Sciences, Stillbirth, 3. Good health, Child Mortality, SURVIVAL, CHILD-MORTALITY, HEALTH, Life Sciences & Biomedicine, DEVELOPMENT GOAL 4, Human, INTERVENTIONS, medicine.medical_specialty, RJ, INTEGRATED APPROACH, Developing country, Communicable Diseases, neonatal, 03 medical and health sciences, Medicine, General & Internal, 030225 pediatrics, General & Internal Medicine, Life Science, Humans, Global Burden of Disease Study, VLAG, Estimation, Science & Technology, business.industry, Klinisk medicin, Infant, GBD 2015 Child Mortality Collaborators, Infant mortality, Malaria, Child mortality, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Life expectancy, Clinical Medicine, RG, business, Demography
Abstract: BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. FUNDING: Bill & Melinda Gates Foundation. Erratum: Department of Error, The Lancet,Volume 389, Issue 10064, 2017, Page e1. DOI: 10.1016/S0140-6736(16)32608-3
Published: 2016

22. Study of Vehicle Speeds on a Major Highway in Ghana: Implication for monitoring and control

Author: Francis K. Afukaar, Peter Donkor, Charles N. Mock, and James Damsere Derry
Subjects: Truck, Automobile Driving, Safety Management, Engineering, Electronic speed control, Radar, Road accident, business.product_category, business.industry, Speed limit, Acceleration, Public Health, Environmental and Occupational Health, Poison control, Ghana, Monitoring and control, law.invention, Transport engineering, law, Radar gun, business, Safety Research
Abstract: Vehicular speeds have been identified to be at the core of road accident severity and frequency globally. Whereas speed control is a fundamental priority and the cornerstone of road safety in the developed world, the subject is at rudimentary stages in most developing countries thus making research into vehicle speeds in developing nations imperative. The main aim of the study was to establish two major speed parameters, namely the mean speed and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana.Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 4,163 vehicles over two 24-hour periods at two separate sites on one of the main inter-urban roads (Accra-Kumasi). Both sites were settled areas with posted speed limits of 50 km/hr.Over 95% of vehicles travelled above the posted speed limit of 50 km/hr. Vehicles on an average travelled at 87 km/hr, (95% CI=87, 88). Variation in speeds was wide, with a standard deviation of 18 km/hr for all classes of vehicles, and with a range of 40 to 187 km/hr. The highest vehicular speed was associated with the private car (97.6+/-18.3 km/hr) followed by large buses (93.6+/-13.3 km/hr) and the least was with heavy trucks (73.8+/-12.9 km/hr).The excessive vehicular speeds coupled with the wide speed variations explain in part the high incidence of traffic crashes and fatalities on the Accra-Kumasi highway. An integrated speed monitoring and control program, and realigning the highway to by-pass small and medium settlements would be required as a long-term measure for the reduction of speed-related road traffic crashes, fatalities, and injuries in Ghana.
Published: 2007

23. Advancing Injury Prevention and Trauma Care in North America and Globally

Author: Carlos Arreola-Risa, Robert Ekow Quansah, Manjul Joshipura, and Charles N Mock
Subjects: Automobile Driving, Alcohol Drinking, Heart disease, Poison control, Disease, Global Health, Suicide prevention, Occupational safety and health, Environmental health, Injury prevention, medicine, Humans, Developing Countries, Poverty, Cause of death, business.industry, Human factors and ergonomics, medicine.disease, Traumatology, Population Surveillance, North America, Practice Guidelines as Topic, Wounds and Injuries, Surgery, Medical emergency, business, Licensure
Abstract: Historically, in all societies, infectious diseases were the leading cause ofdeath and disability. This pattern changed in the past two centuries in high-income countries with decreases in infection as a result of improved sanita-tion and medical care and with consequent increases in life expectancy.Some of these gains were oﬀset by increases by other disease, such as cancer,heart disease, and injury. In most high-income countries today injury is theleading cause of death between age 1 and 44. Similar trends are underway intoday’s low- and middle-income countries (LMICs) with decreases in mostinfectious diseases, except HIV-AIDS, and also with increases in many in-jury-related causes of death, especially from road traﬃc. Because of recentincreases in use of motorized transport globally, road traﬃc crashes havenow become a leading cause of death among young, working-aged adultsin almost every country. In the age group 15 to 44 years, road traﬃc deathsare second only to HIV-AIDS as a cause of death [1–3].
Published: 2007

24. Organization of Essential Services and the Role of First-Level Hospitals

Author: Meena Cherian, Colin McCord, Mike English, Sarah Russell, Charles N Mock, Margaret E Kruk, and Johan von Schreeb
Subjects: Administrative services organization, medicine.medical_specialty, business.industry, Public health, MEDLINE, Surgical procedures, medicine.disease, Hospital care, Small hospital, Health services, Minor surgery, Medicine, Medical emergency, business
Abstract: Every country has some sort of system to provide surgical and other health services at various levels, with a progressive increase in the capacity to treat more complicated problems. Reliable evidence indicates that properly functioning small hospitals and health centers can deliver effective basic surgical services at very low cost; these surgical services can be one of the most cost-effective components of the public health system in low- and middle-income countries (LMICs) (Alkire and others 2012; Debas and others 2006; Gosselin, Maldonado, and Elder 2010; Gosselin, Thind, and Bellardinelli 2006; McCord and Chowdhury 2003). Properly functioning is a key phrase; a hospital lacking personnel trained in surgery and in the administration of anesthesia cannot provide major surgical procedures. Even minor surgery requires trained personnel. More than 50 percent of the disability-adjusted life years (DALYs) averted in a small hospital can derive from surgical treatment, (McCord and Chowdhury 2003) so the cost-effectiveness of these units is drastically reduced if this treatment is not available. Box 12.1 defines the three levels of hospital care.
Published: 2015

25. Essential Surgery: Key Messages of This Volume

Author: Charles N Mock, Haile T. Debas, Atul A. Gawande, Peter Donkor, Dean T. Jamison, and Margaret E Kruk
Subjects: medicine.medical_specialty, Complications of pregnancy, business.industry, Public health, MEDLINE, medicine.disease, Surgery, Malnutrition, Intervention (counseling), Economic evaluation, medicine, business, Health policy, Disease burden
Abstract: Conditions that are treated primarily or frequently by surgery constitute a significant portion of the global burden of disease. In 2011, injuries killed nearly 5 million people; 270,000 women died from complications of pregnancy (WHO 2014). Many of these injury- and obstetric-related deaths, as well as deaths from other causes such as abdominal emergencies and congenital anomalies, could be prevented by improved access to surgical care.Despite this substantial burden, surgical services are not being delivered to many of those who need them most. An estimated 2 billion people lack access to even the most basic surgical care (Funk and others 2010). This need has not been widely acknowledged, and priorities for investing in health systems’ surgical capacities have only recently been investigated. Indeed, until the 1990s, health policy in resource-constrained settings focused sharply on infectious diseases and undernutrition, especially in children. Surgical capacity was developing in urban areas but was often viewed as a secondary priority that principally served those who were better off.In the 1990s, a number of studies began to question the perception that surgery was costly and low in effectiveness. Economic evaluations of cataract surgery found the procedure to be cost-effective, even under resource-constrained circumstances; Javitt pioneered cost-effectiveness analysis (CEA) for surgery, including his chapter on cataract in Disease Control Priorities, first edition (DCP1) in 1993 (Javitt 1993). In 2003, McCord and Chowdhury enriched the approach to economic evaluation in surgery in a paper looking at the overall cost-effectiveness of a surgical platform in Bangladesh (McCord and Chowdhury 2003). By design, DCP2, published in 2006, placed much more emphasis on surgery than had previous health policy documents. DCP2 included a dedicated chapter on surgery that amplified the approach of McCord and Chowdhury and provided an initial estimate of the amount of disease burden that could be addressed by surgical intervention in LMICs (Debas and others 2006). DCP3 places still greater emphasis on surgery by dedicating this entire volume (out of a total of nine volumes) to the topic. There is also a growing academic literature on surgery’s importance in health system development; for example, Paul Farmer and Jim Kim’s paper observes that “surgery may be thought of as the neglected stepchild of global public health” (Farmer and Kim 2008, 533). The WHO is paying increasing attention to surgical care through such vehicles as its Global Initiative for Emergency and Essential Surgical Care. Finally, the creation of The Lancet Commission on Global Surgery, now well into its work, points to a major change in the perceived importance of surgery.The chapter seeks to do the following:Box 1.1 describes the history, objectives, and contents of DCP3 (Jamison 2015).
Published: 2015

26. 'Improved' But Not Necessarily Safe: An Assessment of Fecal Contamination of Household Drinking Water in Rural Peru

Author: Stephen E. Hawes, Charles N. Mock, A. Jannet Carrasco, Silvia M. Montano, Ricardo M. Cabrera, Drake H. Tilley, Kristen Heitzinger, Claudio Rocha, and Robert Quick
Subjects: Adult, Male, Rural Population, Improved water source, Adolescent, media_common.quotation_subject, Water supply, Water safety, Water Purification, Toxicology, Feces, Young Adult, Hygiene, Environmental protection, Water Supply, Virology, Water Quality, Peru, Escherichia coli, Humans, Prevalence ratio, media_common, Family Characteristics, business.industry, Drinking Water, Articles, Contamination, Middle Aged, Fecal coliform, Infectious Diseases, Cross-Sectional Studies, Environmental science, Parasitology, Water treatment, Female, business
Abstract: The indicator used to measure progress toward the Millennium Development Goal (MDG) for water is access to an improved water supply. However, improved supplies are frequently fecally contaminated in developing countries. We examined factors associated with Escherichia coli contamination of improved water supplies in rural Pisco province, Peru. A random sample of 207 households with at least one child less than 5 years old was surveyed, and water samples from the source and storage container were tested for E. coli contamination. Although over 90% of households used an improved water source, 47% of source and 43% of stored water samples were contaminated with E. coli. Pouring or using a spigot to obtain water from the storage container instead of dipping a hand or object was associated with decreased risk of contamination of stored water (adjusted prevalence ratio [aPR] = 0.58, 95% confidence interval [CI] = 0.42, 0.80). Container cleanliness (aPR = 0.67, 95% CI = 0.45, 1.00) and correct handwashing technique (aPR = 0.62, 95% CI = 0.42, 0.90) were also associated with decreased contamination risk. These findings highlighted the limitations of improved water supplies as an indicator of safe water access. To ensure water safety in the home, household water treatment and improved hygiene, water handling, and storage practices should be promoted.
Published: 2014

27. Long-term injury related disability in Ghana

Author: Frederick Acheampong, Samuel Adjei, Edward Boland, and Charles N Mock
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Poison control, Ghana, Suicide prevention, Occupational safety and health, Interviews as Topic, Disability Evaluation, Injury prevention, Prevalence, medicine, Humans, Disabled Persons, Trauma Severity Indices, Rehabilitation, business.industry, Trauma Severity Indexes, Accidents, Traffic, Human factors and ergonomics, medicine.disease, Term (time), Emergency medicine, Wounds and Injuries, Female, Medical emergency, business
Abstract: (2003). Long-term injury related disability in Ghana. Disability and Rehabilitation: Vol. 25, No. 13, pp. 732-741.
Published: 2003

28. Economic consequences of injury and resulting family coping strategies in Ghana

Author: Frederick Acheampong, Oscar Gish, Samuel Adjei, Charles N Mock, and Stephen Gloyd
Subjects: Employment, Rural Population, Financing, Personal, Coping (psychology), Urban Population, Developing country, Poison control, Human Factors and Ergonomics, Efficiency, Ghana, Suicide prevention, Occupational safety and health, Eating, Cost of Illness, Absenteeism, Adaptation, Psychological, Injury prevention, Humans, Medicine, Safety, Risk, Reliability and Quality, Socioeconomics, Family Health, Family Characteristics, Actuarial science, Health economics, business.industry, Public Health, Environmental and Occupational Health, Wounds and Injuries, business
Abstract: The toll of human suffering from illness and injury is usually measured by mortality and disability rates. Economic consequences, such as treatment costs and lost productivity, are often considered as well. Lately, increasing attention has been paid to the economic effects of illness on a household level. In this study, we sought to assess the economic consequences of injuries in Ghana by looking at the effects on households and the coping mechanisms these households employed. Using cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. We sought information on any injury that occurred to a household member during the prior year and that resulted in one or more days of disability time.A total of 1609 injuries were reported for the prior year. Treatment costs and disability days were higher in the urban area than in the rural. Coping strategies were different between the two areas. Rural households were more likely to utilize intra-family labor reallocation (90%) than were urban households (75%). Rural households were also more likely to borrow money (24%) than were urban (19%). Households in both areas were equally likely to sell belongings, although the nature of the belongings sold were different. Although injuries in the urban area had more severe primary effects (treatment cost and disability time), the ultimate effect on rural households appeared more severe. A greater percentage of rural households (28%) reported a decline in food consumption than did urban households (19%). These findings result in several policy implications, including measures that could be used to assist family coping strategies and measures directed toward injuries themselves.
Published: 2003

29. The relationship between body weight and risk of death and serious injury in motor vehicle crashes

Author: Robert Kaufman, David C. Grossman, Charles N Mock, Christopher D. Mack, and Frederick P. Rivara
Subjects: Adult, Male, Poison control, Human Factors and Ergonomics, Overweight, Injury Severity Score, Injury prevention, Odds Ratio, Forensic engineering, medicine, Humans, Safety, Risk, Reliability and Quality, Retrospective Studies, business.industry, Body Weight, Accidents, Traffic, Public Health, Environmental and Occupational Health, Odds ratio, medicine.disease, Obesity, Multivariate Analysis, Crashworthiness, Female, medicine.symptom, business, human activities, Body mass index, Demography
Abstract: We sought to investigate the effect of increased body weight on the risk of death and serious injury to occupants in motor vehicle crashes. We employed a retrospective cohort study design utilizing data from the National Automotive Sampling System, Crashworthiness Data System (CDS), 1993-1996. Subjects in the study included occupants involved in tow-away crashes of passenger cars, light trucks, vans and sport utility vehicles. Two outcomes were analyzed: death within 30 days of the crash and injury severity score (ISS). Two exposures were considered: occupant body weight and body mass index (BMI; kg/m2). Occupant weight was available on 27263 subjects (76%) in the CDS database. Mortality was 0.67%. Increased body weight was associated with increased risk of mortality and increased risk of severe injury. The odds ratio for death was 1.013 (95% CI: 1.007, 1.018) for each kilogram increase in body weight. The odds ratio for sustaining an injury with ISS > or = 9 was 1.008 (95% CI: 1.004, 1.011) for each kilogram increase in body weight. After adjustment for potentially confounding variables (age, gender, seatbelt use, seat position and vehicle curbweight), the significant relationship between occupant weight and mortality persisted. After adjustment, the relationship between occupant weight and ISS was present, although less marked. Similar trends were found when BMI was analyzed as the exposure. In conclusion, increased occupant body weight is associated with increased mortality in automobile crashes. This is probably due in part to increased co-morbid factors in the more overweight occupants. However, it is possibly also due to an increased severity of injury in these occupants. These findings may have implications for vehicle safety design, as well as for transport safety policy.
Published: 2002

30. Neuropsychological changes in asymptomatic persons with Alzheimer disease neuropathology

Author: Jason Hassenstab, John C. Morris, Sarah E. Monsell, Walter A. Kukull, Catherine M. Roe, Nigel J. Cairns, and Charles N. Mock
Subjects: Male, medicine.medical_specialty, Pediatrics, Clinical Dementia Rating, Neuropsychological Tests, Article, Alzheimer Disease, Medicine, Dementia, Humans, Effects of sleep deprivation on cognitive performance, Longitudinal Studies, Psychiatry, Episodic memory, Aged, Aged, 80 and over, business.industry, Working memory, Neuropsychology, Cognition, Middle Aged, medicine.disease, Asymptomatic Diseases, Female, Neurology (clinical), Alzheimer's disease, business
Abstract: Objective: To determine whether asymptomatic persons with Alzheimer disease (AD) neuropathologic change differ in the trajectory of their cognitive performance compared to asymptomatic persons without AD neuropathologic change. Methods: Longitudinal performance on standard neuropsychological tests was examined in participants who died within 2 years of their last cognitive assessment and who were never diagnosed with mild cognitive impairment or dementia (Clinical Dementia Rating global score of 0 at all assessments). Using cognitive and neuropathologic data collected between 2005 and 2013 from the 34 National Institute on Aging–sponsored Alzheimer9s Disease Centers, cognitive trajectories were compared for persons with and without evidence of AD neuropathologic change. We evaluated rates of decline in 4 domains (episodic memory, language, attention/working memory, executive function). The significance of the differences (β) in rates of decline was tested using linear regression, adjusting for age, education, sex, and other neuropathologic lesions. Results: Participants who had low to high levels of AD neuropathologic change (n = 131) showed a greater rate of decline on the attention/working memory domain score (β = −0.11; 95% confidence interval = −0.19, −0.02; p = 0.02) when compared to 80 participants who died without evidence of AD neuropathologic change. Conclusions: Clinically normal individuals who come to autopsy with AD neuropathologic change exhibit subtle evidence of declining cognitive trajectories for attention/working memory.
Published: 2014

31. Epidemiology of transport-related injuries in Ghana

Author: Frederick P. Rivara, Charles N Mock, and Samuel N. Forjuoh
Subjects: Adult, Male, Rural Population, Urban Population, Poison control, Developing country, Human Factors and Ergonomics, Urban area, Ghana, Suicide prevention, Occupational safety and health, Transport engineering, Environmental health, Injury prevention, Humans, Safety, Risk, Reliability and Quality, Developing Countries, Aged, geography, geography.geographical_feature_category, Incidence, Accidents, Traffic, Public Health, Environmental and Occupational Health, Human factors and ergonomics, Middle Aged, Motor Vehicles, Cross-Sectional Studies, Wounds and Injuries, Female, Rural area
Abstract: To better elucidate the incidence, characteristics, and consequences of transport-related injuries in a less developed country in Africa, we undertook an epidemiologic survey in Ghana. A total of 21,105 persons were surveyed, in both an urban area (Kumasi, n = 11,663) and a rural area (Brong-Ahafo, n = 9442). In the preceding year, a total of 656 injuries were reported in the urban area and 928 injuries reported in the rural area. Transport-related mechanisms accounted for 16% of all injuries in the urban and 10% of all injuries in the rural area. The annual incidence of transport-related injuries was almost identical in the two settings, 997/100,000 persons in the urban area and 941/100,000 in the rural area. In both settings, transport-related injuries were more severe than other types of injuries in terms of mortality, length of disability, and economic consequences. In the urban area, the most common transport-related mechanisms were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). In the rural area, the most common transport-related mechanisms were bicycle crashes. The second most common rural mechanisms were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed countries and should target commercial drivers more than private road users.
Published: 1999

32. Epidemiology of Transportation Related Injuries in Rural Africa

Author: D Nii-Amon-Kotei, Samuel N. Forjuoh, Charles N Mock, and Frederick P. Rivara
Subjects: Transport engineering, business.industry, Environmental health, Injury prevention, Developing country, Human factors and ergonomics, Poison control, Medicine, Rural area, business, Suicide prevention, Developed country, Occupational safety and health
Abstract: To ascertain the incidence, characteristics, and consequences of transport-related injuries in a developing rural area, we conducted an epidemiologic survey in Ghana. Among the 9442 persons surveyed, 928 injuries were reported for the preceding year. Transport-related mechanisms accounted for 10% of these, hut were more severe than other mechanisms in terms of mortality, length of disability, and economic consequences. The most common transport-related injuries were due to bicycle crashes, followed by motor vehicle crashes, which resulted in the most severe injuries and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed nations and need to target commercial drivers more than private road users.
Published: 1999

33. Injury Prevention Strategies to Promote Helmet Use Decrease Severe Head Injuries at a Level I Trauma Center

Author: Charles N Mock, Ronald V. Maier, Frederick P. Rivara, Susan Pilcher, and Edward M. Boyle
Subjects: Adult, Male, Washington, medicine.medical_specialty, Adolescent, Poison control, Health Promotion, Helmet use, Occupational safety and health, Injury Severity Score, Trauma Centers, Injury prevention, medicine, Craniocerebral Trauma, Humans, Child, Aged, Abbreviated Injury Scale, business.industry, Trauma center, Accidents, Traffic, Length of Stay, Middle Aged, Bicycling, Surgery, Motorcycles, Child, Preschool, Emergency medicine, Female, Head Protective Devices, business, human activities, Hospital stay
Abstract: Head injuries (HIs) remain a major contributor to trauma mortality, with many deaths occurring despite optimal use of available therapy. Injury prevention is vital to decrease the impact of HIs. Helmets can decrease the severity of HIs in both bicycle crashes (BCs) and motorcycle crashes (MCCs). A major challenge is to increase helmet use. A mandatory motorcycle helmet law in 1990 and information campaigns aimed at bicyclists have increased the percentage of riders wearing helmets in Washington State. We hypothesized that there would be an associated decrease in the proportion of severe HIs in BC and MCC admissions to the state's only level I trauma center. We analyzed injury region and outcomes for all 466 BC and 992 MCC instate admissions from 1986 to 1993. For BCs, the proportion of severe HIs (Abbreviated Injury Scale score of 4 or 5) declined from 29% in 1986 to 11% in 1993 (p = 0.02). BC trends paralleled helmet use in observations on 8,860 bicycle riders in the area, in which the percentage of helmeted riders rose from 5% in 1987 to 62% in 1993 (p < 0.001). For MCCs, severe HIs declined from 20% before passage of the helmet law to 9% afterward (p < 0.001). Mortality decreased for BCs and MCCs (p < 0.05), and length of hospital stay and ICU stay decreased for BCs (p < 0.05). The percentage of helmeted BC admissions rose from 0% to 32% (p = 0.009), and helmeted MCC admissions rose from 41% to 80% (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Published: 1995

34. Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013

Author: Hmwe H, Kyu, Christine, Pinho, Joseph A, Wagner, Jonathan C, Brown, Amelia, Bertozzi-Villa, Fiona J, Charlson, Luc Edgar, Coffeng, Lalit, Dandona, Holly E, Erskine, Alize J, Ferrari, Christina, Fitzmaurice, Thomas D, Fleming, Mohammad H, Forouzanfar, Nicholas, Graetz, Caterina, Guinovart, Juanita, Haagsma, Hideki, Higashi, Nicholas J, Kassebaum, Heidi J, Larson, Stephen S, Lim, Ali H, Mokdad, Maziar, Moradi-Lakeh, Shaun V, Odell, Gregory A, Roth, Peter T, Serina, Jeffrey D, Stanaway, Awoke, Misganaw, Harvey A, Whiteford, Timothy M, Wolock, Sarah, Wulf Hanson, Foad, Abd-Allah, Semaw Ferede, Abera, Laith J, Abu-Raddad, Fadia S, AlBuhairan, Azmeraw T, Amare, Carl Abelardo T, Antonio, Al, Artaman, Suzanne L, Barker-Collo, Lope H, Barrero, Corina, Benjet, Isabela M, Bensenor, Zulfiqar A, Bhutta, Boris, Bikbov, Alexandra, Brazinova, Ismael, Campos-Nonato, Carlos A, Castañeda-Orjuela, Ferrán, Catalá-López, Rajiv, Chowdhury, Cyrus, Cooper, John A, Crump, Rakhi, Dandona, Louisa, Degenhardt, Robert P, Dellavalle, Samath D, Dharmaratne, Emerito Jose A, Faraon, Valery L, Feigin, Thomas, Fürst, Johanna M, Geleijnse, Bradford D, Gessner, Katherine B, Gibney, Atsushi, Goto, David, Gunnell, Graeme J, Hankey, Roderick J, Hay, John C, Hornberger, H Dean, Hosgood, Guoqing, Hu, Kathryn H, Jacobsen, Sudha P, Jayaraman, Panniyammakal, Jeemon, Jost B, Jonas, André, Karch, Daniel, Kim, Sungroul, Kim, Yoshihiro, Kokubo, Barthelemy, Kuate Defo, Burcu, Kucuk Bicer, G Anil, Kumar, Anders, Larsson, Janet L, Leasher, Ricky, Leung, Yongmei, Li, Steven E, Lipshultz, Alan D, Lopez, Paulo A, Lotufo, Raimundas, Lunevicius, Ronan A, Lyons, Marek, Majdan, Reza, Malekzadeh, Taufiq, Mashal, Amanda J, Mason-Jones, Yohannes Adama, Melaku, Ziad A, Memish, Walter, Mendoza, Ted R, Miller, Charles N, Mock, Joseph, Murray, Sandra, Nolte, In-Hwan, Oh, Bolajoko Olubukunola, Olusanya, Katrina F, Ortblad, Eun-Kee, Park, Angel J, Paternina Caicedo, Scott B, Patten, George C, Patton, David M, Pereira, Norberto, Perico, Frédéric B, Piel, Suzanne, Polinder, Svetlana, Popova, Farshad, Pourmalek, D Alex, Quistberg, Giuseppe, Remuzzi, Alina, Rodriguez, David, Rojas-Rueda, Dietrich, Rothenbacher, David H, Rothstein, Juan, Sanabria, Itamar S, Santos, David C, Schwebel, Sadaf G, Sepanlou, Amira, Shaheen, Rahman, Shiri, Ivy, Shiue, Vegard, Skirbekk, Karen, Sliwa, Chandrashekhar T, Sreeramareddy, Dan J, Stein, Timothy J, Steiner, Lars Jacob, Stovner, Bryan L, Sykes, Karen M, Tabb, Abdullah Sulieman, Terkawi, Alan J, Thomson, Andrew L, Thorne-Lyman, Jeffrey Allen, Towbin, Kingsley Nnanna, Ukwaja, Tommi, Vasankari, Narayanaswamy, Venketasubramanian, Vasiliy Victorovich, Vlassov, Stein Emil, Vollset, Elisabete, Weiderpass, Robert G, Weintraub, Andrea, Werdecker, James D, Wilkinson, Solomon Meseret, Woldeyohannes, Charles D A, Wolfe, Yuichiro, Yano, Paul, Yip, Naohiro, Yonemoto, Seok-Jun, Yoon, Mustafa Z, Younis, Chuanhua, Yu, Maysaa, El Sayed Zaki, Mohsen, Naghavi, Christopher J L, Murray, Theo, Vos, and Public Health
Subjects: Male, COUNTRIES, SUICIDE, Adolescent, Nutrition and Disease, Adolescent Health, Global Health, Article, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, SDG 3 - Good Health and Well-being, Voeding en Ziekte, 030225 pediatrics, SYSTEMATIC ANALYSIS, Life Science, Humans, Medicine, Public Health Surveillance, 030212 general & internal medicine, Child, Developing Countries, VLAG, business.industry, Developed Countries, DISABILITY, MORTALITY, Child Health, DEATH, 1. No poverty, HIV, Bayes Theorem, PREVALENCE, TIME, 3. Good health, Child, Preschool, Child Mortality, Pediatrics, Perinatology and Child Health, Wounds and Injuries, Female, Quality-Adjusted Life Years, business, Demography
Abstract: Importance The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.Objective To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged Evidence Review Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.Findings Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.Conclusions and Relevance Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.
Published: 2016

35. Paediatric trauma in the rural developing world: low cost measures to improve outcome

Author: Ellis S. Adzotor, D. Denno, and Charles N. Mock
Subjects: Adult, Pediatrics, medicine.medical_specialty, Time Factors, Adolescent, Poison control, Ghana, Suicide prevention, Occupational safety and health, Injury Severity Score, Health care, Injury prevention, Epidemiology, Humans, Medicine, Disabled Persons, Child, Developing Countries, Referral and Consultation, General Environmental Science, business.industry, Prognosis, Hospitalization, El Niño, Child, Preschool, Wounds and Injuries, General Earth and Planetary Sciences, Morbidity, business
Abstract: We reviewed 181 injured children admitted to a rural African hospital from 1987 to 1990 to ascertain factors influencing survival and functional outcome. Burns were the most common (39 per cent), occurred in the youngest patients, and were due to domestic scalding in 54 per cent of cases. Of the patients, 65 per cent presented more than 24 h after injury and 81 per cent presented without any previous treatment. Major disability occurred in 14 per cent of survivors and was associated with Injury Severity Score (ISS), extremity injury, and delayed presentation. Mortality was associated with the ISS. The mean ISS was 6.3. An ISS of 20-25 was associated with 75 per cent mortality. Trauma caused 8 per cent of hospital deaths in the 5-19 years age group. To reduce the mortality and disability from paediatric trauma in the rural developing world, we recommend: (i) prevention strategies targeting domestic burns in younger children, (ii) increased attention to care of extremity injuries and burns, and (iii) increased use of non-medical health care providers in more remote areas.
Published: 1993

36. Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull

Author: Charles N. Mock, Wilfred I. Carney, Robert G. McRae, and Michael P. Lilly
Subjects: Subluxation, medicine.medical_specialty, business.industry, Digastric muscle, Anatomy, Dissection (medical), medicine.disease, Skull, medicine.anatomical_structure, Cadaver, medicine.artery, Medicine, Surgery, Radiology, Internal carotid artery, business, Sternocleidomastoid muscle, Cardiology and Cardiovascular Medicine, Cervical vertebrae
Abstract: Although several approaches for exposure of distal internal carotid artery lesions have been reported, the precise anatomic levels for which each of these maneuvers are most appropriate have not been well described. Since these techniques may require preoperative preparation, it is useful to determine in advance how much exposure will be needed and to select the most suitable and effective technique. We used anatomic dissection in 12 human cadaver specimens (24 carotid bifurcations) to define the limits of distal internal carotid artery exposure by several commonly advocated methods. The standard anterior approach along the sternocleidomastoid muscle allowed exposure of the internal carotid artery to the level of the upper one third of the second cervical vertebra. The upper limit of this exposure was extended to the middle of the first cervical vertebra by division of the posterior belly of the digastric muscle. Anterior subluxation of the mandible increased the distal exposure of the internal carotid artery to the superior border of the first cervical vertebra. Styloidectomy in combination with the preceding maneuvers extended the exposure an additional 0.5 cm cephalad. Lateral mandibulotomy did not significantly extend exposure beyond that obtained with mandibular subluxation and styloidectomy. Exposure of the internal carotid artery in the 1 cm immediately below the base of the skull required a posterior approach with mastoidectomy.
Published: 1991

37. Traffic related deaths in Nuevo Leon, Mexico: causes and associated factors Muertes relacionadas con accidentes viales en Nuevo León, México: causas y factores asociados

Author: Carlos Arreola-Rissa, Jesús Santos-Guzmán, Adol Esquivel-Guzmán, and Charles N Mock
Subjects: México, accidents traffic, lcsh:Public aspects of medicine, consumo de bebidas alcohólicas, mortalidad, lcsh:RA1-1270, alcohol drinking, mortality, Mexico, accidentes de tránsito
Abstract: OBJECTIVE: The effects of alcohol on mortality due to motor vehicle accidents was studied. MATERIAL AND METHODS: During the first semester of 2003, a sample of 243 fatality victims of traffic-related accidents and their blood alcohol levels were analyzed in the state of Nuevo Leon, Mexico. The age-adjusted mortality rate for traffic accidents was 8.9/100000 pop. (13.2 for males and 3.21 for females, per 100000). Fatal accidents were more common in the Metropolitan Area (MA). RESULTS: Fatalities were four times greater in males and the mean age was 34.7±18.2 years. Blood alcohol was detected in almost half of the victims who were drivers of the vehicles; the other cases of fatalities may be associated with road/car condition, weather and other factors. CONCLUSIONS: Alcohol intoxication levels were primarily associated with male drivers ages 16 to 45 (p=0.029); levels increased with age. In females, alcohol played a lesser role, affecting mostly ages 31 to 45 y (p=0.055).OBJETIVO:Durante seis meses de 2003 se estudió el efecto del alcohol en 243 víctimas fatales relacionadas con accidentes viales del estado de Nuevo León, México. MATERIAL Y MÉTODOS: Se realizó autopsia en todos los casos y se determinó el nivel de alcohol en sangre. La tasa de mortalidad ajustada por edad para accidentes viales fue 8.9/100000 hab. (13.2 para hombres y 3.21 para mujeres, por 100000). Accidentes fatales fueron comunes en el Área Metropolitana. RESULTADOS: Las fatalidades fueron cuatro veces mayores en hombres y la edad promedio fue de 34.7±18.2 años. Se detectaron niveles de alcohol en sangre en casi la mitad de los conductores que fueron víctimas; los otros casos de fatalidad fueron asociados con las condiciones del camino, el auto, factores meteorológicos, entre otros. CONCLUSIONES: Los niveles de intoxicación alcohólica fueron básicamente con conductores masculinos, de 16-45 años (p=0.029), aumentando con la edad. Entre las mujeres, el alcohol jugó un papel menos preponderante, afectando mayormente las de 31-45 años (p=0.055).
Published: 2008

38. Utilization of health services by the injured residents in Kumasi, Ghana

Author: Charles N Mock and Kathryn Spangenberg
Subjects: Adult, Male, Adolescent, MEDLINE, Developing country, Poison control, Suicide prevention, Ghana, Occupational safety and health, Injury prevention, Medicine, Humans, Poverty, business.industry, Public Health, Environmental and Occupational Health, Human factors and ergonomics, Health Services, Middle Aged, medicine.disease, Health Care Surveys, Wounds and Injuries, Female, Medical emergency, business, Safety Research
Abstract: The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11,663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (> or =1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.
Published: 2006

39. Improvements in trauma care capabilities in Vietnam through use of the WHO-IATSIC Guidelines for Essential Trauma Care

Author: Charles N Mock and Nguyen Thai Son
Subjects: business.industry, Public Health, Environmental and Occupational Health, Developing country, Human factors and ergonomics, Poison control, medicine.disease, Trauma care, World Health Organization, Suicide prevention, Occupational safety and health, Traumatology, Vietnam, Injury prevention, Practice Guidelines as Topic, Asian country, Medicine, Humans, Wounds and Injuries, Medical emergency, Clinical Competence, business, Emergency Service, Hospital, Safety Research, Program Evaluation, Retrospective Studies
Abstract: Injury, especially road traffic related, is increasing rapidly in most Asian countries, including Vietnam (Le and Linnan 2001, Peden et al. 2004, UNICEF 2004) ( table 1). To meet these challenges, ...
Published: 2006

40. An evaluation of the association between vehicle type and the source and severity of pedestrian injuries

Author: Bahman Sayyar Roudsari, Charles N. Mock, and Robert Kaufman
Subjects: Thorax, Adult, Male, medicine.medical_specialty, Poison control, Crash, Pedestrian, Walking, Injury prevention, Forensic engineering, Medicine, Humans, Crash data, Child, business.industry, Public Health, Environmental and Occupational Health, Accidents, Traffic, Age Factors, Equipment Design, Surgery, Motor Vehicles, medicine.anatomical_structure, Abdomen, Female, Vehicle type, business, Safety Research
Abstract: To evaluate the effect of vehicle type (passenger vehicle vs. light truck vehicle) on crash trajectory and on the consequent source and severity of pedestrian injury, we analyzed data from the Pedestrian Crash Data Study (PCDS), conducted by National Highway Traffic Safety Administration (NHTSA) from 1994 to 1998. While 62% of the adults in PV (passenger vehicle)-related crashes were carried by the vehicle, such pedestrian-vehicle interaction was observed only in 28% of LTV (light truck vehicle)-adult crashes. Being thrown forward or knocked down were the most common (65%) type of pedestrian-vehicle interactions for LTV-adult crashes. For children, 93% of those struck by LTVs and 46% of those struck by PVs were thrown forward or knocked down. For adults, LTVs were more likely than PVs to cause thorax (37% vs. 20%) and abdomen injuries (33% vs. 18%). For children, LTVs were more likely than PVs to cause injuries to the upper extremity (71% vs. 56%) and abdomen (14% vs. 8%). For adults struck by PVs the most common sources of injury were windshield for head injuries (63%), hood surface for thorax (67%), abdomen (58%), spine (30%), and upper extremity (36%) injuries, and bumper for the lower extremity injuries (60%). The leading causes of injury for adult-LTV crashes were ground for head (39%) and upper extremity (37%) injuries, hood edge for thorax (48%) and abdomen (56%) injuries, hood surface for spine injuries (36%), and bumper for lower extremity injuries (45%). For child-PV crashes, ground was the most common source of face (37%) abdomen (83%), spine (43%), and upper extremity injuries (54%). For children hit by LTVs, 52% of face, 67% of abdomen, 100% of spine, and 60% of upper extremity injuries were attributed to ground contacts. Altogether, the major sources of injury were hood surface and windshield for PV-pedestrian crashes and hood surface and hood edge for LTV-pedestrian crashes. Changes in design, such as altering the geometry and stiffness of front-end structures, might be associated with considerable decrease in the frequency and severity of pedestrian injury.
Published: 2005

41. The development of continuing education for trauma care in an African nation

Author: Robert Quansah, Peter Donkor, Charles N Mock, and Lawrence Addae-Mensah
Subjects: Pediatrics, medicine.medical_specialty, Educational measurement, Thoracic Injuries, Poison control, Traumatology, Rural Health, Ghana, Occupational safety and health, Injury prevention, medicine, Intubation, Intratracheal, Humans, Surgery, Plastic, Developing Countries, General Environmental Science, business.industry, Rural health, Physicians, Family, Hospitals, Test (assessment), Radiography, Orthopedics, Physical therapy, General Earth and Planetary Sciences, Drainage, Education, Medical, Continuing, Curriculum, Educational Measurement, Advanced airway management, business
Abstract: Summary Background: A trauma continuing education course was developed to meet the needs of rural hospitals in Ghana. Methods: The course's effectiveness was evaluated by pre-course and post-course test scores; and by interviews with course participants 1 year afterwards. Results: Mean test scores improved from 69% (% correct) to 80%. There were improvements in all major categories: initial management, torso, plastic surgery, orthopaedics, and X-ray interpretation. Follow-up interviews revealed high level of utilisation of basic airway manoeuvres (93% of participants utilising at least once) and chest tube insertion (67%), but limited utilisation of advanced airway manoeuvres (20%). Participants reported that their provision of most categories of care had improved. Categories with less improvement were: management of open fractures (33% not improved), closed fractures (20%), and diagnosis of abdominal injury (20%). Discussion: This locally developed course improved the participants’ knowledge and their self-reported process of trauma care. Aspects of trauma care with low test scores indicate areas needing reinforcement. Aspects with low subsequent utilisation, such as advanced airway management, indicate areas that might need attention to other components of care, such as equipment availability and training of ancillary staff. These findings provide lessons for efforts to improve trauma care in other low-income countries.
Published: 2003

42. Understanding the knowledge and attitudes of commercial drivers in Ghana regarding alcohol impaired driving

Author: Godfried Asiamah, Jones Blantari, and Charles N Mock
Subjects: Adult, Male, Engineering, Automobile Driving, Health Knowledge, Attitudes, Practice, Alcohol Drinking, business.industry, Applied psychology, Public Health, Environmental and Occupational Health, Accidents, Traffic, Human factors and ergonomics, Poison control, Focus Groups, Suicide prevention, Focus group, Ghana, Social marketing, Traffic psychology, Risk Factors, Injury prevention, Forensic engineering, Humans, Blood alcohol content, Original Article, business
Abstract: Objectives: The knowledge and attitudes of commercial drivers in Ghana as regards alcohol impaired driving were investigated. This was done in order to provide information that could subsequently be used to develop antidrunk driving social marketing messages built upon the intrinsic values and motivation of these drivers. Methods: Focus group discussions were held with 43 bus and minibus drivers in the capital city, Accra. A structured discussion guide was used to capture information related to values, risk perceptions, leisure time activities, and attitudes on alcohol impaired driving. Results: The majority of drivers expressed an understanding that drunk driving was a significant risk factor for crashes. There was a significant under-appreciation of the extent of the problem, however. Most believed that it was only rare, extremely intoxicated drivers who were the problem. The drivers also had a minimal understanding of the concept of blood alcohol concentration and related legal limits. Despite these factors, there was widespread support for increased enforcement of existing antidrunk driving laws. Conclusions: In Ghana, commercial drivers understand the basic danger of drunk driving and are motivated to assist in antidrunk driving measures. There are misconceptions and deficits in knowledge that need to be addressed in subsequent educational campaigns.
Published: 2002

43. Case Series and Trauma Registries

Author: Charles N Mock, Frederick P. Rivara, David C. Grossman, Ronald V. Maier, Peter Cummings, and Thomas D. Koepsell
Subjects: medicine.medical_specialty, Series (mathematics), business.industry, General surgery, medicine, business
Published: 2000

44. Systematic review of published evidence regarding trauma system effectiveness

Author: Ellen J. MacKenzie, Richard J. Mullins, N. C. Mann, Charles N. Mock, and Gregory J. Jurkovich
Subjects: Research design, Gerontology, education.field_of_study, Evidence-Based Medicine, business.industry, Clinical study design, Data Collection, Population, Trauma center, MEDLINE, Poison control, Evidence-based medicine, CINAHL, Regional Medical Programs, United States, Trauma Centers, Research Design, Outcome Assessment, Health Care, Medicine, Humans, Wounds and Injuries, education, business, Program Evaluation
Abstract: Objective: Provide a systematic review of the published literature assessing the affect of trauma center/system implementation on patient outcomes. Data Sources: A bibliographic search of MEDLINE (1966 -May of 1998), HealthSTAR (1995 - May of 1998), and CINAHL (1982 - May of 1998). Additional manuscripts were identified in the references of reviewed manuscripts. Literature was limited to English language reports on trauma systems in the United States and Canada. Study Selection: Initial inclusion criteria were based on methodologic criteria (i.e., a comparative [controlled] study). Authors independently assessed the strength of evidence demonstrated by each article. Data Extraction: Included articles were classified into three groups based on study design: panel review studies, trauma registry comparison studies, and population-based studies. Key demographic, sampling frame, study design, and outcome variables were tabulated for each included study. Potential sources of bias were also identified and tabled. Data Synthesis: A total of 12, 11, and 17 studies were incorporated into individual evidence tables for panel review, registry comparison, and population-based studies, respectively. Included studies rely on weak evidence (Class III) to assess the impact of trauma systems on patient care and outcome. Conclusions: To date, studies assessing trauma system efficacy rely on hospital deaths as the primary indicator of effectiveness. Future research should use more sophisticated study designs (Class II) and expand available outcome measures to assess the entire continuum of care, including prehospital, rehabilitation outcomes, and long-term quality of life.
Published: 1999

45. The effect of recall on estimation of incidence rates for injury in Ghana

Author: Samuel Adjei, Charles N Mock, Frederick Acheampong, and Thomas D. Koepsell
Subjects: Gerontology, Adult, Male, Rural Population, medicine.medical_specialty, Adolescent, Urban Population, Epidemiology, Developing country, Poison control, Suicide prevention, Ghana, Occupational safety and health, Disability Evaluation, Injury prevention, medicine, Humans, Registries, Child, Trauma Severity Indices, Recall, business.industry, Incidence (epidemiology), Incidence, Infant, Newborn, Infant, Reproducibility of Results, General Medicine, Middle Aged, Child, Preschool, Population Surveillance, Mental Recall, Wounds and Injuries, Female, business, Demography
Abstract: Injury is a major public health problem in many developing countries. Due to limitations of vital registry and health service data, surveys are an important tool to obtain information about injury in these countries. The value of such surveys can be limited by incomplete recall. The most appropriate recall period to use in surveys on injury in developing countries has not been well addressed.A household survey of injury in Ghana was conducted. Estimated annual non-fatal injury incidence rates were calculated for 12 recall periods (1-12 months prior to the interview, with each successively longer period including the preceding shorter periods).There was a notable decline in the estimated rate from 27.6 per 100 per year for a one-month recall period to 7.6 per 100 per year for a 12-month recall period (72% decline). The extent of this decline was not influenced by age, gender, rural versus urban location, nor by type of respondent (in-person versus proxy). Rate of decline was influenced by severity of injury. Injuries resulting in7 days of disability showed an 86% decline in estimated rates from a one-month to a 12-month recall period, whereas injuries resulting inor =30 days of disability showed minimal decline.In this setting, longer recall periods significantly underestimate the injury rate compared to shorter recall periods. Shorter recall periods (1-3 months) should be used when calculating the overall non-fatal injury incidence rate. However, longer recall periods (12 months) may be safely used to obtain information on the more severe, but less frequent, injuries.
Published: 1999

46. Aggressive fluid resuscitation and broad spectrum antibiotics decrease mortality from typhoid ileal perforation

Author: Charles N. Mock, Donna M. Denno, Ronald V. Maier, and Lucia E. Visser
Subjects: Adult, medicine.medical_specialty, Resuscitation, Ileal Perforation, Adolescent, 030231 tropical medicine, Perforation (oil well), Ghana, Typhoid fever, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Typhoid Fever, Child, Antibacterial agent, business.industry, Ileal Diseases, Mortality rate, Chloramphenicol, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Surgery, Anti-Bacterial Agents, Metronidazole, Infectious Diseases, Treatment Outcome, Intestinal Perforation, Child, Preschool, Fluid Therapy, business, medicine.drug
Abstract: One of the most severe complications of typhoid enteritis is perforation of ileal ulcerations. The typically high mortality rates from these perforations are in part due to extremely limited supportive care in hospitals in typhoid endemic areas. In the setting of a rural African hospital, this study demonstrated a decrease in overall mortality rate from 40% with one layer closure and chloramphenicol alone to 19% with two-layer closure and chloramphenicol, gentamicin and metronidazole. This was primarily due to a decrease in late (> 24 h) mortality. There was also a decrease in overall mortality rate from 43% with < 10 ml/kg of intraoperative fluid administration to 14% with > 10 ml/kg. This was primarily due to a decrease in early (< 24 h) mortality. Even within the constraints of the rural developing world, more aggressive initial fluid resuscitation can decrease early mortality, while broader spectrum antibiotics and two-layer closure can decrease late mortality from typhoid ileal perforation.
Published: 1995

47. Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world

Author: Charles N. Mock, E. Conklin, Donna M. Denno, Frederick P. Rivara, and Ellis S. Adzotor
Subjects: Adult, Male, Rural Population, Pediatrics, medicine.medical_specialty, Adolescent, Hospitals, Rural, Population, Poison control, Suicide prevention, Ghana, Occupational safety and health, Age Distribution, Patient Admission, Injury prevention, Epidemiology, medicine, Humans, Disabled Persons, Survivors, education, Child, Developing Countries, education.field_of_study, business.industry, Public health, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, Middle Aged, Child, Preschool, Emergency medicine, Wounds and Injuries, Female, business, Developed country, Research Article
Abstract: OBJECTIVES. Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS. All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS. The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS. Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.
Published: 1995

48. Ileosigmoid knotting

Author: Eugene J. Gibney and Charles N. Mock
Subjects: Adult, Aged, 80 and over, Male, Sigmoid Diseases, Ileal Diseases, Gastroenterology, General Medicine, Middle Aged, Ghana, Humans, Female, Intestinal Obstruction, Aged, Retrospective Studies
Abstract: To study the presentation, management, and outcome of patients with ileosigmoid knotting admitted to a district general hospital in an area of relatively high incidence.A retrospective study of 15 patients treated for ileosigmoid knotting at Holy Family Hospital, Berekum, Ghana, during the period 1984 to 1990 inclusive.The overall mortality was 47 percent and did not differ between those with viable bowel and those with gangrenous bowel. There appeared to be a significant risk of recurrent volvulus in patients who did not undergo resection at initial presentation.Ileosigmoid knotting carries a significant risk of mortality, and sigmoid resection should be considered for all patients with this unusual condition.
Published: 1993

49. Improvement in survival from typhoid ileal perforation. Results of 221 operative cases

Author: Charles N. Mock, Joseph F. Amaral, and Lucia E. Visser
Subjects: Enterocutaneous fistula, Adult, Male, medicine.medical_specialty, Ileal Perforation, Adolescent, Perforation (oil well), Peritonitis, Typhoid fever, Postoperative Complications, Preoperative Care, medicine, Humans, Prospective Studies, Typhoid Fever, Prospective cohort study, Child, Aged, Retrospective Studies, Postoperative Care, business.industry, Ileal Diseases, Mortality rate, Middle Aged, medicine.disease, Surgery, Anti-Bacterial Agents, Metronidazole, Intestinal Perforation, Child, Preschool, Female, business, medicine.drug, Research Article
Abstract: Typhoid ileal perforation remains a frequently fatal illness in the developing world. The purpose of a retrospective review of 195 cases was to ascertain prognostic indices and therapeutic options influencing outcome. The overall mortality rate of 31% was worsened by extremes of age (p less than 0.025), generalized peritonitis (p less than 0.025), lower white blood cell count (p less than 0.05), increased number of perforations (p less than 0.005), and postoperative enterocutaneous fistula (p less than 0.005). Double-layer closure of the perforation lowered the mortality rate compared with single-layer closure (p less than 0.01). Broader-spectrum antibiotics, in the form of chloramphenicol with gentamycin, metronidazole, or both, reduced the mortality rate compared with chloramphenicol alone (p less than 0.05). Based on these findings, a prospective series was initiated in which all patients were treated with two-layer closure and chloramphenicol, gentamycin, and metronidazole. The mortality rate of 8% for the 26 patients treated in this manner confirmed the improved survival with these treatment modalities. Improved survival from typhoid perforation is possible with simple, low-cost measures.
Published: 1992

50. Ataxia telangiectasia and acinic cell carcinoma of the parotid gland

Author: John H. Ree, James P. Crowley, Dianne N. Abuelo, Charles N. Mock, and George Coleman
Subjects: Adult, congenital, hereditary, and neonatal diseases and abnormalities, Pathology, medicine.medical_specialty, Malignancy, Acinic cell carcinoma, Pathogenesis, Immunodeficiency Syndrome, Ataxia Telangiectasia, stomatognathic system, Immunopathology, medicine, Humans, Chromosome Aberrations, business.industry, Carcinoma, General Medicine, medicine.disease, Parotid Neoplasms, Parotid gland, stomatognathic diseases, medicine.anatomical_structure, Oncology, Ataxia-telangiectasia, Etiology, Female, Surgery, business
Abstract: An increased incidence of malignancies occurs in ataxia telangiectasia. These are most frequently hematopoietic in children and epithelial in adults. Both cellular immunodeficiency and chromosome damage have been implicated in their etiology. There has been only one report of a salivary malignancy, a parotid mucoepidermoid carcinoma. We describe a second salivary malignancy, a metastasizing acinic cell carcinoma of the parotid gland, that developed in a 33-yr-old woman with ataxia telangiectasia. The marked chromosomal abnormalities that were present may have been involved in the pathogenesis of her tumor.
Published: 1988

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