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1. Assessment of cultural beliefs and practices during the postnatal period in a coastal town of South India - A mixed method research study

Author: Chythra R Rao, Dhanya SM, Ashok K, and Niroop SB
Subjects: Postnatal, diet, hygiene, home remedies, mixed method study, Medicine
Abstract: BACKGROUND The postpartum period continues to be an important part of the tradition and culture among Indian women. But frequently the health of the postnatal women is neglected. So, the present study aimed to explore the beliefs and practices in the postpartum period regarding diet, rest, hygiene and confinement and assess association between cultural practices and socio demographic characteristics. METHODS A combined quantitative and qualitative study was carried out in the rural areas of Udupi district in Karnataka. Participants for the quantitative study were 110 women who had given birth in the past three months. This was followed by one focus group discussion (FGD) among twelve consenting mothers at one of the rural health centers. RESULTS Among the 110 women, over 80% of women had increased their diet intake postpartum. Vegetables such as brinjal and fruits like papaya were avoided by 65.5% and 73.6% women respectively. Among the mothers 10.9% consumed less than 500 ml of water every day and 10% did not drink milk at all. Majority 94 (85%) were aware of vulval and perineal hygiene. Household work was avoided by 56% of the women while 86.3% avoided going outdoors. Many women took home remedies for faster recuperation. These practices were influenced by the socioeconomic status and the woman’s educational status. CONCLUSION Traditional postpartum practices are still popular among women in rural Karnataka. It is critical to identify the harmful practices and reinforce the positive healthy practices to make postpartum period a healthy and joyful period for the mother.
Published: 2024

2. A step towards real-time implementation of GDM guidelines in India: Review of Gaps in RCH Programme

Author: Surabhi Mishra, Chythra R Rao, Ajeet Singh Bhadoria, Raman Kumar, Pradeep Aggarwal, Shaili Vyas, and Sudip Bhattacharya
Subjects: empowered action group state, hyperglycemia in pregnancy, maternal health, reproductive and child health programme, uttarakhand, Medicine
Abstract: Gestational Diabetes Mellitus (GDM) risks the affected mother-child duos not only with respect to adverse perinatal outcomes but also for chronic diseases later in life. Therefore, in 2014, the Government of India (GoI) mandated universal GDM screening for all pregnant women as a part of essential obstetric care within the Reproductive and Child Health (RCH) programme. Later in 2018, the domain experts from GoI envisaged pan India implementation of GDM screening services within its RCH framework by 2023. As Uttarakhand—a hilly, EAG state of north India—would also be part of this nation-wide drive; prior identification of RCH services coverage in the State assumes paramount importance, as it reflects probable executability of GDM screening services within its delivery platform. Therefore, the present review aims to assess the readiness of Uttarakhand maternal health functionary system in view of GDM national guidelines implementation at both state and district levels. In this regard, freely accessible, full-text GoI documents pertaining to GDM implementation guidelines and maternal health program of India and Uttarakhand available in public domain in English language were reviewed. The present review favors the pilot implementation in district Dehradun prior to implementing in all districts of the state. It may, however, require overall improvement in maternal health programmatic services in all parts of the State for much efficient service delivery. Effective implementation of GDM guidelines requires urgent correction in the background performance of RCH program.
Published: 2020
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3. Prevalence of maternal measles antibody and its associated factors among infants in Coastal Karnataka, India

Author: S Sathiyanarayanan, Pawan Kumar, Chythra R Rao, Arun Kumar, Asha Kamath, and Veena Kamath
Subjects: infants, maternal antibodies, measles, persistence, prevalence, vaccine, Public aspects of medicine, RA1-1270
Abstract: Background: The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy.Objectives: To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community.Methodology: Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval.Results: Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant.Conclusion: The prevalence of persistent MMA (IgG titer ≥200 mIU/ml) among the infants aged 9–12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age.
Published: 2020
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4. Inclusion of stress management protocols in the management of gestational diabetes mellitus: Re-visiting Indian guidelines

Author: Surabhi Mishra, Chythra R Rao, Ajeet Singh Bhadoria, and Sudip Bhattacharya
Subjects: hyperglycemia in pregnancy, india, national guidelines, psychological stress, Medicine
Abstract: Gestational diabetes mellitus (GDM) has emerged as a country-wide public health problem. Beyond perinatal implications, GDM is recognized as precursor for most chronic lifestyle diseases. Despite this, the existing Indian guidelines didn't address stress management during pregnancy. In this regard, the present manuscript aims to identify the paralleled need of stress management during pregnancy and suggests related operational strategies for possible inclusion within the existing GDM guidelines of India. As psychological stress in India is already being managed under National Mental Health Programme (NMHP), national level integration of NMHP and Reproductive and Child Health (RCH) will go a long way in providing comprehensive GDM care by avoiding duplication of services and effective utilization of scarce resources.
Published: 2020
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5. Psychological well-being and coping strategies among secondary school teachers: A cross-sectional study

Author: Chinthana Rajesh, Lena Ashok, Chythra R Rao, Veena G Kamath, Asha Kamath, Varalakshmi Chandra Sekaran, Virupaksha Devaramane, and V Thippe Swamy
Subjects: coping skill, psychological factors, secondary school teachers, well-being, Special aspects of education, LC8-6691, Public aspects of medicine, RA1-1270
Abstract: INTRODUCTION: Educators, academicians, and teachers are responsible for the development of the nation's human capital. Teacher coping methods are becoming more widely recognized as a key factor in determining teacher effectiveness. The aim of this study was to identify the various coping strategies adopted by high school teachers in Southern India. MATERIALS AND METHODS: A cross-sectional study was conducted in government, aided, and unaided schools of Udupi, a coastal district in Southern India. A self-administered questionnaire was used to collect the data from 460 high school teachers chosen based on convenience sampling. The coping strategies were identified using a modified version of Brief COPE(Coping Orientation to Problems Experienced) Inventory (Carver, 1997). Data were entered using SPSS version 15 and descriptive statistics was performed. RESULTS: The study found that teachers had moderate level of coping skills in all domains. The most popular coping techniques used by secondary school teachers were positive reframing, active coping, and planning; nevertheless, substance use was recognized as the least popular coping strategy. CONCLUSION: Positive reframing, active coping, and preparation were the most commonly used coping strategies by the teachers in the survey. Teachers are a vital resource who have received less attention than they deserve for their psychological well-being. A customized intervention program based on their perceived needs could be a good place to start.
Published: 2022
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6. Prevalence and risk factors for peripheral neuropathy among type 2 diabetes mellitus patients at a tertiary care hospital in coastal Karnataka

Author: Sonalika Gogia and Chythra R Rao
Subjects: Diabetic Neuropathy Examination, Diabetic Neuropathy Symptom, peripheral neuropathy, prevalence, risk factors, type 2 diabetes mellitus, Diseases of the endocrine glands. Clinical endocrinology, RC648-665, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Context and Objective: In view of the growing burden of type 2 diabetes mellitus (T2DM) globally and associated microvascular and macrovascular complications, the study was done to assess the prevalence and risk factors for diabetic neuropathy among T2DM patients attending a tertiary care hospital. Subjects and Methods: T2DM patients' ≥30 years of both gender, presenting to the Medicine Department at a tertiary care hospital were included in the study. Diabetic Neuropathy Symptom (DNS) questionnaire to assess symptoms and Diabetic Neuropathy Examination (DNE) scoring to assess clinical signs were used. Results: A total of 273 patients were included. The mean age was 57.8 ± 11.5 years. The male to female distribution was 75% (202) and 25% (71), respectively. According to DNS instrument, 41.4% patients scored positive for the presence of neuropathy while only 24.5% had neuropathy according to DNE score. The proportion of males affected by neuropathy was more than females. 43.1% males had a positive DNS score while only 27.2% of them had a positive DNE score. Duration of the disease was positively correlated with neuropathy. Neuropathy was more prevalent among people who had higher systolic and diastolic blood pressure as per DNS and DNE instruments. Conclusions: The present study identified a higher proportion of males to be affected by neuropathy. Hence, more detailed evaluation must be accorded to elderly male diabetic patients with longer duration of the disease. Lifestyle modifications and watchful screening need to be incorporated as part of routine patient health education during follow-up clinic visits.
Published: 2017
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7. Treatment Compliance among Patients with Hypertension and Type 2 Diabetes Mellitus in a Coastal Population of Southern India

Author: Chythra R Rao, Veena G Kamath, Avinash Shetty, and Asha Kamath
Subjects: Adherence, hypertension, treatment compliance, type 2 diabetes mellitus, Medicine
Abstract: Background: Hypertension and diabetes are major risk factors for cardiovascular and cerebrovascular disease. Adherence is a primary determinant of the effectiveness of treatment because poor adherence attenuates optimum clinical benefit and paves the way for complications. Methods: The cross-sectional community-based survey was carried out among men and women aged 30 years and above in the field practice area of a medical college to assess treatment compliance with respect to hypertension and type 2 diabetes mellitus. The study comprised of 426 subjects, already diagnosed with hypertension (287) and type 2 diabetes mellitus (139). During house visits, data were collected by personal face-to-face interview using a pre-tested structured questionnaire. Compliance was determined by indirect methods, which included self-reporting and interviews with the patients. Results: Compliance to hypertension treatment was found to be 82.2%, while 83.6% of individuals with type 2 diabetes mellitus were on regular medication. Among the individuals on regular medication, 88 (37.3%) of them had controlled blood pressure. Although the compliance was good, blood pressure control was not optimal. Adherence was better among females as compared with males. Literacy status and socio-economic background were not found to be associated with treatment compliance. High cost of treatment for hypertension (39.3%) and diabetes (30.4%) and asymptomatic nature of the disease were the most common reasons cited for not taking regular medications. Conclusions: Adherence to hypertension and diabetes treatment was good. High cost of medications and asymptomatic nature of the disease were the reasons identified among the non-adherent patients.
Published: 2014

8. Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 2; peer review: 1 approved with reservations]

Author: Amar Nishad, Anil Kumar Mysore Nagaraj, Chythra R Rao, Keshavaram P, and Priyanka Rajpaul
Subjects: Systematic Review, Articles, Leisure-based interventions, schizophrenia, Adults, Recreation, Scoping review
Abstract: Background Schizophrenia is a severe mental illness characterized by psychosis, apathy, social withdrawal, and cognitive impairment, which results in impaired functioning in work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time. Method A systematic search was conducted using Arksey and O’Malley’s framework with studies published on leisure-based intervention from January 1990 to December 2023. Results The review included 11 articles in the study. In total two studies were pilot interventional study, one randomized controlled study, one case-control, one retrospective study, three were cross sectional, one was cross sectional longitudinal study and two were qualitative in nature. Studies used different types of leisure activities like cooking group, discussions, board games, arts and craft, painting, beading, sewing, clay work, paper craft, etc were used as an intervention. Qualitative studies found that individuals with schizophrenia spent less time in social and leisure activities and more time relaxing and doing nothing. Conclusion The study highlights the need to conduct further research on leisure-based interventions using various study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia.
Published: 2024
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9. Geriatric Concerns - Activities of Daily Living, Nutrition, Social Security Measures in A Coastal South Indian Population

Author: Chythra R Rao, George P Jacob, Sujatha Kuppusamy, Veena G Kamath, and Asha Kamath
Subjects: Elderly, Activities of daily living, nutrition, social security measures, Public aspects of medicine, RA1-1270
Abstract: Background: Globally 10% of the world’s population is elderly and is expected to increase to 21% by 2051. The primary health care system is not geared up to meet the future challenges arising from the increased demands of the geriatric population. Methods: A cross sectional study was conducted among elderly residing in the rural field practice area of a medical college in coastal Karnataka. Detailed information about socio – demographic profile, activities of daily living and dietary pattern was collected by personal interviews. Results: Of the 247 participants, 172 (70%) were females and 75 (30%) were males. There was no impairment in performing activities of daily living among 93.5% of the population. Half of the study participants (51.8%) were aware of social security schemes available for the elderly. About 119 (48.2%) were insured for health whereas only 22 (8.9%) were insured for life. The diet was deficient in protein and calories among nearly 40% of the elderly. Conclusions: Among the elderly only 6.5% of them had impairment in performing activities of daily living. Over 65% of the individuals were socially secure. Two-fifths of the elderly were consuming a diet deficient both in proteins and calories.
Published: 2016

10. Assessment Of Health Status of Successfully Treated Category I Patients Under RNTCP Program, Five Years After Treatment Completion – A Retrospective Cohort Study from A Coastal District of India

Author: Kirthinath Ballal, Muralidhar M Kulkarni, Pawan Kumar, Surekha Bhat Malpe, Mohan K Papanna, and Chythra R Rao
Subjects: RNTCP, DOTS, tuberculosis, current status, NSP patients, Public aspects of medicine, RA1-1270
Abstract: Background: Tuberculosis remains a major public health problem worldwide and also in India. Inspite of RNTCP being a comprehensive programme for effective management and control of tuberculosis, efficacy of DOTS regimen is questioned by private practitioners. Methods: A retrospective cohort study was carried out in a coastal district of India to assess the health status of successfully treated Category I patients under RNTCP program, five years after treatment completion. An interview was conducted with all the available subjects at their residence using a semi-structured pre-tested interview. Results: Out of 224 registered new sputum positive patients, 177 cases were successfully treated during the recruiting year, accounting for a success rate of 79%. Of the 177 treated patients, 118 were traceable during the study period, out of which 100 subjects had survived after 5 years and were available for the interview. Recurrence of TB was reported in 2 patients during the follow up period. Conclusion: This five years follow up study shows a good long term success rate of TB patient’s treatment. Hence, it reaffirms the scientific basis of RNTCP policy of DOTS regimen to be the right strategy for TB control.
Published: 2016

11. Utilization Of Antenatal Care Services in A Rural Field Practice Area in Coastal Part of South India

Author: Darshan Bhagwan, Ashwini Kumar, Chythra R Rao, and Asha Kamath
Subjects: Antenatal care, Iron and Folic Acid, Utilization, Public aspects of medicine, RA1-1270
Abstract: Introduction: Utilization of services during pregnancy will lead to further utilization of additional maternal services. The utilization of these services is not universal which was reflected during National Family Health Survey 3. Objective: To evaluate the utilization of antenatal care services among mothers in south India. Methods: The present community based cross sectional study was conducted among rural mothers who had delivered one year back and accompanied their children for immunization at the rural health centres. A semi-structured Proforma was used and detailed information regarding sociodemographic details and utilization of antenatal services was collected. Results: The study included a total of 300 antenatal mothers. Majority of the antenatal mothers had their antenatal checkups in private set-ups (n=257, 85.7%) and had their first antenatal check up in the first trimester (n=262, 85.3%).Around 95% of the study subjects had consumed more than 100 Iron and Folic Acid tablets. Conclusion: Utilization of antenatal care is much higher in the present study as compared to other available literature for the entire country. Consistent and focused efforts are needed to sustain and consolidate the good coverage and utilization of antenatal services.
Published: 2016

12. Practice of physical activity among future doctors: A cross sectional analysis

Author: Chythra R Rao, B B Darshan, Nairita Das, Vinaya Rajan, Meemansha Bhogun, and Aditya Gupta
Subjects: Body mass index, lack of time, medical students, physical activity, stamina, Medicine
Abstract: Background: Non communicable diseases (NCD) will account for 73% of deaths and 60% of the global disease burden by 2020. Physical activity plays a major role in the prevention of these non-communicable diseases. The stress involved in meeting responsibilities of becoming a physician may adversely affect the exercise habits of students. So, the current study aimed to study the practice of physical activity among undergraduate medical students. Methods: A cross sectional study was conducted among 240 undergraduate medical students. Quota sampling method was used to identify 60 students from each of the four even semesters. A pre-tested, semi-structured questionnaire was used to collect the data. Statistical Package for Social Sciences (SPSS) version 16 was used for data entry and analysis and results are expressed as percentages and proportions. Results: In our study, 55% were 20 to 22 years old. Over half of the students were utilizing the sports facilities provided by the university in the campus. Majority of students 165 (69%) had normal body mass index (BMI), (51) 21% were overweight, while 7 (3%) were obese. Of the 62% who were currently exercising, the practice of physical activity was more among boys as compared to girls (62% v/s 38%). Lack of time 46 (60.5%), laziness (61.8%), and exhaustion from academic activities (42%) were identified as important hindering factors among medical students who did not exercise. Conclusion: A longitudinal study to follow-up student behavior throughout their academic life is needed to identify the factors promoting the practice of physical activity among students.
Published: 2012

13. Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 1; peer review: awaiting peer review]

Author: Amar Nishad, Anil Kumar Mysore Nagaraj, Chythra R Rao, Keshavaram P, and Priyanka Rajpaul
Subjects: Systematic Review, Articles, Leisure-based interventions, schizophrenia, Adults, Recreation, Scoping review
Abstract: Background Schizophrenia is a severe mental illness characterized by psychosis, apathy, social withdrawal, and cognitive impairment, which results in impaired functioning in work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time. Method A systematic search was conducted using Arksey and O’Malley’s framework with studies published on leisure-based intervention from January 1990 to December 2023. Results The review included 11 articles in the study. In total two studies were pilot interventional study, one randomized controlled study, one case-control, one retrospective study, three were cross sectional, one was cross sectional longitudinal study and two were qualitative in nature. Studies used different types of leisure activities like cooking group, discussions, board games, arts and craft, painting, beading, sewing, clay work, paper craft, etc were used as an intervention. Qualitative studies found that individuals with schizophrenia spent less time in social and leisure activities and more time relaxing and doing nothing. Conclusion The study highlights the need to conduct further research on leisure-based interventions using various study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia.
Published: 2024
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14. Study of Clinical Profile and Antibiotic Sensitivity Pattern in Culture-positive Typhoid Fever Cases

Author: Ashwini Kumar, Vinay Pandit, Seema Shetty, Chythra R Rao, Sanjay Pattanshetty, and Charmaine M Samarasinghe
Subjects: Antibiotic sensitivity, clinical profile, typhoid fever, Public aspects of medicine, RA1-1270
Abstract: Background: Salmonella enteric serotype Typhi has created a significant therapeutic problem as these strains have developed resistance to the commonly used antimicrobials for the treatment of typhoid fever. Objectives: To assess the clinical profile and sensitivity patterns to anti-typhoid drugs. Materials and Methods: A retrospective analysis of 106 culture-positive typhoid cases admitted in a tertiary care hospital during the years 2005-2008. Results: Records of 106 patients were evaluated, 83 (78.3%) males and 23 (21.7%) females. Fever was present in all patients. Headache in 63 (59.4%) patients and generalized body ache in 53 (32.5%) patients were the most common symptoms, while spleenomegaly in 47 (44.3%) patients and hepatomegaly in 42 (39.6%) patients were the common presenting signs. A maximum sensitivity of 96.6% was observed with cephalosporins, whereas a resistance of 29.2% was seen with fluoroquinolones. Conclusion: A high degree of sensitivity was noted to chloramphenicol, ampicillin and sulphonamides, showing a trend of roll-back of sensitivity to conventional antibiotics.
Published: 2012
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15. Effects of physical activity breaks during prolonged sitting on vascular and executive function—A randomised cross-over trial

Author: Obhuli Chandran, MSc, Poovitha Shruthi, MSc, Suresh Sukumar, PhD, Rajagopal Kadavigere, DM, Kalyana Chakravarthy, PhD, Chythra R. Rao, DNB, and Baskaran Chandrasekaran, MPT
Subjects: Endothelial function, Executive function, Movement breaks, Physical activity, Sedentary behaviour, Sitting posture, Medicine (General), R5-920
Abstract: المخلص: أهداف البحث: يرتبط السلوك الخامل المرتفع بوظائف الأوعية الدموية المركزية المعاكسة والخلل الإدراكي. التدخلات لتخفيف الآثار السلبية للجلوس في مكان العمل مثيرة للاهتمام، ومع ذلك، فإن الأدلة التي تدعي فعالية مثل هذه التدخلات لا تزال تظهر. تهدف تجربة التقاطع العشوائية الحالية إلى استكشاف فعالية الجلوس لفترات طويلة مع أو بدون فواصل النشاط البدني على وظائف الأوعية الدموية المركزية والطرفية والمعرفية لدى البالغين. طرق البحث: أكمل واحد وعشرين من البالغين الأصحاء أربع ساعات من محاكاة ظروف العمل في ثلاث زيارات تجريبية: (1) الجلوس دون انقطاع؛ (2) يقطع الجلوس ثلاث دقائق سيرا على الأقدام كل ساعة؛ (3) يقطع الجلوس ثلاث دقائق من صعود السلم كل ساعة. تم قياس قطر الشريان السباتي والسطحي والسرعة ومعدل القص وتدفق الدم باستخدام الموجات فوق الصوتية المزدوجة عند 50 ميجاهرتز في ثلاث نقاط زمنية (الساعة صفر والثانية والرابعة) بينما تم تقييم الوظائف التنفيذية باستخدام إريكسن فلانكر المعتمدة على الحاسوب كل ساعة. النتائج: كان الانخفاض في أوقات رد الفعل (-30.59٪) والدقة (-10.56٪) أثناء ظروف الجلوس غير المنقطعة ذات دلالة إحصائية، بينما كان الانخفاض أقل أثناء الجلوس المتقطع بثلاث دقائق من المشي كل ساعة والجلوس بثلاث دقائق من صعود السلم كل ساعة. لم يلاحظ وجود فروق ذات دلالة إحصائية في وظائف الشريان السباتي والشريان الفخذي السطحي مع توقف الجلوس لمدة ثلاث دقائق من المشي كل ساعة والجلوس بثلاث دقائق من صعود السلم كل ساعة تدخل. الاستنتاجات: تم العثور على فواصل النشاط البدني متفاوتة الشدة أثناء الجلوس لفترات طويلة لتحسين أوقات رد الفعل. ومع ذلك، يجب تأكيد الفوائد الوعائية لفواصل النشاط البدني من خلال الدراسات المستقبلية في الوقت الفعلي. Abstract: Objectives: High sedentary behaviour is associated with adverse effects on central vascular function and cognitive function. Although interventions to mitigate the adverse effects of workplace sitting are intriguing, evidence of the efficacy of such interventions remains lacking. This randomised cross-over trial was aimed at exploring the effectiveness of prolonged sitting, with or without physical activity breaks, on central, peripheral vascular and cognitive function in adults. Methods: Twenty one healthy adults completed 4 h of simulated work conditions in three experimental visits: (1) uninterrupted sitting (SIT); (2) sitting interrupted by 3 min of walking every hour (LIT); and (3) sitting interrupted by 3 min of stair climbing every hour (MIT). Carotid (CA) and superficial femoral artery (SFA) diameter, velocity, shear rate and blood flow were measured with Duplex ultrasound at 50 MHz at three time points (hours 0, 2 and 4), and executive function was assessed with the computer based Eriksen Flanker task every hour. Results: The decreases in reaction time (−30.59%) and accuracy (−10.56%) during SIT conditions were statistically significant, and less of a decrease was observed under LIT and MIT conditions. No significant differences in CA and SFA function were observed with LIT and MIT interventions. Conclusion: Physical activity breaks of varying intensity during prolonged sitting improve reaction time. However, the vascular benefits of physical activity breaks should be confirmed in the future through long term studies in natural environment.
Published: 2023
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16. The burden of metabolic risk factors in North Africa and the Middle East, 1990–2019: findings from the Global Burden of Disease StudyResearch in context

Author: Mohammad-Reza Malekpour, Mohsen Abbasi-Kangevari, Seyyed-Hadi Ghamari, Javad Khanali, Mahsa Heidari-Foroozan, Sahar Saeedi Moghaddam, Mohammadreza Azangou-Khyavy, Sahba Rezazadeh-Khadem, Negar Rezaei, Parnian Shobeiri, Zahra Esfahani, Nazila Rezaei, Ali H. Mokdad, Mohsen Naghavi, Bagher Larijani, Farshad Farzadfar, Amirali Aali, Sherief Abd-Elsalam, Meriem Abdoun, Abdorrahim Absalan, Eman Abu-Gharbieh, Niveen ME. Abu-Rmeileh, Ahmed Abu-Zaid, Ali Ahmadi, Sepideh Ahmadi, Ayman Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Tariq A. Alalwan, Khalid F. Alhabib, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Mahmoud A. Alomari, Saleh A. Alqahatni, Rajaa M. Al-Raddadi, Javad Javad Aminian Dehkordi, Mehrdad Amir-Behghadami, Sohrab Amiri, Davood Anvari, Jalal Arabloo, Judie Arulappan, Ashokan Arumugam, Zahra Aryan, Mohammad Athar, Seyyed Shamsadin Athari, Abolfazl Avan, Sina Azadnajafabad, Samad Azari, Hosein Azizi, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Ovidiu Constantin Baltatu, Akshaya Srikanth Bhagavathula, Vijayalakshmi S. Bhojaraja, Souad Bouaoud, Muhammad Hammad Butt, Luciana Aparecida Campos, Abdulaal Chitheer, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Shirin Djalalinia, Milad Dodangeh, Maysaa El Sayed Zaki, Iffat Elbarazi, Muhammed Elhadi, Waseem El-Huneidi, Rana Ezzeddini, Mohammad Fareed, Hossein Farrokhpour, Ali Fatehizadeh, Yaseen Galali, Amir Ghaderi, Mansour Ghafourifard, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Maryam Gholamalizadeh, Pouya Goleij, Mohamad Golitaleb, Parham Habibzadeh, Nima Hafezi-Nejad, Rabih Halwani, Hamidreza Hasani, Maryam Hashemian, Amr Hassan, Soheil Hassanipour, Hadi Hassankhani, Kamal Hezam, Reza Homayounfar, Seyed Kianoosh Hosseini, Kaveh Hosseini, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Jalil Jaafari, Haitham Jahrami, Elham Jamshidi, Tahereh Javaheri, Sathish Kumar Jayapal, Ali Kabir, Amirali Karimi, Neda Kaydi, Mohammad Keykhaei, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Moien A.B. Khan, Kashif Ullah Khan, Yusra H. Khan, Moawiah Mohammad Khatatbeh, Farzad Kompani, Hamid Reza Koohestani, Mohammed Kuddus, Savita Lasrado, Sang-woong Lee, Soleiman Mahjoub, Ata Mahmoodpoor, Elham Mahmoudi, Elaheh Malakan Rad, Narges Malih, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Borhan Mansouri, Mohammad Ali Mansournia, Parham Mardi, Abdoljalal Marjani, Sahar Masoudi, Entezar Mehrabi Nasab, Ritesh G. Menezes, Vildan Mevsim, Yousef Mohammad, Mokhtar Mohammadi, Esmaeil Mohammadi, Noushin Mohammadifard, Arif Mohammed, Sara Momtazmanesh, Fateme Montazeri, Maryam Moradi, Maziar Moradi-Lakeh, Negar Morovatdar, Christopher J.L. Murray, Zuhair S. Natto, Seyed Aria Nejadghaderi, Ali Nowroozi, Morteza Oladnabi, Ahmed Omar Bali, Emad Omer, Hamidreza Pazoki Toroudi, Raffaele Pezzani, Ashkan Pourabhari Langroudi, Sima Rafiei, Mehran Rahimi, Vafa Rahimi-Movaghar, Shayan Rahmani, Amir Masoud Rahmani, Vahid Rahmanian, Chythra R. Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Reza Rawassizadeh, Elrashdy Moustafa Mohamed Redwan, Malihe Rezaee, Maryam Rezaei, Seyed Mohammad Riahi, Gholamreza Roshandel, Aly Saad, Maha Mohamed Saber-Ayad, Siamak Sabour, Leila Sabzmakan, Basema Saddik, Erfan Sadeghi, Saeid Sadeghian, Amirhossein Sahebkar, Morteza Saki, Saina Salahi, Sarvenaz Salahi, Amir Salek Farrokhi, Marwa Rashad Salem, Hamideh Salimzadeh, Abdallah M. Samy, Nizal Sarrafzadegan, Brijesh Sathian, Melika Shafeghat, Syed Mahboob Shah, Jaffer Shah, Ataollah Shahbandi, Fariba Shahraki-Sanavi, Mehran Shams-Beyranvand, Mohd Shanawaz, Kiomars Sharafi, Javad Sharifi-Rad, Jeevan K. Shetty, Zahra Shokri Varniab, Seyed Afshin Shorofi, Soraya Siabani, Mohammad Sadegh Soltani-Zangbar, Seidamir Pasha Tabaeian, Seyed-Amir Tabatabaeizadeh, Mohammad Tabish, Majid Taheri, Yasaman Taheri Abkenar, Moslem Taheri Soodejani, Amir Taherkhani, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Bereket M. Tigabu, Alireza Vakilian, Siavash Vaziri, Bay Vo, Fereshteh Yazdanpanah, Arzu Yigit, Vahit Yiğit, Mazyar Zahir, Burhan Abdullah Zaman, Maryam Zamanian, Moein Zangiabadian, Iman Zare, and Zahra Zareshahrabadi
Subjects: Global burden of disease, Metabolic risk factors, High systolic blood pressure, High fasting plasma glucose, High body-mass index, High-LDL, Medicine (General), R5-920
Abstract: Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.
Published: 2023
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17. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050

Author: Manuela L Ferreira, Katie de Luca, Lydia M Haile, Jaimie D Steinmetz, Garland T Culbreth, Marita Cross, Jacek A Kopec, Paulo H Ferreira, Fiona M Blyth, Rachelle Buchbinder, Jan Hartvigsen, Ai-Min Wu, Saeid Safiri, Anthony D Woolf, Gary S Collins, Kanyin Liane Ong, Stein Emil Vollset, Amanda E Smith, Jessica A Cruz, Kai Glenn Fukutaki, Semagn Mekonnen Abate, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Ahmed Abdelalim, Aidin Abedi, Hassan Abidi, Qorinah Estiningtyas Sakilah Adnani, Ali Ahmadi, Rufus Olusola Akinyemi, Abayneh Tadesse Alamer, Adugnaw Zeleke Alem, Yousef Alimohamadi, Mansour Abdullah Alshehri, Mohammed Mansour Alshehri, Hosam Alzahrani, Saeed Amini, Sohrab Amiri, Hubert Amu, Catalina Liliana Andrei, Tudorel Andrei, Benny Antony, Jalal Arabloo, Judie Arulappan, Ashokan Arumugam, Tahira Ashraf, Seyyed Shamsadin Athari, Nefsu Awoke, Sina Azadnajafabad, Till Winfried Bärnighausen, Lope H Barrero, Amadou Barrow, Akbar Barzegar, Lindsay M Bearne, Isabela M Bensenor, Alemshet Yirga Berhie, Bharti Bhandari Bhandari, Vijayalakshmi S Bhojaraja, Ali Bijani, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Javier Brazo-Sayavera, Andrew M Briggs, Chao Cao, Periklis Charalampous, Vijay Kumar Chattu, Flavia M Cicuttini, Benjamin Clarsen, Sarah Cuschieri, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Azizallah Dehghan, Takele Gezahegn G Demie, Edgar Denova-Gutiérrez, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Mandira Lamichhane Dhimal, Meghnath Dhimal, Daniel Diaz, Mojtaba Didehdar, Lankamo Ena Digesa, Mengistie Diress, Hoa Thi Do, Linh Phuong Doan, Michael Ekholuenetale, Muhammed Elhadi, Sharareh Eskandarieh, Shahriar Faghani, Jawad Fares, Ali Fatehizadeh, Getahun Fetensa, Irina Filip, Florian Fischer, Richard Charles Franklin, Balasankar Ganesan, Belete Negese Belete Gemeda, Motuma Erena Getachew, Ahmad Ghashghaee, Tiffany K Gill, Mahaveer Golechha, Pouya Goleij, Bhawna Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Pawan Kumar Hamal, Asif Hanif, Netanja I Harlianto, Hamidreza Hasani, Simon I Hay, Jeffrey J Hebert, Golnaz Heidari, Mohammad Heidari, Reza Heidari-Soureshjani, Mbuzeleni Mbuzeleni Hlongwa, Mohammad-Salar Hosseini, Alexander Kevin Hsiao, Ivo Iavicoli, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Sheikh Mohammed Shariful Islam, Manthan Dilipkumar Janodia, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Gebisa Guyasa Kabito, Himal Kandel, Rimple Jeet Kaur, Vikash Ranjan Keshri, Yousef Saleh Khader, Ejaz Ahmad Khan, Md Jobair Khan, Moien AB Khan, Hamid Reza Khayat Kashani, Jagdish Khubchandani, Yun Jin Kim, Adnan Kisa, Jitka Klugarová, Ali-Asghar Kolahi, Hamid Reza Koohestani, Ai Koyanagi, G Anil Kumar, Narinder Kumar, Tea Lallukka, Savita Lasrado, Wei-Chen Lee, Yo Han Lee, Ata Mahmoodpoor, Jeadran N Malagón-Rojas, Mohammad-Reza Malekpour, Reza Malekzadeh, Narges Malih, Man Mohan Mehndiratta, Entezar Mehrabi Nasab, Ritesh G Menezes, Alexios-Fotios A Mentis, Mohamed Kamal Mesregah, Ted R Miller, Mohammad Mirza-Aghazadeh-Attari, Maryam Mobarakabadi, Yousef Mohammad, Esmaeil Mohammadi, Shafiu Mohammed, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Mohammad Ali Moni, Ebrahim Mostafavi, Christopher J L Murray, Tapas Sadasivan Nair, Javad Nazari, Seyed Aria Nejadghaderi, Subas Neupane, Sandhya Neupane Kandel, Cuong Tat Nguyen, Ali Nowroozi, Hassan Okati-Aliabad, Emad Omer, Abderrahim Oulhaj, Mayowa O Owolabi, Songhomitra Panda-Jonas, Anamika Pandey, Eun-Kee Park, Shrikant Pawar, Paolo Pedersini, Jeevan Pereira, Mario F P Peres, Ionela-Roxana Petcu, Mohammadreza Pourahmadi, Amir Radfar, Shahram Rahimi-Dehgolan, Vafa Rahimi-Movaghar, Mosiur Rahman, Amir Masoud Rahmani, Nazanin Rajai, Chythra R Rao, Vahid Rashedi, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Andre M N Renzaho, Negar Rezaei, Zahed Rezaei, Leonardo Roever, Guilherme de Andrade Ruela, Basema Saddik, Amirhossein Sahebkar, Sana Salehi, Francesco Sanmarchi, Sadaf G Sepanlou, Saeed Shahabi, Shayan Shahrokhi, Elaheh Shaker, MohammadBagher Shamsi, Mohammed Shannawaz, Saurab Sharma, Maryam Shaygan, Rahim Ali Sheikhi, Jeevan K Shetty, Rahman Shiri, Siddharudha Shivalli, Parnian Shobeiri, Migbar Mekonnen Sibhat, Ambrish Singh, Jasvinder A Singh, Helen Slater, Marco Solmi, Ranjani Somayaji, Ker-Kan Tan, Rekha Thapar, Seyed Abolfazl Tohidast, Sahel Valadan Tahbaz, Rohollah Valizadeh, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Vasily Vlassov, Bay Vo, Yuan-Pang Wang, Taweewat Wiangkham, Lalit Yadav, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Lin Yang, Fereshteh Yazdanpanah, Naohiro Yonemoto, Mustafa Z Younis, Iman Zare, Armin Zarrintan, Mohammad Zoladl, Theo Vos, Lyn M March, Surgery, Erasmus MC other, Public Health, and Pharmacy
Subjects: Rheumatology, Immunology, Immunology and Allergy
Abstract: Background: Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods: Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings: In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation: Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change. Funding: Bill and Melinda Gates Foundation.
Published: 2023

18. Impact of Sexually Transmitted Diseases on Public Health

Author: Chythra R. Rao and Raghavendra Rao
Published: 2022

19. Glycemic status among newly diagnosed tuberculosis patients and their treatment outcomes- A prospective cohort study

Author: Hithaish Kumar R. N., Chythra R. Rao, Reshma Kumarchandra, Ravindra Maradi, and Chidananda Sanju S. V.
Subjects: General Medicine, General Biochemistry, Genetics and Molecular Biology
Abstract: Introduction and Aim: Tuberculosis is a serious systemic infection, which is a serious threat for developing countries including India. To address the disease burden, India has rolled out National Tuberculosis Elimination Program (NTEP) incorporating daily drug regimen with appropriate weight bands for treatment. Monitoring treatment outcomes for daily drug regimen with one-year post-treatment follow-up was the objective of the study. Materials and Methods: A prospective community-based cohort study was conducted between January 2020 and September 2021, in Udupi district. Patients were recruited from 62 different Primary health centres. Their baseline data was collected, glycaemic status was assessed using glycated hemoglobin. The patients were followed up till their treatment completion and one-year post-treatment follow-up was also done. Results: One hundred and two patients were diagnosed with tuberculosis during the 1st quarter of 2020 (Jan-Mar 2020) and started on daily drug regimen treatment. Favourable outcomes were noted among 107(95.1%), while unfavourable outcomes were noted among 5(4.9%). Females in younger age group and free from comorbidities had favourable outcomes. Older age groups, prediabetics, patients with lower BMI, and pulmonary tuberculosis had unfavourable outcomes. Conclusion: The daily drug regimen for tuberculosis was found to be effective in terms of reducing the treatment failure rates. Evaluation of glycaemic status using Glycosylated hemoglobin at the time of diagnosis of tuberculosis is desirable. So that, life style modification could be suggested to avoid progression of prediabetes to diabetes. Screening for diabetes using Glycosylated hemoglobin at treatment initiation is advocated to avoid unfavourable outcomes during TB treatment.
Published: 2022

20. O-317 Preliminary evidence of physical activity interventions at workplace on cognitive functions among desk-based employees

Author: Baskaran Chandrasekaran, Chythra R Rao, Ashokan Arumugam, Arto J Pesola, and Fiddy Davis
Published: 2023

21. Do energy expenditure differences across work postures influence cognitive processing speed? A counter-balanced randomised cross-over trial

Author: R. Rajeshwari, Chythra R Rao, Ruth Mary D’Silva, and Baskaran Chandrasekaran
Subjects: Rehabilitation, Public Health, Environmental and Occupational Health
Abstract: BACKGROUND: Anecdotal evidence links occupational sedentary behaviour, low energy expenditure (EE) and cognitive dysfunction. Nevertheless, EE across different work postures including active workstations remains unclear and its influence on cognitive processing speed is yet to be established. OBJECTIVE: We aimed to investigate differences in EE across various work postures and its influence on cognitive processing speed. METHODS: Sixteen desk-based employees performed simulated work tasks (typing, reading and cognitive tasks) in three different work positions (sitting, standing, and walking) in three different days. EE was measured for three days consecutively for 30-minutes in three simulated working postures using indirect calorimetry. Cognitive processing speed was assessed through computer-based choice reaction times during each work posture. The outcome variables of interest (EE, reaction times and accuracy) were compared between three work postures using repeated measures ANOVA and Pearson correlation. RESULTS: EE in walking posture was higher (5.57±0.45 Kcal) than sitting (1.07±0.12 Kcal) and standing (1.88±0.42 Kcal). Total EE was significantly higher in walking than standing (35.17±6.86 Kcal) and sitting postures (41.37±8.46 Kcal). We did not find any significant differences in cognitive processing speed between different work postures except within standing work condition (60.22±13.97 ms). Accuracy was found to be reduced in walking compared to sitting (0.76±0.83%) and standing (0.43±0.09%) but not reached significance. CONCLUSION: Although significant differences in EE were observed between work postures, walking or standing at work did not affect the cognitive processing speed.
Published: 2022

22. 'Through their eyes, I can work' – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis

Author: Chythra R Rao, Lena Ashok, Varalakshmi Chandra Sekaran, Padma Rani, Manjula Venkataraghavan, and T. K. Krishnapriya
Subjects: Medical education, Qualitative analysis, Work (electrical), Mobile phone, Perception, media_common.quotation_subject, Public Health, Environmental and Occupational Health, Community health workers, Psychology, mHealth, Education, media_common
Abstract: PurposePhysicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).Design/methodology/approachIn-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.FindingsThe perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.Originality/valueStudies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.
Published: 2021

23. SMART STEP – SMARTphone-driven exercise and pedometer-based STEP intervention to promote physical activity among desk-based employees: Study protocol for a three-arm cluster randomized controlled trial

Author: Ashokan Arumugam, Fiddy Davis, Chythra R Rao, and Baskaran Chandrasekaran
Subjects: Adult, medicine.medical_specialty, Sports medicine, Population, Psychological intervention, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), Humans, Medicine, 030212 general & internal medicine, Effects of sleep deprivation on cognitive performance, Workplace, education, Exercise, Randomized Controlled Trials as Topic, Desk, education.field_of_study, business.industry, Rehabilitation, Public Health, Environmental and Occupational Health, 030229 sport sciences, Middle Aged, Actigraphy, Pedometer, Physical therapy, Smartphone, Sedentary Behavior, business
Abstract: BACKGROUND: Prolonged sitting in desk-based office workers is found to be associated with increased cardiometabolic risk and poor cognitive performance. Technology-based physical activity (PA) interventions using smartphone applications (SmPh app) to promote PA levels might be effective in reducing cardiometabolic risk among sedentary population but the evidence remains inconclusive. OBJECTIVE: The objective is to investigate the effects of a technology-based PA intervention compared to PA education with a worksite manual or no intervention on PA levels, cardiometabolic risk, cognitive performance, and work productivity among desk-based employees. METHOD: A three-arm clustered randomized trial will be conducted. The study will be conducted among various administrative offices of a multifaceted university in India. Desk-based employees aged between 30 and 50 years (n = 159; 53 in each arm) will be recruited. Employees from various constituent institutions (clusters) of the university will be randomized into one of the three following groups - SMART: SmPh app-driven break reminders (visual exercise prompts) plus pedometer-based step intervention, TRADE: worksite PA education with a manual plus American College of Sports Medicine guided PA prescription, or CONTROL: usual work group. At baseline and after the 1st, 3rd and 6th month of the trial period, accelerometer-measured sitting time and PA levels, cardiometabolic risk (fasting blood glucose, triglycerides, insulin, blood pressure, heart rate variability, functional capacity, and subcutaneous fat), cognitive performance (executive function), sickness absenteeism and work limitations will be assessed by a blinded assessor. Therapist delivering interventions will not be blinded. CONCLUSION: This trial will determine whether a combined SmPh-app and pedometer-based intervention is more effective than education or no intervention in altering PA levels, cardiometabolic risk and cognitive performance among desk-based employees in India. This study has the potential to foster institutional recommendations for using SmPh-based technology and pedometers to promote PA and reduce sedentary behavior at work.
Published: 2021

24. Serration pattern analysis as a practical adjunct tool for categorization of subepidermal autoimmune blistering diseases

Author: Sukriti Arora, Varsha M. Shetty, Raghavendra Rao, Chythra R Rao, and Satish B Pai
Subjects: Adult, Male, Epidermolysis bullosa acquisita, Pathology, medicine.medical_specialty, Pemphigoid, Adolescent, Biopsy, Fluorescent Antibody Technique, Pattern analysis, Dermatology, Immunofluorescence, Young Adult, medicine, Humans, Prospective Studies, Child, Direct fluorescent antibody, Rest (music), Aged, Aged, 80 and over, Skin Diseases, Vesiculobullous, integumentary system, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Staining, Serration, Infectious Diseases, Microscopy, Fluorescence, Child, Preschool, Female, business
Abstract: Background: Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely, it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center. Objectives: The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders. Methods: Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. A three millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings. Results: Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed “n” serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an “n” serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a “u” serrated pattern. Three patients with negative indirect immunofluorescence showed “u” serration on direct immunofluorescence while the rest showed “n” serration. Limitations: ELISA and immunoblotting could not be performed due to resource constraints. Conclusion: Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable.
Published: 2021

25. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Author: Dana Bryazka, Marissa B Reitsma, Max G Griswold, Kalkidan Hassen Abate, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Abu Yousuf Md Abdullah, E S Abhilash, Eman Abu-Gharbieh, Juan Manuel Acuna, Giovanni Addolorato, Oladimeji M Adebayo, Victor Adekanmbi, Kishor Adhikari, Sangeet Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Wubetu Yimam Agegnehu, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Md Zakiul Alam, Dejene Tsegaye Alem, Kefyalew Addis Alene, Yousef Alimohamadi, Atiyeh Alizadeh, Kasim Allel, Jordi Alonso, Saba Alvand, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Jalal Arabloo, Muhammad Arshad, Anton A Artamonov, Zahra Aryan, Malke Asaad, Mulusew A Asemahagn, Thomas Astell-Burt, Seyyed Shamsadin Athari, Desta Debalkie Atnafu, Prince Atorkey, Alok Atreya, Floriane Ausloos, Marcel Ausloos, Getinet Ayano, Martin Amogre ayanore Ayanore, Olatunde O Ayinde, Jose L Ayuso-Mateos, Sina Azadnajafabad, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Azzam, Ashish D Badiye, Nasser Bagheri, Sara Bagherieh, Mohan Bairwa, Shankar M Bakkannavar, Ravleen Kaur Bakshi, Awraris Hailu Balchut/Bilchut, Till Winfried Bärnighausen, Fabio Barra, Amadou Barrow, Pritish Baskaran, Luis Belo, Derrick A Bennett, Isabela M Benseñor, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Bagas Suryo Bintoro, Elena A Elena Blokhina, Belay Boda Abule Bodicha, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Hermann Brenner, Nikolay Ivanovich Briko, Andre R Brunoni, Zahid A Butt, Chao Cao, Yin Cao, Rosario Cárdenas, Andre F Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Luis F S Castro-de-Araujo, Maria Sofia Cattaruzza, Promit Ananyo Chakraborty, Jaykaran Charan, Vijay Kumar Chattu, Akhilanand Chaurasia, Nicolas Cherbuin, Dinh-Toi Chu, Nandita Chudal, Sheng-Chia Chung, Chuchu Churko, Liliana G Ciobanu, Massimo Cirillo, Rafael M Claro, Simona Costanzo, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Berihun Assefa Dachew, Omid Dadras, Xiaochen Dai, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Beniam Darge Daniel, Anna Danielewicz, Jiregna Darega Gela, Kairat Davletov, Jacyra Azevedo Paiva de Araujo, Antonio Reis de Sá-Junior, Sisay Abebe Debela, Azizallah Dehghan, Andreas K Demetriades, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Diana Dias da Silva, Daniel Diaz, Lankamo Ena Digesa, Mengistie Diress, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Haneil Larson Dsouza, Bereket Duko, Bruce B Duncan, Kristina Edvardsson, Michael Ekholuenetale, Frank J Elgar, Muhammed Elhadi, Mohamed A Elmonem, Aman Yesuf Endries, Sharareh Eskandarieh, Azin Etemadimanesh, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Fatemeh Farahmand, Carla Sofia e Sá Farinha, Andre Faro, Farshad Farzadfar, Ali Fatehizadeh, Nelsensius Klau Fauk, Valery L Feigin, Rachel Feldman, Xiaoqi Feng, Zinabu Fentaw, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Joel Msafiri Francis, Richard Charles Franklin, Peter Andras Gaal, Mohamed M Gad, Silvano Gallus, Fabio Galvano, Balasankar Ganesan, Tushar Garg, Mesfin Gebrehiwot Damtew Gebrehiwot, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Tadele Regasa Gemechu, Lemma Getacher, Motuma Erena Getachew, Abera Getachew Obsa, Asmare Getie, Amir Ghaderi, Mansour Ghafourifard, Alireza Ghajar, Seyyed-Hadi Ghamari, Lilian A Ghandour, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Sherief Ghozy, Franklin N Glozah, Ekaterina Vladimirovna Glushkova, Justyna Godos, Amit Goel, Salime Goharinezhad, Mahaveer Golechha, Pouya Goleij, Mohamad Golitaleb, Felix Greaves, Michal Grivna, Giuseppe Grosso, Temesgen Worku Gudayu, Bhawna Gupta, Rajeev Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Brian J Hall, Rabih Halwani, Tiilahun Beyene Handiso, Graeme J Hankey, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, Hossein Hassanian-Moghaddam, Simon I Hay, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Delia Hendrie, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Md Mahbub Hossain, Sahadat Hossain, Seyed Kianoosh Hosseini, Mehdi hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Guoqing Hu, Junjie Huang, Salman Hussain, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Lalu Muhammad Irham, M Mofizul Islam, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Ramaiah Itumalla, Masao Iwagami, Roxana Jabbarinejad, Louis Jacob, Mihajlo Jakovljevic, Zahra Jamalpoor, Elham Jamshidi, Sathish Kumar Jayapal, Umesh Umesh Jayarajah, Ranil Jayawardena, Rime Jebai, Seyed Ali Jeddi, Alelign Tasew Jema, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Robel Hussen Kabthymer, Bhushan Dattatray Kamble, Himal Kandel, Girum Gebremeskel Kanno, Neeti Kapoor, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Rimple Jeet Kaur, Gbenga A Kayode, Mohammad Keykhaei, Himanshu Khajuria, Rovshan Khalilov, Imteyaz A Khan, Moien AB Khan, Hanna Kim, Jihee Kim, Min Seo Kim, Ruth W Kimokoti, Mika Kivimäki, Vitalii Klymchuk, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Vladimir Andreevich Korshunov, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, G Anil Kumar, Narinder Kumar, Nithin Kumar, Ben Lacey, Tea Lallukka, Savita Lasrado, Jerrald Lau, Sang-woong Lee, Wei-Chen Lee, Yo Han Lee, Lee-Ling Lim, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Stefan Lorkowski, Rafael Lozano, Giancarlo Lucchetti, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Soleiman Mahjoub, Ata Mahmoodpoor, Rashidul Alam Mahumud, Alaa Makki, Mohammad-Reza Malekpour, Narayana Manjunatha, Borhan Mansouri, Mohammad Ali Mansournia, Jose Martinez-Raga, Francisco A Martinez-Villa, Richard Matzopoulos, Pallab K Maulik, Mahsa Mayeli, John J McGrath, Jitendra Kumar Meena, Entezar Mehrabi Nasab, Ritesh G Menezes, Gert B M Mensink, Alexios-Fotios A Mentis, Atte Meretoja, Bedasa Taye Merga, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, GK Mini, Andreea Mirica, Antonio Mirijello, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Babak Moazen, Maryam Mobarakabadi, Marcello Moccia, Yousef Mohammad, Esmaeil Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Yousef Moradi, Ebrahim Mostafavi, Sumaira Mubarik, Erin C Mullany, Beemnet Tekabe Mulugeta, Efrén Murillo-Zamora, Christopher J L Murray, Julius C Mwita, Mohsen Naghavi, Mukhammad David Naimzada, Vinay Nangia, Biswa Prakash Nayak, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Samata Nepal, Sudan Prasad Prasad Neupane, Sandhya Neupane Kandel, Yeshambel T Nigatu, Ali Nowroozi, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Kehinde O Obamiro, Felix Akpojene Ogbo, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Babayemi Oluwaseun Olakunde, Gláucia Maria Moraes Oliveira, Ahmed Omar Bali, Emad Omer, Doris V Ortega-Altamirano, Adrian Otoiu, Stanislav S Otstavnov, Bilcha Oumer, Mahesh P A, Alicia Padron-Monedero, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Shahina Pardhan, Tarang Parekh, Eun-Kee Park, Charles D H Parry, Fatemeh Pashazadeh Kan, Jay Patel, Siddhartha Pati, George C Patton, Uttam Paudel, Shrikant Pawar, Amy E Peden, Ionela-Roxana Petcu, Michael R Phillips, Marina Pinheiro, Evgenii Plotnikov, Pranil Man Singh Pradhan, Akila Prashant, Jianchao Quan, Amir Radfar, Alireza Rafiei, Pankaja Raghav Raghav, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Mosiur Rahman, Amir Masoud Rahmani, Shayan Rahmani, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Drona Prakash Rasali, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Andre M N Renzaho, Negar Rezaei, Saeid Rezaei, Mohsen Rezaeian, Seyed Mohammad Riahi, Esperanza Romero-Rodríguez, Gregory A Roth, Godfrey M Rwegerera, Basema Saddik, Erfan Sadeghi, Reihaneh Sadeghian, Umar Saeed, Farhad Saeedi, Rajesh Sagar, Amirhossein Sahebkar, Harihar Sahoo, Mohammad Ali Sahraian, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Abdallah M Samy, Francesco Sanmarchi, Milena M Santric-Milicevic, Yaser Sarikhani, Brijesh Sathian, Ganesh Kumar Saya, Mehdi Sayyah, Maria Inês Schmidt, Aletta Elisabeth Schutte, Michaël Schwarzinger, David C Schwebel, Abdul-Aziz Seidu, Nachimuthu Senthil Kumar, SeyedAhmad SeyedAlinaghi, Allen Seylani, Feng Sha, Sarvenaz Shahin, Fariba Shahraki-Sanavi, Shayan Shahrokhi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mehran Shams-Beyranvand, Sara Sheikhbahaei, Rahim Ali Sheikhi, Adithi Shetty, Jeevan K Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, K M Shivakumar, Velizar Shivarov, Parnian Shobeiri, Roman Shrestha, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres da Silva, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Marco Solmi, YONATAN SOLOMON, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Ireneous N Soyiri, Dan J Stein, Sonu Hangma Subba, Miklós Szócska, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Majid Taheri, Ker-Kan Tan, Minale Tareke, Elvis Enowbeyang Tarkang, Gebremaryam Temesgen, Worku Animaw Temesgen, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Rekha Thapar, Nikhil Kenny Thomas, Chalachew Tiruneh, Jovana Todorovic, Marco Torrado, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sergi Trias-Llimós, Jaya Prasad Tripathy, Alireza Vakilian, Rohollah Valizadeh, Mehdi Varmaghani, Shoban Babu Varthya, Tommi Juhani Vasankari, Theo Vos, Birhanu Wagaye, Yasir Waheed, Mandaras Tariku Walde, Cong Wang, Yanzhong Wang, Yuan-Pang Wang, Ronny Westerman, Nuwan Darshana Wickramasinghe, Abate Dargie Wubetu, Suowen Xu, Kazumasa Yamagishi, Lin Yang, Gesila Endashaw E Yesera, Arzu Yigit, Vahit Yiğit, Ayenew Engida Ayenew Engida Yimaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Siddhesh Zadey, Mazyar Zahir, Iman Zare, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Yves Miel H Zuniga, Emmanuela Gakidou, University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Department of Public Health, University of Helsinki, Hjelt Institute (-2014), Helsinki Inequality Initiative (INEQ), Clinicum, Helsinki University Hospital Area, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Alexander von Humboldt Foundation, University of Oxford (Reino Unido), Medical Research Council (Reino Unido), NIH - National Institute of Mental Health (NIMH) (Estados Unidos), Canada Research Chairs, National Health and Medical Research Council (Australia), National Heart Foundation of Australia, Ministry of Education, Science and Technological Development (Serbia), Wellcome Trust, NIH - National Institute on Aging (NIA) (Estados Unidos), Finlands Akademi (Finlandia), Panjab University (India), Federal Ministry of Education & Research (Alemania), National Council for Scientific and Technological Development (Brasil), Danish National Research Foundation, Queensland Centre for Mental Health Research (Australia), South African Medical Research Council, National Natural Science Foundation of China, Charles Sturt University (Australia), Ain Shams University (Egipto), Mizoram University (India), Kasturba Medical College (India), Manipal Academy of Higher Education (India), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Ministerio de Ciencia e Innovación (España), Collaborators, GBD 2020 Alcohol, Bryazka, Dana, Reitsma, Marissa B, Griswold, Max G, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abdoli, Amir, Abdollahi, Mohammad, Abdullah, Abu Yousuf Md, Abhilash, E S, Abu-Gharbieh, Eman, Acuna, Juan Manuel, Addolorato, Giovanni, Adebayo, Oladimeji M, Adekanmbi, Victor, Adhikari, Kishor, Adhikari, Sangeet, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Saira, Agegnehu, Wubetu Yimam, Aggarwal, Manik, Ahinkorah, Bright Opoku, Ahmad, Araz Ramazan, Ahmad, Sajjad, Ahmad, Tauseef, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed Rashid, Tarik, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alam, Md Zakiul, Alem, Dejene Tsegaye, Alene, Kefyalew Addi, Alimohamadi, Yousef, Alizadeh, Atiyeh, Allel, Kasim, Alonso, Jordi, Alvand, Saba, Alvis-Guzman, Nelson, Amare, Firehiwot, Ameyaw, Edward Kwabena, Amiri, Sohrab, Ancuceanu, Robert, Anderson, Jason A, Andrei, Catalina Liliana, Andrei, Tudorel, Arabloo, Jalal, Arshad, Muhammad, Artamonov, Anton A, Aryan, Zahra, Asaad, Malke, Asemahagn, Mulusew A, Astell-Burt, Thoma, Athari, Seyyed Shamsadin, Atnafu, Desta Debalkie, Atorkey, Prince, Atreya, Alok, Ausloos, Floriane, Ausloos, Marcel, Ayano, Getinet, Ayanore, Martin Amogre ayanore, Ayinde, Olatunde O, Ayuso-Mateos, Jose L, Azadnajafabad, Sina, Azanaw, Melkalem Mamuye, Azangou-Khyavy, Mohammadreza, Azari Jafari, Amirhossein, Azzam, Ahmed Y, Badiye, Ashish D, Bagheri, Nasser, Bagherieh, Sara, Bairwa, Mohan, Bakkannavar, Shankar M, Bakshi, Ravleen Kaur, Balchut/bilchut, Awraris Hailu, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Baskaran, Pritish, Belo, Lui, Bennett, Derrick A, Benseñor, Isabela M, Bhagavathula, Akshaya Srikanth, Bhala, Neeraj, Bhalla, Ashish, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhojaraja, Vijayalakshmi S, Bintoro, Bagas Suryo, Blokhina, Elena A Elena, Bodicha, Belay Boda Abule, Boloor, Archith, Bosetti, Cristina, Braithwaite, Dejana, Brenner, Hermann, Briko, Nikolay Ivanovich, Brunoni, Andre R, Butt, Zahid A, Cao, Chao, Cao, Yin, Cárdenas, Rosario, Carvalho, Andre F, Carvalho, Márcia, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Castro-de-Araujo, Luis F S, Cattaruzza, Maria Sofia, Chakraborty, Promit Ananyo, Charan, Jaykaran, Chattu, Vijay Kumar, Chaurasia, Akhilanand, Cherbuin, Nicola, Chu, Dinh-Toi, Chudal, Nandita, Chung, Sheng-Chia, Churko, Chuchu, Ciobanu, Liliana G, Cirillo, Massimo, Claro, Rafael M, Costanzo, Simona, Cowden, Richard G, Criqui, Michael H, Cruz-Martins, Natália, Culbreth, Garland T, Dachew, Berihun Assefa, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dandona, Lalit, Dandona, Rakhi, Daniel, Beniam Darge, Danielewicz, Anna, Darega Gela, Jiregna, Davletov, Kairat, de Araujo, Jacyra Azevedo Paiva, de Sá-Junior, Antonio Rei, Debela, Sisay Abebe, Dehghan, Azizallah, Demetriades, Andreas K, Derbew Molla, Meseret, Desai, Rupak, Desta, Abebaw Alemayehu, Dias da Silva, Diana, Diaz, Daniel, Digesa, Lankamo Ena, Diress, Mengistie, Dodangeh, Milad, Dongarwar, Deepa, Dorostkar, Fariba, Dsouza, Haneil Larson, Duko, Bereket, Duncan, Bruce B, Edvardsson, Kristina, Ekholuenetale, Michael, Elgar, Frank J, Elhadi, Muhammed, Elmonem, Mohamed A, Endries, Aman Yesuf, Eskandarieh, Sharareh, Etemadimanesh, Azin, Fagbamigbe, Adeniyi Franci, Fakhradiyev, Ildar Ravisovich, Farahmand, Fatemeh, Farinha, Carla Sofia e Sá, Faro, Andre, Farzadfar, Farshad, Fatehizadeh, Ali, Fauk, Nelsensius Klau, Feigin, Valery L, Feldman, Rachel, Feng, Xiaoqi, Fentaw, Zinabu, Ferrero, Simone, Ferro Desideri, Lorenzo, Filip, Irina, Fischer, Florian, Francis, Joel Msafiri, Franklin, Richard Charle, Gaal, Peter Andra, Gad, Mohamed M, Gallus, Silvano, Galvano, Fabio, Ganesan, Balasankar, Garg, Tushar, Gebrehiwot, Mesfin Gebrehiwot Damtew, Gebremeskel, Teferi Gebru, Gebremichael, Mathewos Alemu, Gemechu, Tadele Regasa, Getacher, Lemma, Getachew, Motuma Erena, Getachew Obsa, Abera, Getie, Asmare, Ghaderi, Amir, Ghafourifard, Mansour, Ghajar, Alireza, Ghamari, Seyyed-Hadi, Ghandour, Lilian A, Ghasemi Nour, Mohammad, Ghashghaee, Ahmad, Ghozy, Sherief, Glozah, Franklin N, Glushkova, Ekaterina Vladimirovna, Godos, Justyna, Goel, Amit, Goharinezhad, Salime, Golechha, Mahaveer, Goleij, Pouya, Golitaleb, Mohamad, Greaves, Felix, Grivna, Michal, Grosso, Giuseppe, Gudayu, Temesgen Worku, Gupta, Bhawna, Gupta, Rajeev, Gupta, Sapna, Gupta, Veer Bala, Gupta, Vivek Kumar, Hafezi-Nejad, Nima, Haj-Mirzaian, Arvin, Hall, Brian J, Halwani, Rabih, Handiso, Tiilahun Beyene, Hankey, Graeme J, Hariri, Sanam, Haro, Josep Maria, Hasaballah, Ahmed I, Hassanian-Moghaddam, Hossein, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Hendrie, Delia, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hlongwa, Mbuzeleni Mbuzeleni, Holla, Ramesh, Hossain, Md Mahbub, Hossain, Sahadat, Hosseini, Seyed Kianoosh, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hu, Guoqing, Huang, Junjie, Hussain, Salman, Ibitoye, Segun Emmanuel, Ilic, Irena M, Ilic, Milena D, Immurana, Mustapha, Irham, Lalu Muhammad, Islam, M Mofizul, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Iso, Hiroyasu, Itumalla, Ramaiah, Iwagami, Masao, Jabbarinejad, Roxana, Jacob, Loui, Jakovljevic, Mihajlo, Jamalpoor, Zahra, Jamshidi, Elham, Jayapal, Sathish Kumar, Jayarajah, Umesh Umesh, Jayawardena, Ranil, Jebai, Rime, Jeddi, Seyed Ali, Jema, Alelign Tasew, Jha, Ravi Prakash, Jindal, Har Ashish, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kabir, Ali, Kabthymer, Robel Hussen, Kamble, Bhushan Dattatray, Kandel, Himal, Kanno, Girum Gebremeskel, Kapoor, Neeti, Karaye, Ibraheem M, Karimi, Salah Eddin, Kassa, Bekalu Getnet, Kaur, Rimple Jeet, Kayode, Gbenga A, Keykhaei, Mohammad, Khajuria, Himanshu, Khalilov, Rovshan, Khan, Imteyaz A, Khan, Moien AB, Kim, Hanna, Kim, Jihee, Kim, Min Seo, Kimokoti, Ruth W, Kivimäki, Mika, Klymchuk, Vitalii, Knudsen, Ann Kristin Skrindo, Kolahi, Ali-Asghar, Korshunov, Vladimir Andreevich, Koyanagi, Ai, Krishan, Kewal, Krishnamoorthy, Yuvaraj, Kumar, G Anil, Kumar, Narinder, Kumar, Nithin, Lacey, Ben, Lallukka, Tea, Lasrado, Savita, Lau, Jerrald, Lee, Sang-woong, Lee, Wei-Chen, Lee, Yo Han, Lim, Lee-Ling, Lim, Stephen S, Lobo, Stany W, Lopukhov, Platon D, Lorkowski, Stefan, Lozano, Rafael, Lucchetti, Giancarlo, Madadizadeh, Farzan, Madureira-Carvalho, Áurea M, Mahjoub, Soleiman, Mahmoodpoor, Ata, Mahumud, Rashidul Alam, Makki, Alaa, Malekpour, Mohammad-Reza, Manjunatha, Narayana, Mansouri, Borhan, Mansournia, Mohammad Ali, Martinez-Raga, Jose, Martinez-Villa, Francisco A, Matzopoulos, Richard, Maulik, Pallab K, Mayeli, Mahsa, Mcgrath, John J, Meena, Jitendra Kumar, Mehrabi Nasab, Entezar, Menezes, Ritesh G, Mensink, Gert B M, Mentis, Alexios-Fotios A, Meretoja, Atte, Merga, Bedasa Taye, Mestrovic, Tomislav, Miao Jonasson, Junmei, Miazgowski, Bartosz, Micheletti Gomide Nogueira de Sá, Ana Carolina, Miller, Ted R, Mini, Gk, Mirica, Andreea, Mirijello, Antonio, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Misra, Sanjeev, Moazen, Babak, Mobarakabadi, Maryam, Moccia, Marcello, Mohammad, Yousef, Mohammadi, Esmaeil, Mohammadian-Hafshejani, Abdollah, Mohammed, Teroj Abdulrahman, Moka, Nagabhishek, Mokdad, Ali H, Momtazmanesh, Sara, Moradi, Yousef, Mostafavi, Ebrahim, Mubarik, Sumaira, Mullany, Erin C, Mulugeta, Beemnet Tekabe, Murillo-Zamora, Efrén, Murray, Christopher J L, Mwita, Julius C, Naghavi, Mohsen, Naimzada, Mukhammad David, Nangia, Vinay, Nayak, Biswa Prakash, Negoi, Ionut, Negoi, Ruxandra Irina, Nejadghaderi, Seyed Aria, Nepal, Samata, Neupane, Sudan Prasad Prasad, Neupane Kandel, Sandhya, Nigatu, Yeshambel T, Nowroozi, Ali, Nuruzzaman, Khan M, Nzoputam, Chimezie Igwegbe, Obamiro, Kehinde O, Ogbo, Felix Akpojene, Oguntade, Ayodipupo Sikiru, Okati-Aliabad, Hassan, Olakunde, Babayemi Oluwaseun, Oliveira, Gláucia Maria Morae, Omar Bali, Ahmed, Omer, Emad, Ortega-Altamirano, Doris V, Otoiu, Adrian, Otstavnov, Stanislav S, Oumer, Bilcha, P A, Mahesh, Padron-Monedero, Alicia, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandey, Anamika, Pandey, Ashok, Pardhan, Shahina, Parekh, Tarang, Park, Eun-Kee, Parry, Charles D H, Pashazadeh Kan, Fatemeh, Patel, Jay, Pati, Siddhartha, Patton, George C, Paudel, Uttam, Pawar, Shrikant, Peden, Amy E, Petcu, Ionela-Roxana, Phillips, Michael R, Pinheiro, Marina, Plotnikov, Evgenii, Pradhan, Pranil Man Singh, Prashant, Akila, Quan, Jianchao, Radfar, Amir, Rafiei, Alireza, Raghav, Pankaja Raghav, Rahimi-Movaghar, Vafa, Rahman, Azizur, Rahman, Md Mosfequr, Rahman, Mosiur, Rahmani, Amir Masoud, Rahmani, Shayan, Ranabhat, Chhabi Lal, Ranasinghe, Priyanga, Rao, Chythra R, Rasali, Drona Prakash, Rashidi, Mohammad-Mahdi, Ratan, Zubair Ahmed, Rawaf, David Laith, Rawaf, Salman, Rawal, Lal, Renzaho, Andre M N, Rezaei, Negar, Rezaei, Saeid, Rezaeian, Mohsen, Riahi, Seyed Mohammad, Romero-Rodríguez, Esperanza, Roth, Gregory A, Rwegerera, Godfrey M, Saddik, Basema, Sadeghi, Erfan, Sadeghian, Reihaneh, Saeed, Umar, Saeedi, Farhad, Sagar, Rajesh, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Saif-Ur-Rahman, Km, Salahi, Sarvenaz, Salimzadeh, Hamideh, Samy, Abdallah M, Sanmarchi, Francesco, Santric-Milicevic, Milena M, Sarikhani, Yaser, Sathian, Brijesh, Saya, Ganesh Kumar, Sayyah, Mehdi, Schmidt, Maria Inê, Schutte, Aletta Elisabeth, Schwarzinger, Michaël, Schwebel, David C, Seidu, Abdul-Aziz, Senthil Kumar, Nachimuthu, Seyedalinaghi, Seyedahmad, Seylani, Allen, Sha, Feng, Shahin, Sarvenaz, Shahraki-Sanavi, Fariba, Shahrokhi, Shayan, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Shams-Beyranvand, Mehran, Sheikhbahaei, Sara, Sheikhi, Rahim Ali, Shetty, Adithi, Shetty, Jeevan K, Shiferaw, Damtew Solomon, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shivakumar, K M, Shivarov, Velizar, Shobeiri, Parnian, Shrestha, Roman, Sidemo, Negussie Boti, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, Natacha Torres da, Singh, Jasvinder A, Singh, Surjit, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sleet, David A, Solmi, Marco, Solomon, Yonatan, Song, Suhang, Song, Yimeng, Sorensen, Reed J D, Soshnikov, Sergey, Soyiri, Ireneous N, Stein, Dan J, Subba, Sonu Hangma, Szócska, Mikló, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Taheri, Majid, Tan, Ker-Kan, Tareke, Minale, Tarkang, Elvis Enowbeyang, Temesgen, Gebremaryam, Temesgen, Worku Animaw, Temsah, Mohamad-Hani, Thankappan, Kavumpurathu Raman, Thapar, Rekha, Thomas, Nikhil Kenny, Tiruneh, Chalachew, Todorovic, Jovana, Torrado, Marco, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Tran, Mai Thi Ngoc, Trias-Llimós, Sergi, Tripathy, Jaya Prasad, Vakilian, Alireza, Valizadeh, Rohollah, Varmaghani, Mehdi, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Vos, Theo, Wagaye, Birhanu, Waheed, Yasir, Walde, Mandaras Tariku, Wang, Cong, Wang, Yanzhong, Wang, Yuan-Pang, Westerman, Ronny, Wickramasinghe, Nuwan Darshana, Wubetu, Abate Dargie, Xu, Suowen, Yamagishi, Kazumasa, Yang, Lin, Yesera, Gesila Endashaw E, Yigit, Arzu, Yiğit, Vahit, Yimaw, Ayenew Engida Ayenew Engida, Yon, Dong Keon, Yonemoto, Naohiro, Yu, Chuanhua, Zadey, Siddhesh, Zahir, Mazyar, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhong, Chenwen, Zmaili, Mohammad, Zuniga, Yves Miel H, Gakidou, Emmanuela, Bryazka, D, Reitsma, Mb, Griswold, Mg, Abate, Kh, Abbafati, C, Kangevari, Ma, Kangevari, Za, Abdoli, A, Abdollahi, M, Abdullah, Am, Abhilash, E, Abu Gharbieh, E, Acuna, Jm, Addolorato, G, Adebayo, Om, Adekanmbi, V, Adhikari, K, Adhikari, S, Adnani, Qe, Afzal, S, Agegnehu, Wy, Aggarwal, M, Ahinkorah, Bo, Ahmad, Ar, Ahmad, S, Ahmad, T, Ahmadi, A, Ahmadi, S, Ahmed, H, Rashid, Ta, Akunna, Cj, Al Hamad, H, Alam, Mz, Alem, Dt, Alene, Ka, Alimohamadi, Y, Alizadeh, A, Allel, K, Alonso, J, Alvand, S, Guzman, Na, Amare, F, Ameyaw, Ek, Amiri, S, Ancuceanu, R, Anderson, Ja, Andrei, Cl, Andrei, T, Arabloo, J, Arshad, M, Artamonov, Aa, Aryan, Z, Asaad, M, Asemahagn, Ma, Burt, Ta, Athari, S, Atnafu, Dd, Atorkey, P, Atreya, A, Ausloos, F, Ausloos, M, Ayano, G, Ayanore, Ma, Ayinde, Oo, Mateos, Jla, Azadnajafabad, S, Azanaw, Mm, Khyavy, Ma, Jafari, Aa, Azzam, Ay, Badiye, Ad, Bagheri, N, Bagherieh, S, Bairwa, M, Bakkannavar, Sm, Bakshi, Rk, Balchut, Ah, Null, T, Barra, F, Barrow, A, Baskaran, P, Belo, L, Bennett, Da, Bensenor, Im, Bhagavathula, A, Bhala, N, Bhalla, A, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bintoro, B, 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Nk, Feigin, Vl, Feldman, R, Feng, Xq, Fentaw, Z, Ferrero, S, Desideri, Lf, Filip, I, Fischer, F, Francis, Jm, Franklin, Rc, Gaal, Pa, Gad, Mm, Gallus, S, Galvano, F, Ganesan, B, Garg, T, Gebrehiwot, Mgd, Gebremeskel, Tg, Gebremichael, Ma, Gemechu, Tr, Getacher, L, Getachew, Me, Obsa, Ag, Getie, A, Ghaderi, A, Ghafourifard, M, Ghajar, A, Ghamari, Sh, Ghandour, La, Nour, Mg, Ghashghaee, A, Ghozy, S, Glozah, Fn, Glushkova, Ev, Godos, J, Goel, A, Goharinezhad, S, Golechha, M, Goleij, P, Golitaleb, M, Greaves, F, Grivna, M, Grosso, G, Gudayu, Tw, Gupta, B, Gupta, R, Gupta, S, Gupta, Vb, Gupta, Vk, Nejad, Nh, Mirzaian, Ah, Hall, Bj, Halwani, R, Handiso, Tb, Hankey, Gj, Hariri, S, Haro, Jm, Hasaballah, Ai, Moghaddam, Hh, Hay, Si, Hayat, K, Heidari, G, Heidari, M, Hendrie, D, Herteliu, C, Heyi, Dz, Hezam, K, Hlongwa, Mm, Holla, R, Hossain, Mm, Hossain, S, Hosseini, Sk, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, Gq, Huang, Jj, Hussain, S, Ibitoye, Se, Ilic, Im, Ilic, Md, Immurana, M, Irham, Lm, Islam, Mm, Islam, Rm, Islam, Sm, Iso, H, Itumalla, R, Iwagami, M, Jabbarinejad, R, Jacob, L, Jakovljevic, M, Jamalpoor, Z, Jamshidi, E, Jayapal, Sk, Jayarajah, Uu, Jayawardena, R, Jebai, R, Jeddi, Sa, Jema, At, Jha, Rp, Jindal, Ha, Jonas, Jb, Joo, T, Joseph, N, Joukar, F, Jozwiak, Jj, Jurisson, M, Kabir, A, Kabthymer, Rh, Kamble, Bd, Kandel, H, Kanno, Gg, Kapoor, N, Karaye, Im, Karimi, Se, Kassa, Bg, Kaur, Rj, Kayode, Ga, Keykhaei, M, Khajuria, H, Khalilov, R, Khan, Ia, Ab Khan, M, Kim, H, Kim, J, Kim, M, Kimokoti, Rw, Kivimaki, M, Klymchuk, V, Knudsen, Ak, Kolahi, Aa, Korshunov, Va, Koyanagi, A, Krishan, K, Krishnamoorthy, Y, Kumar, Ga, Kumar, N, Ben, Lacey, Lallukka, T, Lasrado, S, Lau, J, Lee, Sw, Lee, Wc, Lee, Yh, Lim, Ll, Lim, S, Lobo, Sw, Lopukhov, Pd, Lorkowski, S, Lozano, R, Lucchetti, G, Madadizadeh, F, Mahjoub, S, Mahmoodpoor, A, Mahumud, Ra, Makki, A, Malekpour, Mr, Manjunatha, N, Mansouri, B, Mansournia, Ma, Raga, Jm, Villa, Fam, Matzopoulos, R, Maulik, Pk, Mayeli, M, Mcgrath, Jj, Meena, Jk, Nasab, Em, Menezes, Rg, Mensink, Gbm, Mentis, Afa, Meretoja, A, Merga, Bt, Mestrovic, T, Jonasson, Jm, Miazgowski, B, de Sa, Acmgn, Miller, Tr, Mini, G, Mirica, A, Mirijello, A, Mirmoeeni, S, Mirrakhimov, Em, Misra, S, Moazen, B, Mobarakabadi, M, Moccia, M, Mohammad, Y, Mohammadi, E, Hafshejani, Am, Mohammed, Ta, Moka, N, Mokdad, Ah, Momtazmanesh, S, Moradi, Y, Mostafavi, E, Mubarik, S, Mullany, Ec, Mulugeta, Bt, Zamora, Em, Murray, Cjl, Mwita, Jc, Naghavi, M, Naimzada, Md, Nangia, V, Nayak, Bp, Negoi, I, Negoi, Ri, Nejadghaderi, Sa, Nepal, S, Neupane, Spp, Kandel, Sn, Nigatu, Yt, Nowroozi, A, Nuruzzaman, Km, Nzoputam, Ci, Obamiro, Ko, Ogbo, Fa, Oguntade, A, Aliabad, Ho, Olakunde, Bo, Oliveira, Gmm, Bali, Ao, Omer, E, Altamirano, Dvo, Otoiu, A, Otstavnov, S, Oumer, B, Mahesh, Pa, Monedero, Ap, Palladino, R, Pana, A, Jonas, Sp, Pandey, A, Pardhan, S, Parekh, T, Park, Ek, Parry, Cdh, Kan, Fp, Patel, J, Pati, S, Patton, Gc, Paudel, U, Pawar, S, Peden, Ae, Petcu, Ir, Phillips, Mr, Pinheiro, M, Plotnikov, E, Pradhan, Pm, Prashant, A, Quan, Jc, Radfar, A, Rafiei, A, Raghav, Pr, Movaghar, Vr, Rahman, A, Rahman, Mm, Rahman, M, Rahmani, Am, Rahmani, S, Ranabhat, Cl, Ranasinghe, P, Rao, Cr, Rasali, Dp, Rashidi, Mm, Ratan, Za, Rawaf, Dl, Rawaf, S, Rawal, L, Renzaho, Amn, Rezaei, N, Rezaei, S, Rezaeian, M, Riahi, Sm, Rodriguez, Er, Roth, Ga, Rwegerera, Gm, Saddik, B, Sadeghi, E, Sadeghian, R, Saeed, U, Saeedi, F, Sagar, R, Sahebkar, A, Sahoo, H, Sahraian, Ma, Rahman, Ksu, Salahi, S, Salimzadeh, H, Samy, Am, Sanmarchi, F, Milicevic, Mm, Sarikhani, Y, Sathian, B, Saya, Gk, Sayyah, M, Schmidt, Mi, Schutte, Ae, Schwarzinger, M, Schwebel, Dc, Seidu, Aa, Seyedalinaghi, S, Seylani, A, Sha, F, Shahin, S, Sanavi, F, Shahrokhi, S, Shaikh, Ma, Shaker, E, Shakhmardanov, Mz, Beyranvand, M, Sheikhbahaei, S, Sheikhi, Ra, Shetty, A, Shetty, Jk, Shiferaw, D, Shigematsu, M, Shiri, R, Shirkoohi, R, Shivakumar, Km, Shivarov, V, Shobeiri, P, Shrestha, R, Sidemo, Nb, Sigfusdottir, Id, Silva, Da, da Silva, Nt, Singh, Ja, Singh, S, Skryabin, Vy, Skryabina, Aa, Sleet, Da, Solmi, M, Solomon, Y, Song, S, Song, Ym, Sorensen, Rjd, Soshnikov, S, Soyiri, In, Stein, Dj, Subba, Sh, Szocska, M, Seisdedos, Rt, Tabuchi, T, Taheri, M, Tan, Kk, Tareke, M, Tarkang, Ee, Temesgen, G, Temesgen, Wa, Temsah, Mh, Thankappan, Kr, Thapar, R, Thomas, Nk, Tiruneh, C, Todorovic, J, Torrado, M, Touvier, M, Palone, Mrt, Tran, Mtn, Llimos, St, Tripathy, Jp, Vakilian, A, Valizadeh, R, Varmaghani, M, Varthya, Sb, Vasankari, Tj, Vos, T, Wagaye, B, Waheed, Y, Walde, Mt, Wang, C, Wang, Yz, Wang, Yp, Westerman, R, Wickramasinghe, Nd, Wubetu, Ad, Xu, S, Yamagishi, K, Yang, L, Yesera, Gee, Yigit, A, Yimaw, Ae, Yon, Dk, Yonemoto, N, Yu, Ch, Zadey, S, Zahir, M, Zare, I, Zastrozhin, M, Zastrozhina, A, Zhang, Zj, Zhong, Cw, Zmaili, M, Zuniga, Ymh, Gakidou, E, Madureira-Carvalho, Am, Ciobanu, LG, Gakidou, Emma, and GBD 2020 Alcohol Collaborators
Subjects: Adult, Male, Alcohol Drinking, CONTROL POLICIES, adult, Child, Preschool, Female, Geography, Global Burden of Disease, Global Health, Humans, Middle Aged, Quality-Adjusted Life Years, Risk Factors, NDAS, ALL-CAUSE, GUIDELINES, GBD 2020 Alcohol Collaborators, COST-EFFECTIVENESS, Medicine, General & Internal, DRINKING, SDG 3 - Good Health and Well-being, RA0421, General & Internal Medicine, Quality-Adjusted Life Year, RA0421 Public health. Hygiene. Preventive Medicine, DRINKERS, Child, Preschool, 11 Medical and Health Sciences, METAANALYSIS, MCC, Science & Technology, global burden of disease, Risk Factor, General Medicine, CANCER, alcohol drinking, AC, 3121 General medicine, internal medicine and other clinical medicine, REDUCED MORTALITY, Life Sciences & Biomedicine, Human
Abstract: Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Research reported in this publication was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges the support for intellectual contributions to this manuscript by the Department of Community Medicine and Epidemiology at King Edward Medical University, Lahore, Pakistan. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford (Oxford, UK). M Carvalho acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. L Castro-de-Araujo was funded by the Medical Research Council (UK), Grant no. MR/T03355X/1 and by the National Institute of Mental Health Grant no. R01MH128911. FJ Elgar is supported by the Canada Research Chairs program. F Greaves acknowledges support from the NIHR Applied Research Collaboration for NW London. V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. VB Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. C Herteliu is partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is partially supported by a grant from the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported by the Operational Programme Research, Development and Education –Project, Postdoc2MUNI “(No. CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the National Health and Medical Research Council and received funding from the National Heart Foundation of Australia. The Serbian part of this GBD-related contribution has been co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426). K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B Lacey acknowledges support from the UK Biobank, funded largely by the UK Medical Research Council and Wellcome. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). G Lucchetti received a productivity scholarship from the Brazilian National Council for Scientific and Technological Development — CNPq (Level 1D). J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professor). J McGrath is employed by the Queensland Centre for Mental Health Research (Australia), which receives support from the Queensland Health Department. C Parry acknowleges the South African Medical Research Council. A Peden is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (Grant ID: APP2009306). M R Phillips was supported in part by the Global Alliance for Chronic Diseases - National Natural Science Foundation of China (NSFC. No. 81761128031). M Pinheiro acknowledges FCT for funding through program DL 57/2016 – Norma transitória. A Rahman acknowledges the support from the Data Science Research Unit in Charles Sturt University (Bathurst, NSW, Australia). U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University (Cairo, Egypt) and the Egyptian Fulbright Mission Program. N Senthil Kumar acknowledges the DBT, New Delhi sponsored Advanced State Level Biotech Hub (BT/NER/143/SP44475/2021), Mizoram University (Aizawl, Mizoram, India) for facilitating this work. F Sha is supported by the Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges Kasturba Medical College (Mangalore, India) and Manipal Academy of Higher Education (Manipal, India) for all the academic support. R Shrestha acknowledges a career development award from the National Institutes of Health (K01DA051346). D Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES)-Finance Code 001 and is supported in part by CNPq - Brazil (309589/2021-5). D Sleet acknowledges partial support from Veritas Management Group, Inc and The Bizzell Group, LLC. S Trias-Llimós acknowledges research funding from the Juan de la Cierva-Formación program of the Spanish Ministry of Science and Innovation (FJC-2019-039314-I). Sí
Published: 2022

26. Are free workplace health promotion apps adequately mapped with behavior change theories, techniques and desired features? A content analysis

Author: Poornima Panduranga Kundapur, Chythra R Rao, and Baskaran Chandrasekaran
Subjects: 020205 medical informatics, Health Behavior, Applied psychology, Behavior change, Behavior change methods, Health Promotion, 02 engineering and technology, Sedentary behavior, Mobile Applications, 03 medical and health sciences, Behavioral Neuroscience, Social support, 0302 clinical medicine, Workplace health promotion, Behavior Therapy, Content analysis, Smartphone app, 0202 electrical engineering, electronic engineering, information engineering, Humans, 030212 general & internal medicine, Workplace, Psychology, Exercise, Goal setting, Applied Psychology
Abstract: Free smartphone applications that aim to promote physical activity or reduce sedentary behavior at workplaces were questioned for its content such as technical features, behavior change techniques (BCT) and security concerns. To evaluate systematically whether smartphone apps are mapped adequately with BCTs and security concerns. Free apps in Google Play store were searched and coded for BCTs systematically in July 2020. Two reviewers independently coded apps that aimed to promote physical activity (n = 18) and reduce sedentary behavior (n = 16) using a taxonomy of 26 BCTs. BCTs, features and security concerns among apps promoting physical activity and reducing sedentary behavior were analyzed. While the features (social support, gamification, or rewards) help increase physical activity and decrease sedentary behavior, the apps do not typically include the above features. Further, the apps were based on an average of 13 (4–21) BCTs. The BCTs coded most frequently were “self-monitoring” (100%), “general encouragement” (97%), and “goal setting” (n = 94%). No significant relation between user rating and BCTs was found in the apps. Majority of the free apps that aimed to increase physical activity or reduce sedentary behavior at workplaces were not adequately based on BCTs and lacked essential features facilitating long term behavior compliance at workplaces. Hence, there is a need to develop newer applications mapped adequately with BCTs, involving the collaborative work of behavioral scientists, app developers and policymakers. Clinical Trial Registry of India CTRI/2020/03/024138.
Published: 2021

27. Economic burden of type 2 diabetes mellitus management: Epidemiological determinants from a coastal community of Southern India

Author: K, Eshwari, Veena G, Kamath, Chythra R, Rao, and Asha, Kamath
Subjects: Male, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Humans, India, Financial Stress, Health Expenditures
Abstract: Expenditure on diabetes mellitus is increasing worldwide and is determined by multiple factors and knowledge about these factors may help to improve patient management and reduce health-care cost. The present study aims to determine the factors influencing the expenditure incurred by patients with type 2 diabetes mellitus (T2DM). A cross-sectional survey was conducted among 809 patients with T2DM from a coastal community in Southern India. Expenditure incurred for the management of T2DM in the previous year was collected using a predesigned survey tool. Duration of disease, source of diabetes care, presence of comorbidities, hospitalization, and adherence to medications were studied as potential cost predictors. Age, gender, education, occupation, and socioeconomic status as key determinants were evaluated. Expenditure incurred by patients with T2DM was estimated to be INR 5041 (2516-11,224) annually while the presence of comorbidities led to higher expenditure, INR 9133 (4034-19,053). Medication and hospitalization were the major drivers of direct cost. Subjects visiting private health facilities had a higher median cost with respect to diabetes-related care. Advancing age, male gender, high socioeconomic status, higher literacy, and longer duration of diabetes were identified as significant independent predictors of cost on multivariate analysis. The high cost of diabetes supports the need for strengthening public and private primary care facilities to provide standard care for diabetes.
Published: 2022

28. Dose-response effects of periodic physical activity breaks on the chronic inflammatory risk associated with sedentary behavior in high- and upper-middle income countries: A systematic review and meta-analysis

Author: Azarudheen Sahabudhee, Chythra R. Rao, Baskaran Chandrasekaran, and Scott J. Pedersen
Subjects: Endocrinology, Diabetes and Metabolism, Internal Medicine, General Medicine
Published: 2023

29. Micronutrients and cognitive functions among urban school-going children and adolescents: A cross-sectional multicentric study from India

Author: Shweta Singh, Shally Awasthi, Divas Kumar, Seema Rani Sarraf, Anuj Kumar Pandey, Girdhar G. Agarwal, Avivar Awasthi, Anish T. S., Joseph L. Mathew, Sonali Kar, Suma Nair, Chythra R. Rao, Harsh Pande, B. N. Mahanta, Bhavneet Bharti, C. M. Singh, Kuldeep Singh, Mushtaq A. Bhat, Somashekar A. R., Rajiv Awasthi, and Abbas Ali Mahdi
Subjects: Multidisciplinary
Abstract: Background Micronutrient deficiency (MD) is associated with deficits in cognitive functioning of children. However, no comprehensive multicentric study has been conducted in India to explore the role of multiple MD in cognition of children and adolescents. The present study aimed to explore association of MD with level of general intelligence and specific cognitive functions, in urban school-going children and adolescents across ten cities of India. Method Cross-sectional multicentric study, enrolled participants aged 6–16 years. Blood samples were collected for biochemical analysis of calcium, iron, zinc, selenium, folate, vitamin A, D and B12. Colored Progressive Matrices / Standard Progressive Matrices (CPM/SPM), Coding, Digit Span and Arithmetic tests were used for the assessment of cognitive functions of participants. Height and weight measures were collected along with socio-economic status. Results From April-2019 to February-2020, 2428 participants were recruited from 60 schools. No MD was found in 7.0% (134/1918), any one MD in 23.8% (457/1918) and ≥ 2 MD in 69.2% (1327/1918) participants. In presence of ≥ 2 MD, adjusted odds ratio (OR) for borderline or dull normal in CPM/SPM was 1.63, (95% CI: 1.05–2.52), coding was 1.66 (95% CI: 1.02–2.71), digit span was 1.55 (95% CI: 1.06–2.25) and arithmetic was 1.72 (95% CI: 1.17–2.53), controlling for gender, socioeconomic status and anthropometric indicators. Conclusion Since ≥ 2 MD were found in more than 2/3rd of participants and was associated with impairment in cognitive function, attempts must be made to ameliorate them on priority in school going children in India. Trial registration number CTRI/2019/02/017783.
Published: 2023

30. Predictors of psychological well-being among high school teachers: A cross-sectional study from Southern India

Author: Veena G Kamath, Chythra R Rao, Varalakshmi Chandra Sekaran, Lena Ashok, Chinthana Rajesh, and Asha Kamath
Subjects: School teachers, Cross-sectional study, business.industry, Psychological well-being, education, Work–life balance, Public Health, Environmental and Occupational Health, Medicine, business, Clinical psychology
Abstract: Background: Well-being is increasingly emerging as an important determinant of teacher effectiveness. Aim and objective: To assess the predictors of psychological well-being in Southern India. Settings and design: A cross-sectional study was conducted among 460 high school teachers from government and private schools in Udupi district. Methods and materials: Ryff’s psychological well-being scale (1989) was used. Statistical analysis used: Predictors were identified using logistic regression and p
Published: 2020

31. Is hackathon in oncology a plausible way to foster innovation? An experiential narrative account of conducting Hacking Cancer

Author: Arun Shanbhag, Shirley Lewis, Krishnananda Prabhu, Rangan Viveganandan, Chythra R Rao, Chiranjay Mukhopadhyay, Padmaja A. Shenoy, Naveen Salins, and Sharath K Rao
Subjects: Oncology, medicine.medical_specialty, 020205 medical informatics, business.industry, media_common.quotation_subject, Problem statement, Pharmacy, 02 engineering and technology, General Medicine, Creativity, Experiential learning, 03 medical and health sciences, 0302 clinical medicine, Seed money, Internal medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Relevance (information retrieval), Narrative, 030212 general & internal medicine, Psychology, business, Hacker, media_common
Abstract: BackgroundHackathons are a popular trend in the technology domain and is considered a powerful tool to spur creativity and innovation. In a health hackathon, an interdisciplinary team of health, technology and management experts work collaboratively to solve a common problem. Health hackathon can be one of the quickest means to derive technology or process-based solutions to the challenges faced by clinicians.MethodsA 2-day hackathon: Hacking Cancer was conducted at a tertiary cancer centre in India to develop quick, cost-effective solutions in cancer care. Twelve oncology-related problem statements were explored. Undergraduate and postgraduate students of health and dental sciences, pharmacy, nursing, engineering and business management were the participants.OutcomesOne hundred and fifty-seven participants expressed interest, and 90 participated in the event. The participants did a time-bound exploration of 12 challenges in oncology elucidated problem statements. The oncology specialists mentored the participants during the hackathon. Seventeen teams presented their solutions. Judges reviewed the solutions and scored the teams based on feasibility, relevance and applicability. The top-scoring three projects were acute lymphoblastic leukaemia (ALL) better-improving adherence to treatment in ALL patients, Donate Life—application for voluntary blood donation and Lumiflex—a novel illuminated flexible abdominal retractor. They received seed funding to develop prototypes and implement their ideas.ConclusionHacking Cancer was an effective way of developing quick, cost-effective solutions to the common problems faced in cancer care. The pool of local participants developed solutions that were relevant and applicable to the practice setting. This one was the first oncology themed hackathon in the country.
Published: 2020

32. Risk factors for gestational diabetes mellitus: A prospective case-control study from coastal Karnataka

Author: Chythra R Rao, Avinash Shetty, Asha Kamath, Sathisha Nayak, and Surabhi Mishra
Subjects: Microbiology (medical), medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Epidemiology, Obstetrics, business.industry, Public health, Public Health, Environmental and Occupational Health, Case-control study, Physical activity, medicine.disease, Gestational diabetes, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Diabetes mellitus, medicine, Gestation, University medical, 030212 general & internal medicine, Family history, business
Abstract: Background Identification of gestational diabetes mellitus (GDM) risk factors is pertinent, for it can be an effective intervention for its prevention. As previous information regarding GDM risk factors from India were mostly descriptive and scarce from coastal Karnataka, a current prospective case-control study was designed to identify GDM risk factors among pregnant women seeking antenatal care. Methods A hospital-based prospective matched case–control study was carried among antenatal subjects seeking routine antenatal care at two secondary-level care private hospitals, affiliated to a University Medical College in coastal Karnataka. It comprised of 100 incident GDM cases and 273 frequency-matched controls. Data was collected by personal interviews using a pretested questionnaire. Data was entered and analyzed using Statistical Package for Social Sciences(SPSS), version 15.0. Results Risk factors using Carpenter and Coustan criteria and DIPSI criteria were found similar. Pooled data identified following significant GDM risk factors: marital age (25–29 years)(adjusted OR:18.2; 95% CI:1.9–177.6; p=0.012), delayed menarche (adjusted OR:11.4; 95% CI:1.1–124.6; p=0.045), multiparity (adjusted OR:14.1; 95% CI:1.8–109.8; p=0.011), family history of DM (adjusted OR:66.6; 95% CI:6.9–645.2; p Conclusions Modifiable risk factors identified were low physical activity, high antenatal perceived stress, multiparity, marital age ≥25 years, and low pre-pregnancy intake of GLV, which were also comparable using two criteria in vogue for GDM diagnosis. Pre-conception advice on healthy lifestyle may prove beneficial.
Published: 2020

33. A step towards real-time implementation of GDM guidelines in India: Review of Gaps in RCH Programme

Author: Ajeet Singh Bhadoria, Chythra R Rao, Pradeep Aggarwal, Surabhi Mishra, Sudip Bhattacharya, Shaili Vyas, and Raman Kumar
Subjects: Government, Pilot implementation, endocrine system diseases, Service delivery framework, business.industry, Empowered Action Group State, Maternal Health, lcsh:R, Reproductive and Child Health Programme, lcsh:Medicine, English language, Invited Articles, Public domain, Child health, Obstetric care, Nursing, Uttarakhand, Medicine, Maternal health, business, Hyperglycemia in Pregnancy
Abstract: Gestational Diabetes Mellitus (GDM) risks the affected mother-child duos not only with respect to adverse perinatal outcomes but also for chronic diseases later in life. Therefore, in 2014, the Government of India (GoI) mandated universal GDM screening for all pregnant women as a part of essential obstetric care within the Reproductive and Child Health (RCH) programme. Later in 2018, the domain experts from GoI envisaged pan India implementation of GDM screening services within its RCH framework by 2023. As Uttarakhand-a hilly, EAG state of north India-would also be part of this nation-wide drive; prior identification of RCH services coverage in the State assumes paramount importance, as it reflects probable executability of GDM screening services within its delivery platform. Therefore, the present review aims to assess the readiness of Uttarakhand maternal health functionary system in view of GDM national guidelines implementation at both state and district levels. In this regard, freely accessible, full-text GoI documents pertaining to GDM implementation guidelines and maternal health program of India and Uttarakhand available in public domain in English language were reviewed. The present review favors the pilot implementation in district Dehradun prior to implementing in all districts of the state. It may, however, require overall improvement in maternal health programmatic services in all parts of the State for much efficient service delivery. Effective implementation of GDM guidelines requires urgent correction in the background performance of RCH program.
Published: 2020

34. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Author: Ewerton Cousin, Bruce B Duncan, Caroline Stein, Kanyin Liane Ong, Theo Vos, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Michael Abdelmasseh, Amir Abdoli, Rami Abd-Rabu, Hassan Abolhassani, Eman Abu-Gharbieh, Manfred Mario Kokou Accrombessi, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Gina Agarwal, Krishna K Agrawaal, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Keivan Ahmadi, Sepideh Ahmadi, Ali Ahmadi, Ali Ahmed, Yusra Ahmed Salih, Wuraola Akande-Sholabi, Tayyaba Akram, Hanadi Al Hamad, Ziyad Al-Aly, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Syed Mohamed Aljunid, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Robert Ancuceanu, Tudorel Andrei, Catalina Liliana Andrei, Ranjit Mohan Anjana, Adnan Ansar, Ippazio Cosimo Antonazzo, Benny Antony, Anayochukwu Edward Anyasodor, Jalal Arabloo, Damian Arizmendi, Benedetta Armocida, Anton A Artamonov, Judie Arulappan, Zahra Aryan, Samaneh Asgari, Tahira Ashraf, Thomas Astell-Burt, Prince Atorkey, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Ashish D Badiye, Atif Amin Baig, Mohan Bairwa, Jennifer L Baker, Ovidiu Constantin Baltatu, Palash Chandra Banik, Anthony Barnett, Mark Thomaz Ugliara Barone, Francesco Barone-Adesi, Amadou Barrow, Neeraj Bedi, Rebuma Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Derrick A Bennett, Isabela M Bensenor, David Beran, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Boris Bikbov, Setognal Birara, Virginia Bodolica, Aime Bonny, Hermann Brenner, Nikolay Ivanovich Briko, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Ismael R Campos-Nonato, Yin Cao, Chao Cao, Ester Cerin, Promit Ananyo Chakraborty, Joht Singh Chandan, Vijay Kumar Chattu, Simiao Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Barbara Corso, Omid Dadras, Xiaochen Dai, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Claudio Alberto Dávila-Cervantes, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Deepak Dhamnetiya, Daniel Diaz, Sanam Ebtehaj, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Islam Y Elgendy, Muhammed Elhadi, Mohamed A Elmonem, Mohammed Faisaluddin, Umar Farooque, Xiaoqi Feng, Eduarda Fernandes, Florian Fischer, David Flood, Marisa Freitas, Peter Andras Gaal, Mohamed M Gad, Piyada Gaewkhiew, Lemma Getacher, Mansour Ghafourifard, Reza Ghanei Gheshlagh, Ahmad Ghashghaee, Nermin Ghith, Ghozali Ghozali, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Sameer Vali Gopalani, Rafael Alves Guimarães, Rajat Das Gupta, Rajeev Gupta, Vivek Kumar Gupta, Veer Bala Gupta, Sapna Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Rabih Halwani, Asif Hanif, Graeme J Hankey, Shafiul Haque, Ahmed I Hasaballah, Syed Shahzad Hasan, Abdiwahab Hashi, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Mohammad Heidari, Mohammad Bellal Hossain Hossain, Sahadat Hossain, Mostafa Hosseini, Soodabeh Hoveidamanesh, Junjie Huang, Ayesha Humayun, Rabia Hussain, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Kevin S Ikuta, Leeberk Raja Inbaraj, Usman Iqbal, Md Shariful Islam, Sheikh Mohammed Shariful Islam, Rakibul M Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Ramaiah Itumalla, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Mohammad Ali Jahani, Mihajlo Jakovljevic, Ranil Jayawardena, Ravi Prakash Jha, Oommen John, Jost B Jonas, Tamas Joo, Ali Kabir, Rohollah Kalhor, Ashwin Kamath, Tanuj Kanchan, Himal Kandel, Neeti Kapoor, Gbenga A Kayode, Sewnet Adem Kebede, Pedram Keshavarz, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Moien AB Khan, Md Nuruzzaman Khan, Maseer Khan, Amir M Khater, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Vladimir Andreevich Korshunov, Oleksii Korzh, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Nithin Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Anders O Larsson, Savita Lasrado, Wei-Chen Lee, Chiachi Bonnie Lee, Paul H Lee, Shaun Wen Huey Lee, Ming-Chieh Li, Stephen S Lim, Lee-Ling Lim, Giancarlo Lucchetti, Azeem Majeed, Ahmad Azam Malik, Borhan Mansouri, Lorenzo Giovanni Mantovani, Santi Martini, Prashant Mathur, Colm McAlinden, Nafiul Mehedi, Teferi Mekonnen, Ritesh G Menezes, Amanual Getnet Mersha, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Andreea Mirica, Erkin M Mirrakhimov, Agha Zeeshan Mirza, Prasanna Mithra, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Ali Moni, Farhad Moradpour, Rahmatollah Moradzadeh, Ebrahim Mostafavi, Ulrich Otto Mueller, Christopher J L Murray, Ahmad Mustafa, Gabriele Nagel, Vinay Nangia, Atta Abbas Naqvi, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ruxandra Irina Negoi, Sandhya Neupane Kandel, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Jean Jacques Noubiap, Christoph Nowak, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, Temitope T Ojo, Andrew T Olagunju, Obinna E Onwujekwe, Alberto Ortiz, Mayowa O Owolabi, Raffaele Palladino, Songhomitra Panda-Jonas, Seithikurippu R Pandi-Perumal, Shahina Pardhan, Tarang Parekh, Mojtaba Parvizi, Veincent Christian Filipino Pepito, Arokiasamy Perianayagam, Ionela-Roxana Petcu, Manju Pilania, Vivek Podder, Roman V Polibin, Maarten J Postma, Akila Prashant, Navid Rabiee, Mohammad Rabiee, Vafa Rahimi-Movaghar, Muhammad Aziz Rahman, Md. Mosfequr Rahman, Mosiur Rahman, Setyaningrum Rahmawaty, Nazanin Rajai, Pradhum Ram, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Satish Rao, Salman Rawaf, David Laith Rawaf, Lal Rawal, Andre M N Renzaho, Nima Rezaei, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Peter Rohloff, Godfrey M Rwegerera, Paul MacDaragh Ryan, Maha Mohamed Saber-Ayad, Siamak Sabour, Basema Saddik, Sahar Saeedi Moghaddam, Amirhossein Sahebkar, Harihar Sahoo, KM Saif-Ur-Rahman, Hamideh Salimzadeh, Mehrnoosh Samaei, Juan Sanabria, Milena M Santric-Milicevic, Brijesh Sathian, Thirunavukkarasu Sathish, Markus P Schlaich, Abdul-Aziz Seidu, Mario Šekerija, Nachimuthu Senthil Kumar, Allen Seylani, Masood Ali Shaikh, Hina Shamshad, Md Shajedur Rahman Shawon, Sara Sheikhbahaei, Jeevan K Shetty, Rahman Shiri, K M Shivakumar, Kerem Shuval, Jasvinder A Singh, Ambrish Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ahmad Sofi-Mahmudi, Amin Soheili, Jing Sun, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Hooman Tadbiri, Eyayou Girma Tadesse, Md. Tariqujjaman, Kavumpurathu Raman Thankappan, Rekha Thapar, Nihal Thomas, Binod Timalsina, Ruoyan Tobe-Gai, Marcello Tonelli, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Jaya Prasad Tripathy, Lorainne Tudor Car, Biruk Shalmeno Tusa, Riaz Uddin, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari, Madhur Verma, Victor E Villalobos-Daniel, Sergey Konstantinovitch Vladimirov, Bay Vo, Giang Thu Vu, Rade Vukovic, Yasir Waheed, Richard G Wamai, Andrea Werdecker, Nuwan Darshana Wickramasinghe, Andrea Sylvia Winkler, Befikadu Legesse Wubishet, Xiaoyue Xu, Suowen Xu, Seyed Hossein Yahyazadeh Jabbari, Hiroshi Yatsuya, Sanni Yaya, Taklo Simeneh Yazie Yazie, Siyan Yi, Naohiro Yonemoto, Ismaeel Yunusa, Siddhesh Zadey, Sojib Bin Zaman, Maryam Zamanian, Nelson Zamora, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Alimuddin Zumla, Mohsen Naghavi, Maria Inês Schmidt, Tampere University, Clinical Medicine, QE Econometrics, RS: GSBE other - not theme-related research, Department of Public Health, University of Helsinki, Cousin, E, Duncan, B, Stein, C, Ong, K, Vos, T, Abbafati, C, Abbasi-Kangevari, M, Abdelmasseh, M, Abdoli, A, Abd-Rabu, R, Abolhassani, H, Abu-Gharbieh, E, Accrombessi, M, Adnani, Q, Afzal, M, Agarwal, G, Agrawaal, K, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadi, S, Ahmadi, A, Ahmed, A, Ahmed Salih, Y, Akande-Sholabi, W, Akram, T, Al Hamad, H, Al-Aly, Z, Alcalde-Rabanal, J, Alipour, V, Aljunid, S, Al-Raddadi, R, Alvis-Guzman, N, Amini, S, Ancuceanu, R, Andrei, T, Andrei, C, Anjana, R, Ansar, A, Antonazzo, I, Antony, B, Anyasodor, A, Arabloo, J, Arizmendi, D, Armocida, B, Artamonov, A, Arulappan, J, Aryan, Z, Asgari, S, Ashraf, T, Astell-Burt, T, Atorkey, P, Atout, M, Ayanore, M, Badiye, A, Baig, A, Bairwa, M, Baker, J, Baltatu, O, Banik, P, Barnett, A, Barone, M, Barone-Adesi, F, Barrow, A, Bedi, N, Belete, R, Belgaumi, U, Bell, A, Bennett, D, Bensenor, I, Beran, D, Bhagavathula, A, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bijani, A, Bikbov, B, Birara, S, Bodolica, V, Bonny, A, Brenner, H, Briko, N, Butt, Z, Caetano dos Santos, F, Camera, L, Campos-Nonato, I, Cao, Y, Cao, C, Cerin, E, Chakraborty, P, Chandan, J, Chattu, V, Chen, S, Choi, J, Choudhari, S, Chowdhury, E, Chu, D, Corso, B, Dadras, O, Dai, X, Damasceno, A, Dandona, L, Dandona, R, Davila-Cervantes, C, De Neve, J, Denova-Gutierrez, E, Dhamnetiya, D, Diaz, D, Ebtehaj, S, Edinur, H, Eftekharzadeh, S, El Sayed, I, Elgendy, I, Elhadi, M, Elmonem, M, Faisaluddin, M, Farooque, U, Feng, X, Fernandes, E, Fischer, F, Flood, D, Freitas, M, Gaal, P, Gad, M, Gaewkhiew, P, Getacher, L, Ghafourifard, M, Ghanei Gheshlagh, R, Ghashghaee, A, Ghith, N, Ghozali, G, Gill, P, Ginawi, I, Glushkova, E, Golechha, M, Gopalani, S, Guimaraes, R, Gupta, R, Gupta, V, Gupta, S, Habtewold, T, Hafezi-Nejad, N, Halwani, R, Hanif, A, Hankey, G, Haque, S, Hasaballah, A, Hasan, S, Hashi, A, Hassanipour, S, Hay, S, Hayat, K, Heidari, M, Hossain, M, Hossain, S, Hosseini, M, Hoveidamanesh, S, Huang, J, Humayun, A, Hussain, R, Hwang, B, Ibitoye, S, Ikuta, K, Inbaraj, L, Iqbal, U, Islam, M, Islam, S, Islam, R, Ismail, N, Isola, G, Itumalla, R, Iwagami, M, Iyamu, I, Jahani, M, Jakovljevic, M, Jayawardena, R, Jha, R, John, O, Jonas, J, Joo, T, Kabir, A, Kalhor, R, Kamath, A, Kanchan, T, Kandel, H, Kapoor, N, Kayode, G, Kebede, S, Keshavarz, P, Keykhaei, M, Khader, Y, Khajuria, H, Khan, M, Khater, A, Khoja, T, Khubchandani, J, Kim, M, Kim, Y, Kimokoti, R, Kisa, S, Kisa, A, Kivimaki, M, Korshunov, V, Korzh, O, Koyanagi, A, Krishan, K, Kuate Defo, B, Kumar, G, Kumar, N, Kusuma, D, La Vecchia, C, Lacey, B, Larsson, A, Lasrado, S, Lee, W, Lee, C, Lee, P, Lee, S, Li, M, Lim, S, Lim, L, Lucchetti, G, Majeed, A, Malik, A, Mansouri, B, Mantovani, L, Martini, S, Mathur, P, Mcalinden, C, Mehedi, N, Mekonnen, T, Menezes, R, Mersha, A, Miao Jonasson, J, Miazgowski, T, Michalek, I, Mirica, A, Mirrakhimov, E, Mirza, A, Mithra, P, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, A, Mokdad, A, Molokhia, M, Monasta, L, Moni, M, Moradpour, F, Moradzadeh, R, Mostafavi, E, Mueller, U, Murray, C, Mustafa, A, Nagel, G, Nangia, V, Naqvi, A, Nayak, B, Nazari, J, Ndejjo, R, Negoi, R, Neupane Kandel, S, Nguyen, C, Nguyen, H, Noubiap, J, Nowak, C, Oancea, B, Odukoya, O, Oguntade, A, Ojo, T, Olagunju, A, Onwujekwe, O, Ortiz, A, Owolabi, M, Palladino, R, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Parekh, T, Parvizi, M, Pepito, V, Perianayagam, A, Petcu, I, Pilania, M, Podder, V, Polibin, R, Postma, M, Prashant, A, Rabiee, N, Rabiee, M, Rahimi-Movaghar, V, Rahman, M, Rahmawaty, S, Rajai, N, Ram, P, Rana, J, Ranabhat, K, Ranasinghe, P, Rao, C, Rao, S, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Rezaei, N, Rezapour, A, Riahi, S, Ribeiro, D, Rodriguez, J, Roever, L, Rohloff, P, Rwegerera, G, Ryan, P, Saber-Ayad, M, Sabour, S, Saddik, B, Saeedi Moghaddam, S, Sahebkar, A, Sahoo, H, Saif-Ur-Rahman, K, Salimzadeh, H, Samaei, M, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sathish, T, Schlaich, M, Seidu, A, Sekerija, M, Senthil Kumar, N, Seylani, A, Shaikh, M, Shamshad, H, Shawon, M, Sheikhbahaei, S, Shetty, J, Shiri, R, Shivakumar, K, Shuval, K, Singh, J, Singh, A, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Soheili, A, Sun, J, Szerencses, V, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tadesse, E, Tariqujjaman, M, Thankappan, K, Thapar, R, Thomas, N, Timalsina, B, Tobe-Gai, R, Tonelli, M, Tovani-Palone, M, Tran, B, Tripathy, J, Tudor Car, L, Tusa, B, Uddin, R, Upadhyay, E, Valadan Tahbaz, S, Valdez, P, Vasankari, T, Verma, M, Villalobos-Daniel, V, Vladimirov, S, Vo, B, Vu, G, Vukovic, R, Waheed, Y, Wamai, R, Werdecker, A, Wickramasinghe, N, Winkler, A, Wubishet, B, Xu, X, Xu, S, Yahyazadeh Jabbari, S, Yatsuya, H, Yaya, S, Yazie, T, Yi, S, Yonemoto, N, Yunusa, I, Zadey, S, Zaman, S, Zamanian, M, Zamora, N, Zastrozhin, M, Zastrozhina, A, Zhang, Z, Zhong, C, Zmaili, M, Zumla, A, Naghavi, M, Schmidt, M, GBD 2019 Diabetes Mortality Collaborators, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Cousin, E., Duncan, B. B., Stein, C., Ong, K. L., Vos, T., Abbafati, C., Abbasi-Kangevari, M., Abdelmasseh, M., Abdoli, A., Abd-Rabu, R., Abolhassani, H., Abu-Gharbieh, E., Accrombessi, M. M. K., Adnani, Q. E. S., Afzal, M. S., Agarwal, G., Agrawaal, K. K., Agudelo-Botero, M., Ahinkorah, B. O., Ahmad, S., Ahmad, T., Ahmadi, K., Ahmadi, S., Ahmadi, A., Ahmed, A., Ahmed Salih, Y., Akande-Sholabi, W., Akram, T., Al Hamad, H., Al-Aly, Z., Alcalde-Rabanal, J. E., Alipour, V., Aljunid, S. M., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Ancuceanu, R., Andrei, T., Andrei, C. L., Anjana, R. M., Ansar, A., Antonazzo, I. C., Antony, B., Anyasodor, A. E., Arabloo, J., Arizmendi, D., Armocida, B., Artamonov, A. A., Arulappan, J., Aryan, Z., Asgari, S., Ashraf, T., Astell-Burt, T., Atorkey, P., Atout, M. M. W., Ayanore, M. A., Badiye, A. D., Baig, A. A., Bairwa, M., Baker, J. L., Baltatu, O. C., Banik, P. C., Barnett, A., Barone, M. T. U., Barone-Adesi, F., Barrow, A., Bedi, N., Belete, R., Belgaumi, U. I., Bell, A. W., Bennett, D. A., Bensenor, I. M., Beran, D., Bhagavathula, A. S., Bhaskar, S., Bhattacharyya, K., Bhojaraja, V. S., Bijani, A., Bikbov, B., Birara, S., Bodolica, V., Bonny, A., Brenner, H., Briko, N. I., Butt, Z. A., Caetano dos Santos, F. L., Camera, L. A., Campos-Nonato, I. R., Cao, Y., Cao, C., Cerin, E., Chakraborty, P. A., Chandan, J. S., Chattu, V. K., Chen, S., Choi, J. -Y. J., Choudhari, S. G., Chowdhury, E. K., Chu, D. -T., Corso, B., Dadras, O., Dai, X., Damasceno, A. A. M., Dandona, L., Dandona, R., Davila-Cervantes, C. A., De Neve, J. -W., Denova-Gutierrez, E., Dhamnetiya, D., Diaz, D., Ebtehaj, S., Edinur, H. A., Eftekharzadeh, S., El Sayed, I., Elgendy, I. Y., Elhadi, M., Elmonem, M. A., Faisaluddin, M., Farooque, U., Feng, X., Fernandes, E., Fischer, F., Flood, D., Freitas, M., Gaal, P. A., Gad, M. M., Gaewkhiew, P., Getacher, L., Ghafourifard, M., Ghanei Gheshlagh, R., Ghashghaee, A., Ghith, N., Ghozali, G., Gill, P. S., Ginawi, I. A., Glushkova, E. V., Golechha, M., Gopalani, S. V., Guimaraes, R. A., Gupta, R. D., Gupta, R., Gupta, V. K., Gupta, V. B., Gupta, S., Habtewold, T. D., Hafezi-Nejad, N., Halwani, R., Hanif, A., Hankey, G. J., Haque, S., Hasaballah, A. I., Hasan, S. S., Hashi, A., Hassanipour, S., Hay, S. I., Hayat, K., Heidari, M., Hossain, M. B. H., Hossain, S., Hosseini, M., Hoveidamanesh, S., Huang, J., Humayun, A., Hussain, R., Hwang, B. -F., Ibitoye, S. E., Ikuta, K. S., Inbaraj, L. R., Iqbal, U., Islam, M. S., Islam, S. M. S., Islam, R. M., Ismail, N. E., Isola, G., Itumalla, R., Iwagami, M., Iyamu, I. O., Jahani, M. A., Jakovljevic, M., Jayawardena, R., Jha, R. P., John, O., Jonas, J. B., Joo, T., Kabir, A., Kalhor, R., Kamath, A., Kanchan, T., Kandel, H., Kapoor, N., Kayode, G. A., Kebede, S. A., Keshavarz, P., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, M. A., Khan, M. N., Khan, M., Khater, A. M., Khoja, T. A. M., Khubchandani, J., Kim, M. S., Kim, Y. J., Kimokoti, R. W., Kisa, S., Kisa, A., Kivimaki, M., Korshunov, V. A., Korzh, O., Koyanagi, A., Krishan, K., Kuate Defo, B., Kumar, G. A., Kumar, N., Kusuma, D., La Vecchia, C., Lacey, B., Larsson, A. O., Lasrado, S., Lee, W. -C., Lee, C. B., Lee, P. H., Lee, S. W. H., Li, M. -C., Lim, S. S., Lim, L. -L., Lucchetti, G., Majeed, A., Malik, A. A., Mansouri, B., Mantovani, L. G., Martini, S., Mathur, P., Mcalinden, C., Mehedi, N., Mekonnen, T., Menezes, R. G., Mersha, A. G., Miao Jonasson, J., Miazgowski, T., Michalek, I. M., Mirica, A., Mirrakhimov, E. M., Mirza, A. Z., Mithra, P., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, A., Mokdad, A. H., Molokhia, M., Monasta, L., Moni, M. A., Moradpour, F., Moradzadeh, R., Mostafavi, E., Mueller, U. O., Murray, C. J. L., Mustafa, A., Nagel, G., Nangia, V., Naqvi, A. A., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, R. I., Neupane Kandel, S., Nguyen, C. T., Nguyen, H. L. T., Noubiap, J. J., Nowak, C., Oancea, B., Odukoya, O. O., Oguntade, A. S., Ojo, T. T., Olagunju, A. T., Onwujekwe, O. E., Ortiz, A., Owolabi, M. O., Palladino, R., Panda-Jonas, S., Pandi-Perumal, S. R., Pardhan, S., Parekh, T., Parvizi, M., Pepito, V. C. F., Perianayagam, A., Petcu, I. -R., Pilania, M., Podder, V., Polibin, R. V., Postma, M. J., Prashant, A., Rabiee, N., Rabiee, M., Rahimi-Movaghar, V., Rahman, M. A., Rahman, M. M., Rahman, M., Rahmawaty, S., Rajai, N., Ram, P., Rana, J., Ranabhat, K., Ranasinghe, P., Rao, C. R., Rao, S., Rawaf, S., Rawaf, D. L., Rawal, L., Renzaho, A. M. N., Rezaei, N., Rezapour, A., Riahi, S. M., Ribeiro, D., Rodriguez, J. A. B., Roever, L., Rohloff, P., Rwegerera, G. M., Ryan, P. M., Saber-Ayad, M. M., Sabour, S., Saddik, B., Saeedi Moghaddam, S., Sahebkar, A., Sahoo, H., Saif-Ur-Rahman, K. M., Salimzadeh, H., Samaei, M., Sanabria, J., Santric-Milicevic, M. M., Sathian, B., Sathish, T., Schlaich, M. P., Seidu, A. -A., Sekerija, M., Senthil Kumar, N., Seylani, A., Shaikh, M. A., Shamshad, H., Shawon, M. S. R., Sheikhbahaei, S., Shetty, J. K., Shiri, R., Shivakumar, K. M., Shuval, K., Singh, J. A., Singh, A., Skryabin, V. Y., Skryabina, A. A., Sofi-Mahmudi, A., Soheili, A., Sun, J., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Tadbiri, H., Tadesse, E. G., Tariqujjaman, M., Thankappan, K. R., Thapar, R., Thomas, N., Timalsina, B., Tobe-Gai, R., Tonelli, M., Tovani-Palone, M. R., Tran, B. X., Tripathy, J. P., Tudor Car, L., Tusa, B. S., Uddin, R., Upadhyay, E., Valadan Tahbaz, S., Valdez, P. R., Vasankari, T. J., Verma, M., Villalobos-Daniel, V. E., Vladimirov, S. K., Vo, B., Vu, G. T., Vukovic, R., Waheed, Y., Wamai, R. G., Werdecker, A., Wickramasinghe, N. D., Winkler, A. S., Wubishet, B. L., Xu, X., Xu, S., Yahyazadeh Jabbari, S. H., Yatsuya, H., Yaya, S., Yazie, T. S. Y., Yi, S., Yonemoto, N., Yunusa, I., Zadey, S., Zaman, S. B., Zamanian, M., Zamora, N., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Zhong, C., Zmaili, M., Zumla, A., Naghavi, M., Schmidt, M. I., Collaborators, GBD 2019 Diabetes Mortality, and Lacey, BWH
Subjects: Adult, Endocrinology, Diabetes and Metabolism, CHILDHOOD, universal health coverage, Global Health, 3121 Internal medicine, Global Burden of Disease, 1117 Public Health and Health Services, Endocrinology, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, Internal Medicine, Humans, Diabetes mortality, diabetes, mortality, global burden of disease, under 25 years, COHORT, health care services, COMPLICATIONS, CHALLENGES, Diabetes, Mortality trends, Age-specific diabetes, 1103 Clinical Sciences, Public Health, Global Health, Social Medicine and Epidemiology, BRAZIL, Type I Diabetes, INSULIN, 3142 Public health care science, environmental and occupational health, the Socio-demographic Index, Treatment, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, 1101 Medical Biochemistry and Metabolomics, diabete, 3121 General medicine, internal medicine and other clinical medicine, ACCESS, RA, RC
Abstract: Background:Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods:We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings:In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation:Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation.
Published: 2022

35. The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study

Author: Juanita A. Haagsma, Periklis Charalampous, Filippo Ariani, Anne Gallay, Kim Moesgaard Iburg, Evangelia Nena, Che Henry Ngwa, Alexander Rommel, Ausra Zelviene, Kedir Hussein Abegaz, Hanadi Al Hamad, Luciana Albano, Catalina Liliana Andrei, Tudorel Andrei, Ippazio Cosimo Antonazzo, Olatunde Aremu, Ashokan Arumugam, Alok Atreya, Avinash Aujayeb, Jose Luis Ayuso-Mateos, Luchuo Engelbert Bain, Maciej Banach, Till Winfried Bärnighausen, Francesco Barone-Adesi, Massimiliano Beghi, Derrick A. Bennett, Akshaya S. Bhagavathula, Félix Carvalho, Giulio Castelpietra, Ledda Caterina, Joht Singh Chandan, Rosa A. S. Couto, Natália Cruz-Martins, Giovanni Damiani, Anna Dastiridou, Andreas K. Demetriades, Diana Dias-da-Silva, Adeniyi Francis Fagbamigbe, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Pietro Ferrara, Florian Fischer, Urbano Fra.Paleo, Silvia Ghirini, James C. Glasbey, Ionela-Roxana Glavan, Nelson G. M. Gomes, Michal Grivna, Netanja I. Harlianto, Josep Maria Haro, M. Tasdik Hasan, Sorin Hostiuc, Ivo Iavicoli, Milena D. Ilic, Irena M. Ilic, Mihajlo Jakovljevic, Jost B. Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Joonas H. Kauppila, Gbenga A. Kayode, Moien A. B. Khan, Adnan Kisa, Sezer Kisa, Ai Koyanagi, Manasi Kumar, Om P. Kurmi, Carlo La-Vecchia, Demetris Lamnisos, Savita Lasrado, Paolo Lauriola, Shai Linn, Joana A. Loureiro, Raimundas Lunevicius, Aurea Madureira-Carvalho, Enkeleint A. Mechili, Azeem Majeed, Ritesh G. Menezes, Alexios-Fotios A. Mentis, Atte Meretoja, Tomislav Mestrovic, Tomasz Miazgowski, Bartosz Miazgowski, Andreea Mirica, Mariam Molokhia, Shafiu Mohammed, Lorenzo Monasta, Francesk Mulita, Mukhammad David Naimzada, Ionut Negoi, Subas Neupane, Bogdan Oancea, Hans Orru, Adrian Otoiu, Nikita Otstavnov, Stanislav S. Otstavnov, Alicia Padron-Monedero, Songhomitra Panda-Jonas, Shahina Pardhan, Jay Patel, Paolo Pedersini, Marina Pinheiro, Ivo Rakovac, Chythra R. Rao, Salman Rawaf, David Laith Rawaf, Violet Rodrigues, Luca Ronfani, Dominic Sagoe, Francesco Sanmarchi, Milena M. Santric-Milicevic, Brijesh Sathian, Aziz Sheikh, Rahman Shiri, Siddharudha Shivalli, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Catalin-Gabriel Smarandache, Bogdan Socea, Raúl A. R. C. Sousa, Paschalis Steiropoulos, Rafael Tabarés-Seisdedos, Marcos Roberto Tovani-Palone, Fimka Tozija, Sarah Van de Velde, Tommi Juhani Vasankari, Massimiliano Veroux, Francesco S. Violante, Vasiliy Vlassov, Yanzhong Wang, Ali Yadollahpour, Sanni Yaya, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Suzanne Polinder, Marek Majdan, Haagsma, J, Charalampous, P, Ariani, F, Gallay, A, Moesgaard Iburg, K, Nena, E, Ngwa, C, Rommel, A, Zelviene, A, Abegaz, K, Al Hamad, H, Albano, L, Liliana Andrei, C, Andrei, T, Antonazzo, I, Aremu, O, Arumugam, A, Atreya, A, Aujayeb, A, Ayuso-Mateos, J, Engelbert Bain, L, Banach, M, Winfried Bärnighausen, T, Barone-Adesi, F, Beghi, M, Bennett, D, Bhagavathula, A, Carvalho, F, Castelpietra, G, Caterina, L, Chandan, J, Couto, R, Cruz-Martins, N, Damiani, G, Dastiridou, A, Demetriades, A, Dias-da-Silva, D, Francis Fagbamigbe, A, Fereshtehnejad, S, Fernandes, E, Ferrara, P, Fischer, F, Fra. Paleo, U, Ghirini, S, Glasbey, J, Glavan, I, Gomes, N, Grivna, M, Harlianto, N, Haro, J, Hasan, M, Hostiuc, S, Iavicoli, I, Ilic, M, Ilic, I, Jakovljevic, M, Jonas, J, Jerzy Jozwiak, J, Jürisson, M, Kauppila, J, Kayode, G, Khan, M, Kisa, A, Kisa, S, Koyanagi, A, Kumar, M, Kurmi, O, La-Vecchia, C, Lamnisos, D, Lasrado, S, Lauriola, P, Linn, S, Loureiro, J, Lunevicius, R, Madureira-Carvalho, A, Mechili, E, Majeed, A, Menezes, R, Mentis, A, Meretoja, A, Mestrovic, T, Miazgowski, T, Miazgowski, B, Mirica, A, Molokhia, M, Mohammed, S, Monasta, L, Mulita, F, David Naimzada, M, Negoi, I, Neupane, S, Oancea, B, Orru, H, Otoiu, A, Otstavnov, N, Otstavnov, S, Padron-Monedero, A, Panda-Jonas, S, Pardhan, S, Patel, J, Pedersini, P, Pinheiro, M, Rakovac, I, Rao, C, Rawaf, S, Rawaf, D, Rodrigues, V, Ronfani, L, Sagoe, D, Sanmarchi, F, Santric-Milicevic, M, Sathian, B, Sheikh, A, Shiri, R, Shivalli, S, Dora Sigfusdottir, I, Sigurvinsdottir, R, Yurievich Skryabin, V, Aleksandrovna Skryabina, A, Smarandache, C, Socea, B, Sousa, R, Steiropoulos, P, Tabarés-Seisdedos, R, Roberto Tovani-Palone, M, Tozija, F, Van de Velde, S, Juhani Vasankari, T, Veroux, M, Violante, F, Vlassov, V, Wang, Y, Yadollahpour, A, Yaya, S, Sergeevich Zastrozhin, M, Zastrozhina, A, Polinder, S, Majdan, M, Haagsma, J. A., Charalampous, P., Ariani, F., Gallay, A., Moesgaard Iburg, K., Nena, E., Ngwa, C. H., Rommel, A., Zelviene, A., Abegaz, K. H., Al Hamad, H., Albano, L., Liliana Andrei, C., Andrei, T., Antonazzo, I. C., Aremu, O., Arumugam, A., Atreya, A., Aujayeb, A., Ayuso-Mateos, J. L., Engelbert Bain, L., Banach, M., Winfried Barnighausen, T., Barone-Adesi, F., Beghi, M., Bennett, D. A., Bhagavathula, A. S., Carvalho, F., Castelpietra, G., Caterina, L., Chandan, J. S., Couto, R. A. S., Cruz-Martins, N., Damiani, G., Dastiridou, A., Demetriades, A. K., Dias-da-Silva, D., Fagbamigbe, A. F., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, P., Fischer, F., Fr, a. Paleo U., Ghirini, S., Glasbey, J. C., Glavan, I. -R., Gomes, N. G. M., Grivna, M., Harlianto, N. I., Haro, J. M., Hasan, M. T., Hostiuc, S., Iavicoli, I., Ilic, M. D., Ilic, I. M., Jakovljevic, M., Jonas, J. B., Jerzy Jozwiak, J., Jurisson, M., Kauppila, J. H., Kayode, G. A., Khan, M. A. B., Kisa, A., Kisa, S., Koyanagi, A., Kumar, M., Kurmi, O. P., La-Vecchia, C., Lamnisos, D., Lasrado, S., Lauriola, P., Linn, S., Loureiro, J. A., Lunevicius, R., Madureira-Carvalho, A., Mechili, E. A., Majeed, A., Menezes, R. G., Mentis, A. -F. A., Meretoja, A., Mestrovic, T., Miazgowski, T., Miazgowski, B., Mirica, A., Molokhia, M., Mohammed, S., Monasta, L., Mulita, F., David Naimzada, M., Negoi, I., Neupane, S., Oancea, B., Orru, H., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Padron-Monedero, A., Panda-Jonas, S., Pardhan, S., Patel, J., Pedersini, P., Pinheiro, M., Rakovac, I., Rao, C. R., Rawaf, S., Rawaf, D. L., Rodrigues, V., Ronfani, L., Sagoe, D., Sanmarchi, F., Santric-Milicevic, M. M., Sathian, B., Sheikh, A., Shiri, R., Shivalli, S., Dora Sigfusdottir, I., Sigurvinsdottir, R., Yurievich Skryabin, V., Aleksandrovna Skryabina, A., Smarandache, C. -G., Socea, B., Sousa, R. A. R. C., Steiropoulos, P., Tabares-Seisdedos, R., Roberto Tovani-Palone, M., Tozija, F., Van de Velde, S., Juhani Vasankari, T., Veroux, M., Violante, F. S., Vlassov, V., Wang, Y., Yadollahpour, A., Yaya, S., Sergeevich Zastrozhin, M., Zastrozhina, A., Polinder, S., Majdan, M., Haagsma, Ja, Iburg, Km, Ngwa, Ch, Abegaz, Kh, Andrei, Cl, Antonazzo, Ic, Ayuso-Mateos, Jl, Bain, Le, Barnighausen, Tw, Bennett, Da, Couto, Ra, Demetriades, Ak, Fagbamigbe, Af, Fereshtehnejad, Sm, Fra Paleo, U, Glasbey, Jc, Glavan, Ir, Gomes, Ngm, Harlianto, Ni, Haro, Jm, Hasan, Mt, Ilic, Md, Ilic, Im, Jonas, Jb, Jozwiak, Jj, Jurisson, M, Kauppila, Jh, Kayode, Ga, Khan, Mab, Kurmi, Op, Loureiro, Ja, Mechili, Ea, Menezes, Rg, Mentis, Afa, Naimzada, Md, Rao, Cr, Rawaf, Dl, Santric-Milicevic, Mm, Sigfusdottir, Id, Skryabin, Vy, Skryabina, Aa, Smarandache, Cg, Sousa, Rarc, Tabares-Seisdedos, R, Tovani-Palone, Mr, Vasankari, Tj, Wang, Yz, Zastrozhin, M, Bill & Melinda Gates Foundation, Clinicum, University of Helsinki, HUS Neurocenter, Neurologian yksikkö, Public Health, Tampere University, Health Sciences, and Clinical Medicine
Subjects: Science & Technology, Injuries, DEATHS, Public Health, Environmental and Occupational Health, Burden of disease, Public Health, Global Health, Social Medicine and Epidemiology, 3121 Internal medicine, Disability adjusted life years, Mortality, Europe, 3142 Public health care science, environmental and occupational health, 1117 Public Health and Health Services, Injurie, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, SDG 3 - Good Health and Well-being, INEQUALITIES, Public Health, Human medicine, Disability adjusted life year, Life Sciences & Biomedicine, Public, Environmental & Occupational Health
Abstract: Background Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. Results In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. Conclusions Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.
Published: 2022

36. The global burden of cancer attributable to risk factors, 2010–19 : A systematic analysis for the Global Burden of Disease Study 2019

Author: Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, 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Thomas, N, Ticoalu, J, Tiyuri, A, Tollosa, D, Topor-Madry, R, Touvier, M, Tovani-Palone, M, Traini, E, Tran, M, Tripathy, J, Ukke, G, Ullah, I, Ullah, S, Unnikrishnan, B, Vacante, M, Vaezi, M, Valadan Tahbaz, S, Valdez, P, Vardavas, C, Varthya, S, Vaziri, S, Velazquez, D, Veroux, M, Villeneuve, P, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Vu, L, Wadood, A, Waheed, Y, Walde, M, Wamai, R, Wang, C, Wang, F, Wang, N, Wang, Y, Ward, P, Waris, A, Westerman, R, Wickramasinghe, N, Woldemariam, M, Woldu, B, Xiao, H, Xu, S, Xu, X, Yadav, L, Yahyazadeh Jabbari, S, Yang, L, Yazdanpanah, F, Yeshaw, Y, Yismaw, Y, Yonemoto, N, Younis, M, Yousefi, Z, Yousefian, F, Yu, C, Yu, Y, Yunusa, I, Zahir, M, Zaki, N, Zaman, B, Zangiabadian, M, Zare, F, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeineddine, M, Zhang, D, Zhang, J, Zhang, Y, Zhang, Z, Zhou, L, Zodpey, S, Zoladl, M, Vos, T, Hay, S, Force, L, Murray, C, Epidemiologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Bill & Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division
Subjects: Male, DEATHS, DALY, cancer, risk factors, Medizin, systematic analysis, Global Health, Risk Assessment, Cancer prevention, Global Burden of Disease, RC0254, Risk-attributable cancer deaths, SDG 3 - Good Health and Well-being, RA0421, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Quality-Adjusted Life Year, Neoplasms, cancer, Humans, Global Burden of Disease Study, UK, Medicine(all), MCC, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Risk Factor, Smoking, COVID-19, 3rd-DAS, General Medicine, Disability-adjusted life-years, SOCIAL DETERMINANTS, Risk assessments, risk factor, Cardiovascular and Metabolic Diseases, 3121 General medicine, internal medicine and other clinical medicine, OBESITY, Cancer burden, Neoplasm, Female, LIFE-STYLE, Quality-Adjusted Life Years, HEALTH, RA, Human, RC
Abstract: Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí
Published: 2022

37. Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Brittney S Sheena, Lindsey Hiebert, Hannah Han, Helen Ippolito, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Amir Abdoli, Hiwa Abubaker Ali, Mesafint Molla Adane, Oyelola A Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad Sohail Afzal, Saira Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Sepideh Ahmadi, Haroon Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Gizachew Taddesse Akalu, Addis Aklilu, Tayyaba Akram, Hanadi Al Hamad, Fares Alahdab, Adugnaw Zeleke Alem, Dejene Tsegaye Alem, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Liaqat Ali, Muhammad Ashar Ali, Yousef Alimohamadi, Vahid Alipour, Motasem Alkhayyat, Sami Almustanyir, Rajaa M Al-Raddadi, Haya Altawalah, Saeed Amini, Hubert Amu, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Amir Anoushiravani, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Ayele Mamo Argaw, Zeleke Gebru Argaw, Muhammad Arshad, Anton A Artamonov, Tahira Ashraf, Daniel Atlaw, Floriane Ausloos, Marcel Ausloos, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ghasem Azarian, Sayna Bagheri, Saeed Bahadory, Atif Amin Baig, Maciej Banach, Nastaran Barati, Amadou Barrow, Abdul-Monim Mohammad Batiha, Diana Fernanda Bejarano Ramirez, Uzma Iqbal Belgaumi, Alemshet Yirga Berhie, Devidas S Bhagat, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Antonio Biondi, Belay Boda Abule Bodicha, Hunduma Amensisa Bojia, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Nikolay Ivanovich Briko, Zahid A Butt, Luis Alberto Cámera, Raja Chandra Chakinala, Promit Ananyo Chakraborty, Jaykaran Charan, Shu Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Fazle Rabbi Chowdhury, Dinh-Toi Chu, Sheng-Chia Chung, Paolo Angelo Cortesi, Benjamin C Cowie, Garland T Culbreth, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Fernando Pio De la Hoz, Sisay Abebe Debela, Mohammed Gebre Dedefo, Feleke Mekonnen Demeke, Takele Gezahegn G Demie, Getu Debalkie Demissie, Meseret Derbew Molla, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mojtaba Didehdar, Linh Phuong Doan, Fariba Dorostkar, Thomas M Drake, Fatemeh Eghbalian, Michael Ekholuenetale, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Mohamed A Elmonem, Aisha Elsharkawy, Shymaa Enany, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Sayeh Ezzikouri, Hossein Farrokhpour, Getahun Fetensa, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Abhay Motiramji Gaidhane, Shilpa Gaidhane, Natalie C Galles, Silvano Gallus, Teferi Gebru Gebremeskel, Eyob Alemayehu Gebreyohannes, Keyghobad Ghadiri, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Ahmad Ghashghaee, Ali Gholami, Abdolmajid Gholizadeh, Aima Gilani, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Giuseppe Gorini, Yitayal Ayalew Goshu, Max G Griswold, Mohammed Ibrahim Mohialdeen Gubari, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Rasool Haddadi, Rabih Halwani, Saeed S Hamid, Samer Hamidi, Asif Hanif, Shafiul Haque, Harapan Harapan, Arief Hargono, Sanam Hariri, Ahmed I Hasaballah, S M Mahmudul Hasan, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Khezar Hayat, Golnaz Heidari, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Ramesh Holla, Mohammad-Salar Hosseini, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Mowafa Househ, Junjie Huang, Nawfal R Hussein, Ivo Iavicoli, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Lalu Muhammad Irham, Jessica Y Islam, Nahlah Elkudssiah Ismail, Kathryn H Jacobsen, Farhad Jadidi-Niaragh, Amirreza Javadi Mamaghani, Shubha Jayaram, Ranil Jayawardena, Rime Jebai, Ravi Prakash Jha, Nitin Joseph, Farahnaz Joukar, Billingsley Kaambwa, Ali Kabir, Zubair Kabir, Rohollah Kalhor, Himal Kandel, Tesfaye K Tesfaye Kanko, Rami S Kantar, Ibraheem M Karaye, Bekalu Getnet Kassa, Phillip M Kemp Bohan, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Gulfaraz Khan, Imteyaz A Khan, Junaid Khan, Moien AB Khan, Javad Khanali, Amir M Khater, Mahalaqua Nazli Khatib, Mahmoud Khodadost, Abdullah T Khoja, Omid Khosravizadeh, Jagdish Khubchandani, Gyu Ri Kim, Hanna Kim, Min Seo Kim, Yun Jin Kim, Jonathan M Kocarnik, Ali-Asghar Kolahi, Rajasekaran Koteeswaran, G Anil Kumar, Carlo La Vecchia, Dharmesh Kumar Lal, Iván Landires, Savita Lasrado, Jeffrey V Lazarus, Caterina Ledda, Doo Woong Lee, Sang-woong Lee, Yeong Yeh Lee, Miriam Levi, Jiarui Li, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Joana A Loureiro, Jennifer H MacLachlan, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Azeem Majeed, Alaa Makki, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Fariborz Mansour-Ghanaei, Mohammad Ali Mansournia, Francisco Rogerlândio Martins-Melo, Philippa C Matthews, Walter Mendoza, Ritesh G Menezes, Tuomo J Meretoja, Amanual Getnet Mersha, Tomislav Mestrovic, Ted R Miller, Le Huu Nhat Minh, Andreea Mirica, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Prasanna Mithra, Babak Moazen, Ashraf Mohamadkhani, Mokhtar Mohammadi, Shafiu Mohammed, Nagabhishek Moka, Ali H Mokdad, Jalal Moludi, Sara Momtazmanesh, Lorenzo Monasta, Ghobad Moradi, Maliheh Moradzadeh, Rahmatollah Moradzadeh, Paula Moraga, Ebrahim Mostafavi, Sumaira Mubarik, Malaisamy Muniyandi, Christopher J L Murray, Mohsen Naghavi, Mukhammad David Naimzada, Sreenivas Narasimha Swamy, Zuhair S Natto, Biswa Prakash Nayak, Javad Nazari, Ionut Negoi, Serban Mircea Negru, Seyed Aria Nejadghaderi, Sandhya Neupane Kandel, Huong Lan Thi Nguyen, Che Henry Ngwa, Robina Khan Niazi, Chukwudi A Nnaji, Jean Jacques Noubiap, Ali Nowroozi, Virginia Nuñez-Samudio, Bogdan Oancea, Chimedsuren Ochir, Oluwakemi Ololade Odukoya, In-Hwan Oh, Andrew T Olagunju, Babayemi Oluwaseun Olakunde, Ahmed Omar Bali, Emad Omer, Stanislav S Otstavnov, Bilcha Oumer, Jagadish Rao Padubidri, Adrian Pana, Anamika Pandey, Eun-Cheol Park, Fatemeh Pashazadeh Kan, Urvish K Patel, Uttam Paudel, Ionela-Roxana Petcu, Zahra Zahid Piracha, Richard Charles G Pollok, Maarten J Postma, Akram Pourshams, Hossein Poustchi, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Sima Rafiei, Pavan Manibettu Raghuram, Mosiur Rahman, Amir Masoud Rahmani, Setyaningrum Rahmawaty, Aashish Rajesh, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Mahsa Rashidi, Mohammad-Mahdi Rashidi, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Negar Rezaei, Aziz Rezapour, Sahba Rezazadeh-Khadem, Jefferson Antonio Buendia Rodriguez, Godfrey M Rwegerera, Siamak Sabour, Basema Saddik, Mohammad Reza Saeb, Umar Saeed, Amirhossein Sahebkar, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Chethan Sampath, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, Milena M Santric-Milicevic, Arash Sarveazad, Brijesh Sathian, Monika Sawhney, Abdul-Aziz Seidu, Sadaf G Sepanlou, Allen Seylani, Saeed Shahabi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mohammed Shannawaz, Suchitra M Shenoy, Jeevan K Shetty, Pavanchand H Shetty, Kenji Shibuya, Jae Il Shin, Parnian Shobeiri, Migbar Mekonnen Sibhat, Achintya Dinesh Singh, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Amir Ali Sohrabpour, Suhang Song, Seidamir Pasha Tabaeian, Eyayou Girma Tadesse, Majid Taheri, Mircea Tampa, Ker-Kan Tan, Ahmad Tavakoli, Abdelghani Tbakhi, Belay Negash Tefera, Arash Tehrani-Banihashemi, Habtamu Molla Tesfaw, Rekha Thapar, Aravind Thavamani, Seyed Abolfazl Tohidast, Daniel Nigusse Tollosa, Maria Elena Tosti, Marcos Roberto Tovani-Palone, Eugenio Traini, Mai Thi Ngoc Tran, Indang Trihandini, Biruk Shalmeno Tusa, Irfan Ullah, Marco Vacante, Sahel Valadan Tahbaz, Pascual R Valdez, Shoban Babu Varthya, Bay Vo, Yasir Waheed, Adisu Birhanu Weldesenbet, Melat Woldemariam, Suowen Xu, Seyed Hossein Yahyazadeh Jabbari, Mehdi Yaseri, Yigizie Yeshaw, Vahit Yiğit, Birhanu Wubale Yirdaw, Naohiro Yonemoto, Chuanhua Yu, Ismaeel Yunusa, Mazyar Zahir, Leila Zaki, Mohammad Zamani, Maryam Zamanian, Mikhail Sergeevich Zastrozhin, Theo Vos, John W Ward, M Ashworth Dirac, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), Sheena, Brittney S, Hiebert, Lindsey, Han, Hannah, Ippolito, Helen, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abbastabar, Hedayat, Abdoli, Amir, Abubaker Ali, Hiwa, Adane, Mesafint Molla, Adegboye, Oyelola A, Adnani, Qorinah Estiningtyas Sakilah, Advani, Shailesh M, Afzal, Muhammad Sohail, Afzal, Saira, Aghaie Meybodi, Mohamad, Ahadinezhad, Bahman, Ahinkorah, Bright Opoku, Ahmad, Sajjad, Ahmad, Tauseef, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed, Muktar Beshir, Ahmed Rashid, Tarik, Akalu, Gizachew Taddesse, 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Soheil, Hassankhani, Hadi, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Holla, Ramesh, Hosseini, Mohammad-Salar, Hosseini, Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Househ, Mowafa, Huang, Junjie, Hussein, Nawfal R, Iavicoli, Ivo, Ibitoye, Segun Emmanuel, Ilesanmi, Olayinka Stephen, Ilic, Irena M, Ilic, Milena D, Irham, Lalu Muhammad, Islam, Jessica Y, Ismail, Nahlah Elkudssiah, Jacobsen, Kathryn H, Jadidi-Niaragh, Farhad, Javadi Mamaghani, Amirreza, Jayaram, Shubha, Jayawardena, Ranil, Jebai, Rime, Jha, Ravi Prakash, Joseph, Nitin, Joukar, Farahnaz, Kaambwa, Billingsley, Kabir, Ali, Kabir, Zubair, Kalhor, Rohollah, Kandel, Himal, Kanko, Tesfaye K Tesfaye, Kantar, Rami S, Karaye, Ibraheem M, Kassa, Bekalu Getnet, Kemp Bohan, Phillip M, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khan, Gulfaraz, Khan, Imteyaz A, Khan, Junaid, Khan, Moien AB, Khanali, Javad, Khater, Amir M, Khatib, Mahalaqua Nazli, Khodadost, Mahmoud, Khoja, Abdullah T, Khosravizadeh, Omid, Khubchandani, Jagdish, Kim, Gyu Ri, Kim, Hanna, Kim, Min Seo, Kim, Yun Jin, Kocarnik, Jonathan M, Kolahi, Ali-Asghar, Koteeswaran, Rajasekaran, Kumar, G Anil, La Vecchia, Carlo, Lal, Dharmesh Kumar, Landires, Iván, Lasrado, Savita, Lazarus, Jeffrey V, Ledda, Caterina, Lee, Doo Woong, Lee, Sang-woong, Lee, Yeong Yeh, Levi, Miriam, Li, Jiarui, Lim, Stephen S, Lobo, Stany W, Lopukhov, Platon D, Loureiro, Joana A, MacLachlan, Jennifer H, Magdy Abd El Razek, Hassan, Magdy Abd El Razek, Muhammed, Majeed, Azeem, Makki, Alaa, Malekpour, Mohammad-Reza, Malekzadeh, Reza, Malik, Ahmad Azam, Mansour-Ghanaei, Fariborz, Mansournia, Mohammad Ali, Martins-Melo, Francisco Rogerlândio, Matthews, Philippa C, Mendoza, Walter, Menezes, Ritesh G, Meretoja, Tuomo J, Mersha, Amanual Getnet, Mestrovic, Tomislav, Miller, Ted R, Minh, Le Huu Nhat, Mirica, Andreea, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Misra, Sanjeev, Mithra, Prasanna, Moazen, 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Petcu, Ionela-Roxana, Piracha, Zahra Zahid, Pollok, Richard Charles G, Postma, Maarten J, Pourshams, Akram, Poustchi, Hossein, Rabiee, Mohammad, Rabiee, Navid, Rafiei, Alireza, Rafiei, Sima, Raghuram, Pavan Manibettu, Rahman, Mosiur, Rahmani, Amir Masoud, Rahmawaty, Setyaningrum, Rajesh, Aashish, Ranasinghe, Priyanga, Rao, Chythra R, Rao, Sowmya J, Rashidi, Mahsa, Rashidi, Mohammad-Mahdi, Rawaf, David Laith, Rawaf, Salman, Rawassizadeh, Reza, Rezaei, Negar, Rezapour, Aziz, Rezazadeh-Khadem, Sahba, Rodriguez, Jefferson Antonio Buendia, Rwegerera, Godfrey M, Sabour, Siamak, Saddik, Basema, Saeb, Mohammad Reza, Saeed, Umar, Sahebkar, Amirhossein, Saif-Ur-Rahman, KM, Salahi, Sarvenaz, Salimzadeh, Hamideh, Sampath, Chethan, Samy, Abdallah M, Sanabria, Juan, Sanmarchi, Francesco, Santric-Milicevic, Milena M, Sarveazad, Arash, Sathian, Brijesh, Sawhney, Monika, Seidu, Abdul-Aziz, Sepanlou, Sadaf G, Seylani, Allen, Shahabi, Saeed, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Shannawaz, Mohammed, Shenoy, Suchitra M, Shetty, Jeevan K, Shetty, Pavanchand H, Shibuya, Kenji, Shin, Jae Il, Shobeiri, Parnian, Sibhat, Migbar Mekonnen, Singh, Achintya Dinesh, Singh, Jasvinder A, Singh, Surjit, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sohrabpour, Amir Ali, Song, Suhang, Tabaeian, Seidamir Pasha, Tadesse, Eyayou Girma, Taheri, Majid, Tampa, Mircea, Tan, Ker-Kan, Tavakoli, Ahmad, Tbakhi, Abdelghani, Tefera, Belay Negash, Tehrani-Banihashemi, Arash, Tesfaw, Habtamu Molla, Thapar, Rekha, Thavamani, Aravind, Tohidast, Seyed Abolfazl, Tollosa, Daniel Nigusse, Tosti, Maria Elena, Tovani-Palone, Marcos Roberto, Traini, Eugenio, Tran, Mai Thi Ngoc, Trihandini, Indang, Tusa, Biruk Shalmeno, Ullah, Irfan, Vacante, Marco, Valadan Tahbaz, Sahel, Valdez, Pascual R, Varthya, Shoban Babu, Vo, Bay, Waheed, Yasir, Weldesenbet, Adisu Birhanu, Woldemariam, Melat, Xu, Suowen, Yahyazadeh Jabbari, Seyed Hossein, Yaseri, Mehdi, Yeshaw, Yigizie, Yiğit, Vahit, Yirdaw, Birhanu Wubale, Yonemoto, Naohiro, Yu, Chuanhua, Yunusa, Ismaeel, Zahir, Mazyar, Zaki, Leila, Zamani, Mohammad, Zamanian, Maryam, Zastrozhin, Mikhail Sergeevich, Vos, Theo, Ward, John W, Dirac, M Ashworth, Sheena, B, Hiebert, L, Han, H, Ippolito, H, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abbastabar, H, Abdoli, A, Abubaker Ali, H, Adane, M, Adegboye, O, Adnani, Q, Advani, S, Afzal, M, Afzal, S, Aghaie Meybodi, M, Ahadinezhad, B, Ahinkorah, B, Ahmad, S, Ahmad, T, Ahmadi, S, Ahmed, H, Ahmed, M, Rashid, T, Akalu, G, Aklilu, A, Akram, T, Al Hamad, H, Alahdab, F, Alem, A, Alem, D, Alhalaiqa, F, Alhassan, R, Ali, L, Ali, M, Alimohamadi, Y, Alipour, V, Alkhayyat, M, Almustanyir, S, Al-Raddadi, R, Altawalah, H, Amini, S, Amu, H, Ancuceanu, R, Andrei, C, Andrei, T, Anoushiravani, A, Ansar, A, Anyasodor, A, Arabloo, J, Arab-Zozani, M, Argaw, A, Argaw, Z, Arshad, M, Artamonov, A, Ashraf, T, Atlaw, D, Ausloos, F, Ausloos, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari Jafari, A, Azarian, G, Bagheri, S, Bahadory, S, Baig, A, Banach, M, Barati, N, Barrow, A, Batiha, A, Bejarano Ramirez, D, Belgaumi, U, Berhie, A, Bhagat, D, Bhardwaj, N, Bhardwaj, P, Bhattacharyya, K, Bhojaraja, V, Bijani, A, Biondi, A, Bodicha, B, Bojia, H, Boloor, A, Bosetti, C, Braithwaite, D, Briko, N, Butt, Z, Camera, L, Chakinala, R, Chakraborty, P, Charan, J, Chen, S, Choi, J, Choudhari, S, Chowdhury, F, Chu, D, Chung, S, Cortesi, P, Cowie, B, Culbreth, G, Dadras, O, Dai, X, Dandona, L, Dandona, R, De La Hoz, F, Debela, S, Dedefo, M, Demeke, F, Demie, T, Demissie, G, Derbew Molla, M, Desta, A, Dhamnetiya, D, Dhimal, M, Didehdar, M, Doan, L, Dorostkar, F, Drake, T, Eghbalian, F, Ekholuenetale, M, El Sayed, I, El Sayed Zaki, M, Elhadi, M, Elmonem, M, Elsharkawy, A, Enany, S, Enyew, D, Erkhembayar, R, Eskandarieh, S, Esmaeilzadeh, F, Ezzikouri, S, Farrokhpour, H, Fetensa, G, Fischer, F, Foroutan, M, Gad, M, Gaidhane, A, Gaidhane, S, Galles, N, Gallus, S, Gebremeskel, T, Gebreyohannes, E, 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Khubchandani, J, Kim, G, Kim, H, Kim, M, Kim, Y, Kocarnik, J, Kolahi, A, Koteeswaran, R, Kumar, G, La Vecchia, C, Lal, D, Landires, I, Lasrado, S, Lazarus, J, Ledda, C, Lee, D, Lee, S, Lee, Y, Levi, M, Li, J, Lim, S, Lobo, S, Lopukhov, P, Loureiro, J, Maclachlan, J, Magdy Abd El Razek, H, Magdy Abd El Razek, M, Majeed, A, Makki, A, Malekpour, M, Malekzadeh, R, Malik, A, Mansour-Ghanaei, F, Mansournia, M, Martins-Melo, F, Matthews, P, Mendoza, W, Menezes, R, Meretoja, T, Mersha, A, Mestrovic, T, Miller, T, Minh, L, Mirica, A, Mirmoeeni, S, Mirrakhimov, E, Misra, S, Mithra, P, Moazen, B, Mohamadkhani, A, Mohammadi, M, Mohammed, S, Moka, N, Mokdad, A, Moludi, J, Momtazmanesh, S, Monasta, L, Moradi, G, Moradzadeh, M, Moradzadeh, R, Moraga, P, Mostafavi, E, Mubarik, S, Muniyandi, M, Murray, C, Naghavi, M, Naimzada, M, Narasimha Swamy, S, Natto, Z, Nayak, B, Nazari, J, Negoi, I, Negru, S, Nejadghaderi, S, Neupane Kandel, S, Nguyen, H, Ngwa, C, Niazi, R, Nnaji, C, Noubiap, J, Nowroozi, A, Nunez-Samudio, V, Oancea, B, Ochir, C, Odukoya, O, Oh, I, Olagunju, A, Olakunde, B, Omar Bali, A, Omer, E, Otstavnov, S, Oumer, B, Padubidri, J, Pana, A, Pandey, A, Park, E, Pashazadeh Kan, F, Patel, U, Paudel, U, Petcu, I, Piracha, Z, Pollok, R, Postma, M, Pourshams, A, Poustchi, H, Rabiee, M, Rabiee, N, Rafiei, A, Rafiei, S, Raghuram, P, Rahman, M, Rahmani, A, Rahmawaty, S, Rajesh, A, Ranasinghe, P, Rao, C, Rao, S, Rashidi, M, Rawaf, D, Rawaf, S, Rawassizadeh, R, Rezaei, N, Rezapour, A, Rezazadeh-Khadem, S, Rodriguez, J, Rwegerera, G, Sabour, S, Saddik, B, Saeb, M, Saeed, U, Sahebkar, A, Saif-Ur-Rahman, K, Salahi, S, Salimzadeh, H, Sampath, C, Samy, A, Sanabria, J, Sanmarchi, F, Santric-Milicevic, M, Sarveazad, A, Sathian, B, Sawhney, M, Seidu, A, Sepanlou, S, Seylani, A, Shahabi, S, Shaikh, M, Shaker, E, Shakhmardanov, M, Shannawaz, M, Shenoy, S, Shetty, J, Shetty, P, Shibuya, K, Shin, J, Shobeiri, P, Sibhat, M, Singh, A, Singh, J, Singh, S, Skryabin, V, Skryabina, A, Sohrabpour, A, Song, S, Tabaeian, S, Tadesse, E, Taheri, M, Tampa, M, Tan, K, Tavakoli, A, Tbakhi, A, Tefera, B, Tehrani-Banihashemi, A, Tesfaw, H, Thapar, R, Thavamani, A, Tohidast, S, Tollosa, D, Tosti, M, Tovani-Palone, M, Traini, E, Tran, M, Trihandini, I, Tusa, B, Ullah, I, Vacante, M, Valadan Tahbaz, S, Valdez, P, Varthya, S, Vo, B, Waheed, Y, Weldesenbet, A, Woldemariam, M, Xu, S, Yahyazadeh Jabbari, S, Yaseri, M, Yeshaw, Y, Yigit, V, Yirdaw, B, Yonemoto, N, Yu, C, Yunusa, I, Zahir, M, Zaki, L, Zamani, M, Zamanian, M, Zastrozhin, M, Vos, T, Ward, J, Dirac, M, Helsinki University Hospital Area, HUS Comprehensive Cancer Center, Sheena, B. S., Hiebert, L., Han, H., Ippolito, H., Abbasi-Kangevari, M., Abbasi-Kangevari, Z., Abbastabar, H., Abdoli, A., Abubaker Ali, H., Adane, M. M., Adegboye, O. A., Adnani, Q. E. S., Advani, S. M., Afzal, M. S., Afzal, S., Aghaie Meybodi, M., Ahadinezhad, B., Ahinkorah, B. O., Ahmad, S., Ahmad, T., Ahmadi, S., Ahmed, H., Ahmed, M. B., Rashid, T. A., Akalu, G. T., Aklilu, A., Akram, T., Al Hamad, H., Alahdab, F., Alem, A., Alem, D. T., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, L., Ali, M. A., Alimohamadi, Y., Alipour, V., Alkhayyat, M., Almustanyir, S., Al-Raddadi, R. M., Altawalah, H., Amini, S., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Anoushiravani, A., Ansar, A., Anyasodor, A. E., Arabloo, J., Arab-Zozani, M., Argaw, A. M., Argaw, Z. G., Arshad, M., Artamonov, A. A., Ashraf, T., Atlaw, D., Ausloos, F., Ausloos, M., Azadnajafabad, S., Azangou-Khyavy, M., Azari Jafari, A., Azarian, G., Bagheri, S., Bahadory, S., Baig, A. A., Banach, M., Barati, N., Barrow, A., Batiha, A. -M. M., Bejarano Ramirez, D. F., Belgaumi, U. I., Berhie, A. Y., Bhagat, D. S., Bhardwaj, N., Bhardwaj, P., Bhattacharyya, K., Bhojaraja, V. S., Bijani, A., Biondi, A., Bodicha, B. B. A., Bojia, H. A., Boloor, A., Bosetti, C., Braithwaite, D., Briko, N. I., Butt, Z. A., Camera, L. A., Chakinala, R. C., Chakraborty, P. A., Charan, J., Chen, S., Choi, J. -Y. J., Choudhari, S. G., Chowdhury, F. R., Chu, D. -T., Chung, S. -C., Cortesi, P. A., Cowie, B. C., Culbreth, G. T., Dadras, O., Dai, X., Dandona, L., Dandona, R., De La Hoz, F. P., Debela, S. A., Dedefo, M. G., Demeke, F. M., Demie, T. G. G., Demissie, G. D., Derbew Molla, M., Desta, A. A., Dhamnetiya, D., Dhimal, M. L., Dhimal, M., Didehdar, M., Doan, L. P., Dorostkar, F., Drake, T. M., Eghbalian, F., Ekholuenetale, M., El Sayed, I., El Sayed Zaki, M., Elhadi, M., Elmonem, M. A., Elsharkawy, A., Enany, S., Enyew, D. B., Erkhembayar, R., Eskandarieh, S., Esmaeilzadeh, F., Ezzikouri, S., Farrokhpour, H., Fetensa, G., Fischer, F., Foroutan, M., Gad, M. M., Gaidhane, A. M., Gaidhane, S., Galles, N. C., Gallus, S., Gebremeskel, T. G., Gebreyohannes, E. A., Ghadiri, K., Ghaffari, K., Ghafourifard, M., Ghamari, S. -H., Ghashghaee, A., Gholami, A., Gholizadeh, A., Gilani, A., Goel, A., Golechha, M., Goleij, P., Golinelli, D., Gorini, G., Goshu, Y. A., Griswold, M. G., Gubari, M. I. M., Gupta, B., Gupta, S., Gupta, V. B., Gupta, V. K., Haddadi, R., Halwani, R., Hamid, S. S., Hamidi, S., Hanif, A., Haque, S., Harapan, H., Hargono, A., Hariri, S., Hasaballah, A. I., Hasan, S. M. M., Hassanipour, S., Hassankhani, H., Hay, S. I., Hayat, K., Heidari, G., Herteliu, C., Heyi, D. Z., Hezam, K., Holla, R., Hosseini, M. -S., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Househ, M., Huang, J., Hussein, N. R., Iavicoli, I., Ibitoye, S. E., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Irham, L. M., Islam, J. Y., Ismail, N. E., Jacobsen, K. H., Jadidi-Niaragh, F., Javadi Mamaghani, A., Jayaram, S., Jayawardena, R., Jebai, R., Jha, R. P., Joseph, N., Joukar, F., Kaambwa, B., Kabir, A., Kabir, Z., Kalhor, R., Kandel, H., Kanko, T. K. T., Kantar, R. S., Karaye, I. M., Kassa, B. G., Kemp Bohan, P. M., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, G., Khan, I. A., Khan, J., Khan, M. A., Khanali, J., Khater, A. M., Khatib, M. N., Khodadost, M., Khoja, A. T., Khosravizadeh, O., Khubchandani, J., Kim, G. R., Kim, H., Kim, M. S., Kim, Y. J., Kocarnik, J. M., Kolahi, A. -A., Koteeswaran, R., Kumar, G. A., La Vecchia, C., Lal, D. K., Landires, I., Lasrado, S., Lazarus, J. V., Ledda, C., Lee, D. W., Lee, S. -W., Lee, Y. Y., Levi, M., Li, J., Lim, S. S., Lobo, S. W., Lopukhov, P. D., Loureiro, J. A., Maclachlan, J. H., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Majeed, A., Makki, A., Malekpour, M. -R., Malekzadeh, R., Malik, A. A., Mansour-Ghanaei, F., Mansournia, M. A., Martins-Melo, F. R., Matthews, P. C., Mendoza, W., Menezes, R. G., Meretoja, T. J., Mersha, A. G., Mestrovic, T., Miller, T. R., Minh, L. H. N., Mirica, A., Mirmoeeni, S., Mirrakhimov, E. M., Misra, S., Mithra, P., Moazen, B., Mohamadkhani, A., Mohammadi, M., Mohammed, S., Moka, N., Mokdad, A. H., Moludi, J., Momtazmanesh, S., Monasta, L., Moradi, G., Moradzadeh, M., Moradzadeh, R., Moraga, P., Mostafavi, E., Mubarik, S., Muniyandi, M., Murray, C. J. L., Naghavi, M., Naimzada, M. D., Narasimha Swamy, S., Natto, Z. S., Nayak, B. P., Nazari, J., Negoi, I., Negru, S. M., Nejadghaderi, S. A., Neupane Kandel, S., Nguyen, H. L. T., Ngwa, C. H., Niazi, R. K., Nnaji, C. A., Noubiap, J. J., Nowroozi, A., Nunez-Samudio, V., Oancea, B., Ochir, C., Odukoya, O. O., Oh, I. -H., Olagunju, A. T., Olakunde, B. O., Omar Bali, A., Omer, E., Otstavnov, S. S., Oumer, B., Padubidri, J. R., Pana, A., Pandey, A., Park, E. -C., Pashazadeh Kan, F., Patel, U. K., Paudel, U., Petcu, I. -R., Piracha, Z. Z., Pollok, R. C. G., Postma, M. J., Pourshams, A., Poustchi, H., Rabiee, M., Rabiee, N., Rafiei, A., Rafiei, S., Raghuram, P. M., Rahman, M., Rahmani, A. M., Rahmawaty, S., Rajesh, A., Ranasinghe, P., Rao, C. R., Rao, S. J., Rashidi, M., Rashidi, M. -M., Rawaf, D. L., Rawaf, S., Rawassizadeh, R., Rezaei, N., Rezapour, A., Rezazadeh-Khadem, S., Rodriguez, J. A. B., Rwegerera, G. M., Sabour, S., Saddik, B., Saeb, M. R., Saeed, U., Sahebkar, A., Saif-Ur-Rahman, K. M., Salahi, S., Salimzadeh, H., Sampath, C., Samy, A. M., Sanabria, J., Sanmarchi, F., Santric-Milicevic, M. M., Sarveazad, A., Sathian, B., Sawhney, M., Seidu, A. -A., Sepanlou, S. G., Seylani, A., Shahabi, S., Shaikh, M. A., Shaker, E., Shakhmardanov, M. Z., Shannawaz, M., Shenoy, S. M., Shetty, J. K., Shetty, P. H., Shibuya, K., Shin, J. I., Shobeiri, P., Sibhat, M. M., Singh, A. D., Singh, J. A., Singh, S., Skryabin, V. Y., Skryabina, A. A., Sohrabpour, A. A., Song, S., Tabaeian, S. P., Tadesse, E. G., Taheri, M., Tampa, M., Tan, K. -K., Tavakoli, A., Tbakhi, A., Tefera, B. N., Tehrani-Banihashemi, A., Tesfaw, H. M., Thapar, R., Thavamani, A., Tohidast, S. A., Tollosa, D. N., Tosti, M. E., Tovani-Palone, M. R., Traini, E., Tran, M. T. N., Trihandini, I., Tusa, B. S., Ullah, I., Vacante, M., Valadan Tahbaz, S., Valdez, P. R., Varthya, S. B., Vo, B., Waheed, Y., Weldesenbet, A. B., Woldemariam, M., Xu, S., Yahyazadeh Jabbari, S. H., Yaseri, M., Yeshaw, Y., Yigit, V., Yirdaw, B. W., Yonemoto, N., Yu, C., Yunusa, I., Zahir, M., Zaki, L., Zamani, M., Zamanian, M., Zastrozhin, M. S., Vos, T., Ward, J. W., and Dirac, M. A.
Subjects: Liver Cirrhosis, Hepatology, Seroepidemiologic Studies, 3121 General medicine, internal medicine and other clinical medicine, Liver Neoplasms, Gastroenterology, Humans, Bayes Theorem, HBV, Global burden of diseases, HCC, Cirrhosis, Child, Hepatitis B, Global Burden of Disease
Abstract: Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation.
Published: 2022

38. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Elysia M Alvarez, Lisa M Force, Rixing Xu, Kelly Compton, Dan Lu, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, James D Harvey, Alyssa Pennini, Frances E Dean, Weijia Fu, Martina T Vargas, Theresa H M Keegan, Hany Ariffin, Ronald D Barr, Yana Arturovna Erdomaeva, D Sanjeeva Gunasekera, Yetunde O John-Akinola, Tyler G Ketterl, Tezer Kutluk, Marcio Henrique Malogolowkin, Prashant Mathur, Venkatraman Radhakrishnan, Lynn Ann Gloeckler Ries, Carlos Rodriguez-Galindo, Garik Barisovich Sagoyan, Iyad Sultan, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Amir Abdoli, Haimanot Abebe, Aidin Abedi, Hassan Abidi, Hassan Abolhassani, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Isaac Akinkunmi Adedeji, Oyelola A Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad Sohail Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, Sepideh Ahmadi, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Yusra Ahmed Salih, Wajeeha Aiman, Gizachew Taddesse Akalu, Hanadi Al Hamad, Fares Alahdab, Abdulhadi A AlAmodi, Fahad Mashhour Alanezi, Turki M Alanzi, Adugnaw Zeleke Alem, Dejene Tsegaye Alem, Yosef Alemayehu, Fadwa Naji Alhalaiqa, Robert Kaba Alhassan, Saqib Ali, Gianfranco Alicandro, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sunitha Alluri, Nihad A Almasri, Sadeq Ali Al-Maweri, Sami Almustanyir, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Edward Kwabena Ameyaw, Saeed Amini, Hubert Amu, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Fereshteh Ansari, Alireza Ansari-Moghaddam, Davood Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Ayele Mamo Argaw, Muhammad Arshad, Judie Arulappan, Armin Aryannejad, Zatollah Asemi, Mohammad Asghari Jafarabadi, Mohammad Reza Atashzar, Prince Atorkey, Alok Atreya, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel 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Foundation, NIH - National Cancer Institute (NCI) (Estados Unidos), Epidemiologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health
Subjects: adolescent cancer, global burden of disease, epidemiology, Adult, Male, Adolescent, 3122 Cancers, UNITED-STATES, Disability-Adjusted Life Year, Adolescents, Socioeconomic Factor, Global Health, Global Burden of Disease, Young Adult, Life Expectancy, SDG 3 - Good Health and Well-being, Risk Factors, WORLDWIDE, Neoplasms, Cause of Death, Prevalence, Humans, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, Mortality, Cancer burden analyses, Cancer, ACUTE LYMPHOBLASTIC-LEUKEMIA, disease, Global burden, OUTCOMES, CHILDHOOD-CANCER, Incidence, Risk Factor, the GBD 2019 methodology, Disability-Adjusted Life Years, GBD 2019 Adolescent Young Adult Cancer Collaborators, CARE, Cancer control efforts, Socioeconomic Factors, Oncology, Neoplasm, Female, Young adults, Human
Abstract: Funding: J A Loureiro acknowledges support from Base Funding UIDB/00511/2020 of the LEPABE funded by national funds through the FCT/MCTES (PIDDAC) and Scientific Employment Stimulus (FCT) [CEECINST/00049/2018]. Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute. publishersversion published
Published: 2022

39. Global, regional, and national burden of stroke and its risk factors, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Author: Mosiur Rahman, Rehab Salah, Mario F P Peres, Licia Iacoviello, Benjamin A Stark, Mahalaqua Nazli Khatib, Amir Radfar, Kamarul Imran Musa, Yannick Béjot, Deanna Anderlini, Carlos Cantú-Brito, Feng Sha, V. E. Nwatah, Pradip Gyanwali, Boris Bikbov, Bartosz Miazgowski, Sindhura Lakshmi Koulmane Laxminarayana, Ali Bijani, Imteyaz A Khan, Yaser Mokhayeri, Bogdan Oancea, Tarang Parekh, Martin Dichgans, Linh Gia Vu, Naohiro Yonemoto, Ahmad Ghashghaee, Marcos Roberto Tovani-Palone, Gebiyaw Wudie Tsegaye, Mona Pathak, Maciej Banach, Marissa B Reitsma, Derrick A Bennett, Treska S Hassan, Allen Seylani, Gdiom Gebreheat Abady, Islam Y. Elgendy, Hassan Mehmood Lak, Ismael R. Campos-Nonato, Sorin Hostiuc, Sheikh Mohammed Shariful Islam, Alessandra C. Goulart, Silvia Schiavolin, Simona Sacco, Atif Amin Baig, Azeem Majeed, Sahar Eftekharzadeh, Badr Hasan Sobaih, Archith Boloor, Aimé Bonny, Graeme J. Hankey, Jiregna Darega Gela, Mohamed I Hegazy, Pedram Keshavarz, Segun Emmanuel Ibitoye, Maseer Khan, Hatem Abdelaziz Mohamed Wafa, Hualiang Lin, Enayet Karim Chowdhury, Simon I. Hay, Vanessa De la Cruz-Góngora, Xuefeng Liu, Arokiasamy Perianayagam, Maryam Zamanian, Sezer Kisa, Preetam Bhalchandra Mahajan, Junmei Miao Jonasson, Alberto Raggi, Shubha Jayaram, Tahira Ashraf, Ejaz Ahmad Khan, Matthias Endres, Masoumeh Sadeghi, Dominique Vervoort, Hanadi Al Hamad, Mowafa Househ, Elena V. Gnedovskaya, Johan Ärnlöv, Andrea Sylvia Winkler, Yousef Khader, Mikhail Sergeevich Zastrozhin, Yuming Guo, Yunquan Zhang, Sami Almustanyir, Lalit Dandona, Amir Masoud Rahmani, Chythra R Rao, Giancarlo Lucchetti, Irena Ilic, Suzanne Barker-Collo, Priya Rathi, Emerito Jose A. Faraon, Mohamad-Hani Temsah, Reza Ghanei Gheshlagh, Gyu Ri Kim, Carlos A Castañeda-Orjuela, Alaa Makki, Yun Jin Kim, Vida Abedi, Shanshan Li, Kewal Krishan, David Flood, Abdollah Mohammadian-Hafshejani, Michele Romoli, Gregory A. 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Kayode, Dinh-Toi Chu, Truong-Minh Pham, Arielle Wilder Bell, Aziz Rezapour, David Laith Rawaf, Anasthasia Zastrozhina, Yves Miel H Zuniga, Ivo Iavicoli, Adrian Pana, Salman Rawaf, Pankaj Bhardwaj, Omid Dadras, Anayat Ullah, Gina Agarwal, Shafiu Mohammed, Bing-Fang Hwang, Eyayou Girma Tadesse, Charles D.A. Wolfe, Sanjay Basu, Michael Brauer, Tanuj Kanchan, Ahmad Azam Malik, Brigid Unim, Min Seo Kim, Kia Vosoughi, Tomasz Miazgowski, Warren D. Lo, Vivek Podder, Dana Bryazka, Chuanhua Yu, Hassan Magdy Abd El Razek, Rufus Akinyemi, Zhi-Jiang Zhang, Ettore Beghi, Xiaochen Dai, Meghnath Dhimal, Mehrnoosh Samaei, Sathish Kumar Jayapal, Bay Vo, Amanual Getnet Mersha, Rajaa Al-Raddadi, Savita Lasrado, Jalal Arabloo, Pablo M. Lavados, Samaneh Akbarpour, Khezar Hayat, Ritesh G. Menezes, Vahid Alipour, Sowmya J. Rao, Mariam Molokhia, Trang Huyen Nguyen, Aletta E. Schutte, Zahra Kamiab, Lidia Morawska, Mohammad Ali Moni, Bo Norrving, Tommi Vasankari, Bruno Ramos Nascimento, Ai Koyanagi, Tissa Wijeratne, Rizwan Kalani, Chenwen Zhong, Bright Opoku Ahinkorah, Sepideh Ahmadi, Bruce Bartholow Duncan, Andrzej Rynkiewicz, Pradyumna Agasthi, Saeed Shahabi, Adnan Kisa, Fares Alahdab, Vafa Rahimi-Movaghar, Adnan Ansar, Matilde Leonardi, Ali Koolivand, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Daniel Asfaw Erku, Alok Atreya, Jean Jacques Noubiap, Dhaval Kolte, Shajedur Rahman Shawon, Michael Ekholuenetale, Navid Manafi, Narayanaswamy Venketasubramanian, Syed Amir Gilani, Mohamed M. Gad, Christopher J L Murray, Louis Jacob, Robert Ancuceanu, Simona Costanzo, Erkin M. 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Samy, Stefan Stortecky, Reza Malekzadeh, Ashwin Kamath, Nevine El Nahas, Ayesha Humayun, Miguel A Barboza, Sheng-Chia Chung, Carlo La Vecchia, Oluwakemi Ololade Odukoya, Rita Krishnamurthi, Masood Ali Shaikh, Milena Ilic, Lalit Yadav, Nahlah Elkudssiah Ismail, Abdel Douiri, Yousef Mohammad, Jason H Y Wu, Sahar Saeedi Moghaddam, Ramesh Holla, Sadaf G. Sepanlou, Itamar S. Santos, Jost B. Jonas, Dian Kusuma, Atte Meretoja, Yasir Waheed, Ben Lacey, Zahra Aryan, Mulugeta Molla Birhanu, Moien Ab Khan, K. M. Saif-Ur-Rahman, Ramin Zand, Anna Aleksandrovna Skryabina, Sung In Jang, Rakhi Dandona, Emanuele D'Amico, Priyanga Ranasinghe, Jaykaran Charan, Bhaskaran Unnikrishnan, Davide Sattin, Akram Pourshams, Markus P. Schlaich, Arief Hargono, Samaneh Asgari, Ovidiu Baltatu, Ippazio Cosimo Antonazzo, Sandhya Neupane Kandel, Nizal Sarrafzadegan, Jakub Morze, Man Mohan Mehndiratta, Manjari Tripathi, Panniyammakal Jeemon, Rohollah Kalhor, Yogeshwar Kalkonde, Soraya Siabani, Sojib Bin Zaman, Seyed Sina Naghibi Irvani, Shilpa Gaidhane, Sahel Valadan Tahbaz, Yihienew Mequanint Bezabih, Samath D Dharmaratne, Ingan Ukur Tarigan, Vivek Gupta, Klara Dokova, Alireza Vakilian, Vardhmaan Jain, Akshaya Srikanth Bhagavathula, Sarah Wulf Hanson, Umar Farooque, Mohammad Ali Mansournia, Vera Marisa Costa, Alessandro Gialluisi, Valery L. Feigin, Himal Kandel, Suzanne Polinder, Nermin Ghith, Deepak Dhamnetiya, Michael H. Criqui, Asif Hanif, Ahmed Abualhasan, Veer Bala Gupta, Mahaveer Golechha, Bach Xuan Tran, Jason A. Anderson, Catherine Bisignano, Kazumasa Yamagishi, Zahid A Butt, Budi Aji, Baye Dagnew, Rasmus Havmoeller, Victor Volovici, Jitendra Singh, Paramjit Gill, Saverio Stranges, Eun Cheol Park, Andrew T Olagunju, Milena Santric-Milicevic, Woldesellassie M. Bezabhe, Sheikh M. Alif, Junjie Huang, Foad Abd-Allah, Yvonne Teuschl, Rajkumar Doshi, Nelson Alvis-Guzman, Marcel Ausloos, Mohsen Naghavi, Yusra Ahmed Salih, Mohsen Abbasi-Kangevari, Maarten J. Postma, Ghozali Ghozali, Yanzhong Wang, Ali H. Mokdad, Valentin Yurievich Skryabin, Nitin Joseph, Andre M. N. Renzaho, Muhammad Aziz Rahman, Mohammad Athar, Rustam Al-Shahi Salman, Albertino Damasceno, Fatemeh Pashazadeh Kan, Marcello Tonelli, Florentino Luciano Caetano dos Santos, Sonali G. Choudhari, Abdullah Hamid Feroze, Walter D. Johnson, Ro-Ting Lin, Francesca Giulia Magnani, Hermann Brenner, Shaimaa I. El-Jaafary, Tea Lallukka, Niveen M E Abu-Rmeileh, Jacek Jerzy Jozwiak, GBD 2019 Stroke Collaborators, Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., Abbasifard, M., Abbasi-Kangevari, M., Abd-Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M. E., Abushouk, A. I., Adebayo, O. M., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., Salih, Y. A., Aji, B., Akbarpour, S., Akinyemi, R. O., Al Hamad, H., Alahdab, F., Alif, S. M., Alipour, V., Aljunid, S. M., Almustanyir, S., Al-Raddadi, R. M., Salman, R. A. -S., Alvis-Guzman, N., Ancuceanu, R., Anderlini, D., Anderson, J. A., Ansar, A., Antonazzo, I. C., Arabloo, J., Arnlov, J., Artanti, K. D., Aryan, Z., Asgari, S., Ashraf, T., Athar, M., Atreya, A., Ausloos, M., Baig, A. A., Baltatu, O. C., Banach, M., Barboza, M. A., Barker-Collo, S. L., Barnighausen, T. W., Barone, M. T. U., Basu, S., Bazmandegan, G., Beghi, E., Beheshti, M., Bejot, Y., Bell, A. W., Bennett, D. A., Bensenor, I. M., Bezabhe, W. M., Bezabih, Y. M., Bhagavathula, A. S., Bhardwaj, P., Bhattacharyya, K., Bijani, A., Bikbov, B., Birhanu, M. M., Boloor, A., Bonny, A., Brauer, M., Brenner, H., Bryazka, D., Butt, Z. A., Dos Santos, F. L. C., Campos-Nonato, I. R., Cantu-Brito, C., Carrero, J. J., Castaneda-Orjuela, C. A., Catapano, A. L., Chakraborty, P. A., Charan, J., Choudhari, S. G., Chowdhury, E. K., Chu, D. -T., Chung, S. -C., Colozza, D., Costa, V. M., Costanzo, S., Criqui, M. H., Dadras, O., Dagnew, B., Dai, X., Dalal, K., Damasceno, A. A. M., D'Amico, E., Dandona, L., Dandona, R., Gela, J. D., Davletov, K., De La Cruz-Gongora, V., Desai, R., Dhamnetiya, D., Dharmaratne, S. D., Dhimal, M. L., Dhimal, M., Diaz, D., Dichgans, M., Dokova, K., Doshi, R., Douiri, A., Duncan, B. B., Eftekharzadeh, S., Ekholuenetale, M., El Nahas, N., Elgendy, I. Y., Elhadi, M., El-Jaafary, S. I., Endres, M., Endries, A. Y., Erku, D. A., Faraon, E. J. A., Farooque, U., Farzadfar, F., Feroze, A. H., Filip, I., Fischer, F., Flood, D., Gad, M. M., Gaidhane, S., Gheshlagh, R. G., Ghashghaee, A., Ghith, N., Ghozali, G., Ghozy, S., Gialluisi, A., Giampaoli, S., Gilani, S. A., Gill, P. S., Gnedovskaya, E. V., Golechha, M., Goulart, A. C., Guo, Y., Gupta, R., Gupta, V. B., Gupta, V. K., Gyanwali, P., Hafezi-Nejad, N., Hamidi, S., Hanif, A., Hankey, G. J., Hargono, A., Hashi, A., Hassan, T. S., Hassen, H. Y., Havmoeller, R. J., Hay, S. I., Hayat, K., Hegazy, M. I., Herteliu, C., Holla, R., Hostiuc, S., Househ, M., Huang, J., Humayun, A., Hwang, B. -F., Iacoviello, L., Iavicoli, I., Ibitoye, S. E., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Ismail, N. E., Iso, H., Isola, G., Iwagami, M., Jacob, L., Jain, V., Jang, S. -I., Jayapal, S. K., Jayaram, S., Jayawardena, R., Jeemon, P., Jha, R. P., Johnson, W. D., Jonas, J. B., Joseph, N., Jozwiak, J. J., Jurisson, M., Kalani, R., Kalhor, R., Kalkonde, Y., Kamath, A., Kamiab, Z., Kanchan, T., Kandel, H., Karch, A., Katoto, P. D. M. C., Kayode, G. A., Keshavarz, P., Khader, Y. S., Khan, E. A., Khan, I. A., Khan, M., Khan, M. A. B., Khatib, M. N., Khubchandani, J., Kim, G. R., Kim, M. S., Kim, Y. J., Kisa, A., Kisa, S., Kivimaki, M., Kolte, D., Koolivand, A., Laxminarayana, S. L. K., Koyanagi, A., Krishan, K., Krishnamoorthy, V., Krishnamurthi, R. V., Kumar, G. A., Kusuma, D., Vecchia, C. L., Lacey, B., Lak, H. M., Lallukka, T., Lasrado, S., Lavados, P. M., Leonardi, M., Li, B., Li, S., Lin, H., Lin, R. -T., Liu, X., Lo, W. D., Lorkowski, S., Lucchetti, G., Saute, R. L., Abd El Razek, H. M., Magnani, F. G., Mahajan, P. B., Majeed, A., Makki, A., Malekzadeh, R., Malik, A. A., Manafi, N., Mansournia, M. A., Mantovani, L. G., Martini, S., Mazzaglia, G., Mehndiratta, M. M., Menezes, R. G., Meretoja, A., Mersha, A. G., Jonasson, J. M., Miazgowski, B., Miazgowski, T., Michalek, I. M., Mirrakhimov, E. M., Mohammad, Y., Mohammadian-Hafshejani, A., Mohammed, S., Mokdad, A. H., Mokhayeri, Y., Molokhia, M., Moni, M. A., Al Montasir, A., Moradzadeh, R., Morawska, L., Morze, J., Muruet, W., Musa, K. I., Nagarajan, A. J., Naghavi, M., Swamy, S. N., Nascimento, B. R., Negoi, R. I., Kandel, S. N., Nguyen, T. H., Norrving, B., Noubiap, J. J., Nwatah, V. E., Oancea, B., Odukoya, O. O., Olagunju, A. T., Orru, H., Owolabi, M. O., Padubidri, J. R., Pana, A., Parekh, T., Park, E. -C., Kan, F. P., Pathak, M., Peres, M. F. P., Perianayagam, A., Pham, T. -M., Piradov, M. A., Podder, V., Polinder, S., Postma, M. J., Pourshams, A., Radfar, A., Rafiei, A., Raggi, A., Rahim, F., Rahimi-Movaghar, V., Rahman, M., Rahman, M. A., Rahmani, A. M., Rajai, N., Ranasinghe, P., Rao, C. R., Rao, S. J., Rathi, P., Rawaf, D. L., Rawaf, S., Reitsma, M. B., Renjith, V., Renzaho, A. M. N., Rezapour, A., Rodriguez, J. A. B., Roever, L., Romoli, M., Rynkiewicz, A., Sacco, S., Sadeghi, M., Moghaddam, S. S., Sahebkar, A., Saif-Ur-Rahman, K. M., Salah, R., Samaei, M., Samy, A. M., Santos, I. S., Santric-Milicevic, M. M., Sarrafzadegan, N., Sathian, B., Sattin, D., Schiavolin, S., Schlaich, M. P., Schmidt, M. I., Schutte, A. E., Sepanlou, S. G., Seylani, A., Sha, F., Shahabi, S., Shaikh, M. A., Shannawaz, M., Shawon, Md. S. R., Sheikh, A., Sheikhbahaei, S., Shibuya, K., Siabani, S., Silva, D. A. S., Singh, J. A., Singh, J. K., Skryabin, V. Y., Skryabina, A. A., Sobaih, B. H., Stortecky, S., Stranges, S., Tadesse, E. G., Tarigan, I. U., Temsah, M. -H., Teuschl, Y., Thrift, A. G., Tonelli, M., Tovani-Palone, M. R., Tran, B. X., Tripathi, M., Tsegaye, G. W., Ullah, A., Unim, B., Unnikrishnan, B., Vakilian, A., Tahbaz, S. V., Vasankari, T. J., Venketasubramanian, N., Vervoort, D., Vo, B., Volovici, V., Vosoughi, K., Vu, G. T., Vu, L. G., Wafa, H. A., Waheed, Y., Wang, Y., Wijeratne, T., Winkler, A. S., Wolfe, C. D. A., Woodward, M., Wu, J. H., Hanson, S. W., Xu, X., Yadav, L., Yadollahpour, A., Jabbari, S. H. Y., Yamagishi, K., Yatsuya, H., Yonemoto, N., Yu, C., Yunusa, I., Zaman, M. S., Zaman, S. B., Zamanian, M., Zand, R., Zandifar, A., Zastrozhin, M. S., Zastrozhina, A., Zhang, Y., Zhang, Z. -J., Zhong, C., Zuniga, Y. M. H., Murray, C. J. L., Public Health, Neurosurgery, Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki Inequality Initiative (INEQ), HUS Neurocenter, Neurologian yksikkö, Helsinki University Hospital Area, Feigin, V, Stark, B, Johnson, C, Roth, G, Bisignano, C, Abady, G, Abbasifard, M, Abbasi-Kangevari, M, Abd-Allah, F, Abedi, V, Abualhasan, A, Abu-Rmeileh, N, Abushouk, A, Adebayo, O, Agarwal, G, Agasthi, P, Ahinkorah, B, Ahmad, S, Ahmadi, S, Salih, Y, Aji, B, Akbarpour, S, Akinyemi, R, Al Hamad, H, Alahdab, F, Alif, S, Alipour, V, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Salman, R, Alvis-Guzman, N, Ancuceanu, R, Anderlini, D, Anderson, J, Ansar, A, Antonazzo, I, Arabloo, J, Arnlov, J, Artanti, K, Aryan, Z, Asgari, S, Ashraf, T, Athar, M, Atreya, A, Ausloos, M, Baig, A, Baltatu, O, Banach, M, Barboza, M, Barker-Collo, S, Barnighausen, T, Barone, M, Basu, S, Bazmandegan, G, Beghi, E, Beheshti, M, Bejot, Y, Bell, A, Bennett, D, Bensenor, I, Bezabhe, W, Bezabih, Y, Bhagavathula, A, Bhardwaj, P, Bhattacharyya, K, Bijani, A, Bikbov, B, Birhanu, M, Boloor, A, Bonny, A, Brauer, M, Brenner, H, Bryazka, D, Butt, Z, Dos Santos, F, Campos-Nonato, I, Cantu-Brito, C, Carrero, J, Castaneda-Orjuela, C, Catapano, A, Chakraborty, P, Charan, J, Choudhari, S, Chowdhury, E, Chu, D, Chung, S, Colozza, D, Costa, V, Costanzo, S, Criqui, M, Dadras, O, Dagnew, B, Dai, X, Dalal, K, Damasceno, A, D'Amico, E, Dandona, L, Dandona, R, Gela, J, Davletov, K, De La Cruz-Gongora, V, Desai, R, Dhamnetiya, D, Dharmaratne, S, Dhimal, M, Diaz, D, Dichgans, M, Dokova, K, Doshi, R, Douiri, A, Duncan, B, Eftekharzadeh, S, Ekholuenetale, M, El Nahas, N, Elgendy, I, Elhadi, M, El-Jaafary, S, Endres, M, Endries, A, Erku, D, Faraon, E, Farooque, U, Farzadfar, F, Feroze, A, Filip, I, Fischer, F, Flood, D, Gad, M, Gaidhane, S, Gheshlagh, R, Ghashghaee, A, Ghith, N, Ghozali, G, Ghozy, S, Gialluisi, A, Giampaoli, S, Gilani, S, Gill, P, Gnedovskaya, E, Golechha, M, Goulart, A, Guo, Y, Gupta, R, Gupta, V, Gyanwali, P, Hafezi-Nejad, N, Hamidi, S, Hanif, A, Hankey, G, Hargono, A, Hashi, A, Hassan, T, Hassen, H, Havmoeller, R, Hay, S, Hayat, K, Hegazy, M, Herteliu, C, Holla, R, Hostiuc, S, Househ, M, Huang, J, Humayun, A, Hwang, B, Iacoviello, L, Iavicoli, I, Ibitoye, S, Ilesanmi, O, Ilic, I, Ilic, M, Iqbal, U, Irvani, S, Islam, S, Ismail, N, Iso, H, Isola, G, Iwagami, M, Jacob, L, Jain, V, Jang, S, Jayapal, S, Jayaram, S, Jayawardena, R, Jeemon, P, Jha, R, Johnson, W, Jonas, J, Joseph, N, Jozwiak, J, Jurisson, M, Kalani, R, Kalhor, R, Kalkonde, Y, Kamath, A, Kamiab, Z, Kanchan, T, Kandel, H, Karch, A, Katoto, P, Kayode, G, Keshavarz, P, Khader, Y, Khan, E, Khan, I, Khan, M, Khatib, M, Khubchandani, J, Kim, G, Kim, M, Kim, Y, Kisa, A, Kisa, S, Kivimaki, M, Kolte, D, Koolivand, A, Laxminarayana, S, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Krishnamurthi, R, Kumar, G, Kusuma, D, Vecchia, C, Lacey, B, Lak, H, Lallukka, T, Lasrado, S, Lavados, P, Leonardi, M, Li, B, Li, S, Lin, H, Lin, R, Liu, X, Lo, W, Lorkowski, S, Lucchetti, G, Saute, R, Abd El Razek, H, Magnani, F, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Manafi, N, Mansournia, M, Mantovani, L, Martini, S, Mazzaglia, G, Mehndiratta, M, Menezes, R, Meretoja, A, Mersha, A, Jonasson, J, Miazgowski, B, Miazgowski, T, Michalek, I, Mirrakhimov, E, Mohammad, Y, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, A, Mokhayeri, Y, Molokhia, M, Moni, M, Al Montasir, A, Moradzadeh, R, Morawska, L, Morze, J, Muruet, W, Musa, K, Nagarajan, A, Naghavi, M, Swamy, S, Nascimento, B, Negoi, R, Kandel, S, Nguyen, T, Norrving, B, Noubiap, J, Nwatah, V, Oancea, B, Odukoya, O, Olagunju, A, Orru, H, Owolabi, M, Padubidri, J, Pana, A, Parekh, T, Park, E, Kan, F, Pathak, M, Peres, M, Perianayagam, A, Pham, T, Piradov, M, Podder, V, Polinder, S, Postma, M, Pourshams, A, Radfar, A, Rafiei, A, Raggi, A, Rahim, F, Rahimi-Movaghar, V, Rahman, M, Rahmani, A, Rajai, N, Ranasinghe, P, Rao, C, Rao, S, Rathi, P, Rawaf, D, Rawaf, S, Reitsma, M, Renjith, V, Renzaho, A, Rezapour, A, Rodriguez, J, Roever, L, Romoli, M, Rynkiewicz, A, Sacco, S, Sadeghi, M, Moghaddam, S, Sahebkar, A, Saif-Ur-Rahman, K, Salah, R, Samaei, M, Samy, A, Santos, I, Santric-Milicevic, M, Sarrafzadegan, N, Sathian, B, Sattin, D, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Sepanlou, S, Seylani, A, Sha, F, Shahabi, S, Shaikh, M, Shannawaz, M, Shawon, M, Sheikh, A, Sheikhbahaei, S, Shibuya, K, Siabani, S, Silva, D, Singh, J, Skryabin, V, Skryabina, A, Sobaih, B, Stortecky, S, Stranges, S, Tadesse, E, Tarigan, I, Temsah, M, Teuschl, Y, Thrift, A, Tonelli, M, Tovani-Palone, M, Tran, B, Tripathi, M, Tsegaye, G, Ullah, A, Unim, B, Unnikrishnan, B, Vakilian, A, Tahbaz, S, Vasankari, T, Venketasubramanian, N, Vervoort, D, Vo, B, Volovici, V, Vosoughi, K, Vu, G, Vu, L, Wafa, H, Waheed, Y, Wang, Y, Wijeratne, T, Winkler, A, Wolfe, C, Woodward, M, Wu, J, Hanson, S, Xu, X, Yadav, L, Yadollahpour, A, Jabbari, S, Yamagishi, K, Yatsuya, H, Yonemoto, N, Yu, C, Yunusa, I, Zaman, M, Zaman, S, Zamanian, M, Zand, R, Zandifar, A, Zastrozhin, M, Zastrozhina, A, Zhang, Y, Zhang, Z, Zhong, C, Zuniga, Y, Murray, C, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Microbes in Health and Disease (MHD)
Subjects: Male, Aging, 030204 cardiovascular system & hematology, Stroke data, GUIDELINES, 3124 Neurology and psychiatry, Body Mass Index, Global Burden of Disease, 0302 clinical medicine, RA0421, Risk Factors, Epidemiology, Strokes, YOUNG-ADULTS, Prevalence, 80 and over, Aetiology, 610 Medicine & health, Stroke, POPULATION, 1103 Clinical Sciences, 1109 Neurosciences, Cause of death, Aged, 80 and over, education.field_of_study, Mortality rate, Incidence (epidemiology), Incidence, 1. No poverty, Articles, Hälsovetenskaper, Middle Aged, Stroke types, ddc, 3. Good health, ISCHEMIC-STROKE, Income, Female, Quality-Adjusted Life Years, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, GBD, Population, Clinical Sciences, Clinical Neurology, 03 medical and health sciences, Clinical Research, MIDDLE-INCOME COUNTRIES, Health Sciences, medicine, Humans, Risk factor, education, GBD 2019 Stroke Collaborators, Cerebral Hemorrhage, Aged, Ischemic Stroke, Global burden, Science & Technology, Neurology & Neurosurgery, HYPERTENSION, business.industry, MORTALITY, Prevention, 3112 Neurosciences, Neurosciences, 1103 Clinical Sciences, SERVICES, Subarachnoid Hemorrhage, medicine.disease, PREVENTION, Brain Disorders, Good Health and Well Being, Attributable risk, Human medicine, Neurology (clinical), Neurosciences & Neurology, business, 1109 Neurosciences, 030217 neurology & neurosurgery, Demography, 2.4 Surveillance and distribution, RC
Abstract: Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.
Published: 2021

40. Physical activity interventions for glycaemic control in African adults – A systematic review and meta-analysis

Author: Chythra R. Rao, Baskaran Chandrasekaran, N. Ravishankar, Elizeus Rutebemberwa, and David Okello
Subjects: Endocrinology, Diabetes and Metabolism, Internal Medicine, General Medicine
Abstract: Growing evidence indicates that increasing physical activity may aid in regulating altered glycaemic control, thereby mitigating the risk of diabetes. However, the evidence summarising the efficacy of physical activity on glycaemic control among African adults remains unconsolidated. Our objective was to provide an amalgamated summary of the empirical evidence that explored the effectiveness of physical activity interventions on glycaemic control among African adults.A systematic search of six journal databases for the studies exploring the efficacy of physical activity on glycaemic control among African adults until March 21, 2022, was administered. Two independent reviewers screened the citations based on a priori set eligibility criteria. Data were analysed using inverse variance method and a summary of findings was synthesised using the Grading of Recommendations, Assessment, Development and Evaluations approach.Of the 14,624 citations retrieved, 26 articles with 1474 participants were included for final analysis. Most of the included trials had a high risk of bias (N = 20; 76.92%). Our review found a significant reduction in fasting blood glucose (FBG, -2.18 [ 95% CI -3.18, -1.18] mmol/L), insulin (-0.99 [-2.71, 0.74] μU/L), Glycosylated haemoglobin (HbA1C) (-0.53% [-0.88, -0.19]), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.74% [-1.10, -0.38]) and insulin sensitivity (-0.90 μU/l/min [-1.75, -0.06]) following physical activity interventions. The review reports low certainty of evidence across all outcome measures.Physical activity interventions were found to improve glycaemic control among African adults. However, the optimal physical activity dose for demonstrating meaningful benefits on glucose tolerance still remains unclear due to the limited number of primary studies available.
Published: 2022

41. Correlation of cardiotocography abnormalities with position and attitude of the fetal head in labor

Author: Shylabirami Sridharan, Shyamala Guruvare, and Chythra R. Rao
Subjects: Obstetrics and Gynecology
Abstract: Fetal distress indicated as the cause for cesarean delivery based on cardiotocography findings most often does not reflect in the newborn assessment. Cardiotocography findings are just the decision indicators for cesarean delivery, in the background of labor abnormalities owing to deflexed head or occipitoposterior position.This study aimed to investigate the association between cardiotocography findings and the attitude of fetal head and occiput position.We conducted a prospective observational study in a tertiary hospital in South India, including 304 women in labor with vertex presentation. Fetal attitude, the position of the head, labor abnormalities, and cardiotocography findings were noted. The chi-square test was applied using MedCalc software (version 19) to investigate the association of cardiotocography findings with the attitude of fetal head and occiput position.Cardiotocography findings had significant association with occipitoposterior position (relative risk, 1.70; 95% confidence interval, 1.32-2.19) and deflexed attitude of the fetal head (relative risk, 1.44; 95% confidence interval, 1.11-1.87). Among cases with occipitoposterior position, 10 of 42 (24%) had pathologic cardiotocography, and 19 of 42 (45%) had suspicious cardiotocography, whereas among cases with deflexed head position, these proportions were 12 of 61 (20%) and 24 of 61 (40%), respectively.Pathologic and suspicious cardiotocography tracings were more frequent in women with fetal occipitoposterior and deflexed head position. However, the association was not specific to any cardiotocography pattern.
Published: 2022

42. Life-cycle approach for prevention of gestational diabetes mellitus

Author: Ajeet Singh Bhadoria, Surabhi Mishra, Chythra R Rao, Aparna Sen Chaudhary, Surekha Kishore, and Soumya S. Mohanty
Subjects: Microbiology (medical), American diabetes association, Pediatrics, medicine.medical_specialty, Pregnancy, 030219 obstetrics & reproductive medicine, endocrine system diseases, Referral, Epidemiology, business.industry, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Psychological intervention, nutritional and metabolic diseases, Postpartum diabetes, medicine.disease, Gestational diabetes, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Diabetes mellitus, medicine, 030212 general & internal medicine, business
Abstract: Problem considered Despite enough evidence available supporting temporal relation between gestational diabetes mellitus (GDM) and overt DM, former has earned less attention while managing current diabetes epidemic. This calls for a community-based ‘Life-cycle approach' that could employ mutually-linked interventions specific to GDM prevention at various stages of life cycle by utilizing involving already existing Indian health system. Methods Freely accessible, full-text articles published between 1990 and 2018, available in PubMed and Google Scholar in English language, pertaining to GDM risk factors and its preventive strategies were reviewed using combination of medical subject headings (MeSH) and keywords. Results GDM prevention begins right from pre-pregnancy phase. Adoption of a healthy lifestyle, mass awareness of risk factors, early identification and prompt referral are key to avert pre-GDM development. During pregnancy, government of India (GoI) mandates universal GDM screening for all Indian pregnant women, avoiding any undiagnosed/untreated GDM woman, thus preventing occurrence of complications including overt DM. Those screened GDM positive are more likely to develop overt DM throughout postpartum. During postpartum, American Diabetes Association (ADA) recommends postpartum diabetes screening for all women with GDM, by employing two h 75 g oral glucose tolerance test (OGTT) and HbA1C prior to and beyond three months postpartum, respectively. Conclusions Promotion and practice of life-cycle approach would be key to curb overall diabetes incidence.
Published: 2019

43. Inter observer variability among gynecologists in manual cervix image analysis for detection of cervical epithelial abnormalities

Author: Shyamala Guruvare, Suma Nair, Kiran Abhijit Kulkarni, Chythra R Rao, Premalatha T.S, Vidya Kudva, Asha Kamath, and Keerthana Prasad
Subjects: Microbiology (medical), medicine.medical_specialty, Infectious Diseases, medicine.anatomical_structure, Epidemiology, business.industry, Public Health, Environmental and Occupational Health, medicine, Radiology, Observer variation, business, Cervix, Obstetrics gynaecology
Published: 2019

44. Cognitive Dysfunction Among Adults With Type 2 Diabetes Mellitus in Karnataka, India

Author: Chythra R Rao, Henry Seow Ern Lee, Devesh Bhaskar Yerrapragada, and Kavinya Karunakaran
Subjects: medicine.medical_specialty, Cross-sectional study, business.industry, Type 2 Diabetes Mellitus, Montreal Cognitive Assessment, General Medicine, Type 2 diabetes, Anthropometry, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Diabetes mellitus, Internal medicine, medicine, Dementia, 030212 general & internal medicine, business, 030217 neurology & neurosurgery, Original Research
Abstract: Background: Type 2 diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia that affects various body systems. Elevated blood glucose levels cause brain malfunction, sorbitol-induced blood vessel damage, and degeneration of the nerves that can lead to dementia or cognitive impairment. Cognitive impairment can result in nonadherence of patients to diabetes treatment, such as diet, medication, and exercise. Methods: We used a cross-sectional design to individually interview 194 patients with type 2 diabetes in a rural field practice area in India. A questionnaire was used to collect sociodemographic and diabetes disease characteristics; anthropometric measurements were also collected. Cognitive dysfunction was assessed with the Kannada version (local language) of the Montreal Cognitive Assessment (MoCA) tool. Blood pressure was measured for all subjects using a standardized sphygmomanometer on the right arm with the patient in a sitting position. Results: Among the 194 diabetic subjects interviewed, 98 (50.5%) were cognitively impaired. More than half of the subjects (56.2%) were ≥65 years, and female participants (53.6%) outnumbered males (46.4%). The majority of patients (62.4%) had had diabetes for
Published: 2019

45. Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

Author: Samar Al-Hajj, Sarah H Farran, Abla Mehio Sibai, Randah R Hamadeh, Vafa Rahimi-Movaghar, Rajaa M Al-Raddadi, Farideh Sadeghian, Zahra Ghodsi, Wael Alhajyaseen, Niveen ME Abu-Rmeileh, Behzad Abbasi, Mohsen Abbasi-Kangevari, Amir Abdoli, Salam Abdulqadir Abdulrahman, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Muhammad Sohail Afzal, Bahman Ahadinezhad, Sajjad Ahmad, Ali Ahmadi, Ali Ahmed, Haroon Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Hanadi Al Hamad, Fahad Mashhour Alanezi, Turki M Alanzi, Suliman A Alghnam, Fadwa Naji Alhalaiqa, Beriwan Abdulqadir Ali, Liaqat Ali, Yousef Alimohamadi, Cyrus Alinia, Syed Mohamed Aljunid, Sami Almustanyir, Tarek Tawfik Amin, Saeed Amini, Sohrab Amiri, Mohammad Hosein Amirzade-Iranaq, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Davood Anvari, Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Judie Arulappan, Armin Aryannejad, Saeed Asgary, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Zahra Azadmanjir, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Y Azzam, Sara Bagherieh, Mohammad Hossein Bakhshaei, Abdul-Monim Mohammad Batiha, Neeraj Bedi, Akshaya Srikanth Bhagavathula, Zulfiqar A Bhutta, Sadia Bibi, Ali Bijani, Nadeem Shafique Butt, Zahra Chegini, Omar B Da'ar, Saad M A Dahlawi, Sajad Delavari, Mostafa Dianatinasab, Mojtaba Didehdar, Shirin Djalalinia, Saeid Doaei, Milad Dodangeh, Fatemeh Eghbalian, Elham Ehsani-Chimeh, Iman El Sayed, Maysaa El Sayed Zaki, Hala Rashad Elhabashy, Muhammed Elhadi, Sharareh Eskandarieh, Azin Etemadimanesh, Mohamad Ezati Asar, Shahab Falahi, Farshad Farzadfar, Ali Fatehizadeh, Hamed Fattahi, Masoud Foroutan, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Reza Ghanbari, Reza Ghanei Gheshlagh, Ahmad Ghashghaee, Maryam Gholamalizadeh, Alireza Ghorbani, Syed Amir Gilani, Kimiya Gohari, Pouya Goleij, Michal Grivna, Mohammed Ibrahim Mohialdeen Gubari, Rasool Haddadi, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Rabih Halwani, Sajid Hameed, Asif Hanif, Ahmed I Hasaballah, Amr Hassan, Hossein Hassanian-Moghaddam, Soheil Hassanipour, Hadi Hassankhani, Khezar Hayat, Mohammad Heidari, Mohammad-Salar Hosseini, Mostafa Hosseini, Mehdi Hosseinzadeh, Mowafa Househ, Soodabeh Hoveidamanesh, Huda Abu-Saad Huijer, Behzad Imani, Seyed Sina Naghibi Irvani, Roxana Jabbarinejad, Mohammad Ali Jahani, Mahsa Jalili, Amirreza Javadi Mamaghani, Seyed Ali Jeddi, Farahnaz Joukar, Ali Kabir, Laleh R Kalankesh, Leila R Kalankesh, Rohollah Kalhor, Aziz Kamran, Leila Keikavoosi-Arani, Mohammad Keykhaei, Yousef Saleh Khader, Rovshan Khalilov, Mohammad Khammarnia, Ejaz Ahmad Khan, Maseer Khan, Moien AB Khan, Javad Khanali, Hamid Reza Khayat Kashani, Omid Khosravizadeh, Ali-Asghar Kolahi, Hamid Reza Koohestani, Sogol Koolaji, Faris Hasan Lami, Savita Lasrado, Farzan Madadizadeh, Muhammed Magdy Abd El Razek, Mahdi Mahdavi, Soleiman Mahjoub, Ata Mahmoodpoor, Razzagh Mahmoudi, Alaa Makki, Mohammad-Reza Malekpour, Reza Malekzadeh, Narges Malih, Ahmad Azam Malik, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Seyedeh Zahra Masoumi, Entezar Mehrabi Nasab, Ritesh G Menezes, Mohamed Kamal Mesregah, Seyyedmohammadsadeq Mirmoeeni, Mohammad Mirza-Aghazadeh-Attari, Esmaeil Mohammadi, Heidar Mohammadi, Mokhtar Mohammadi, Seyyede Momeneh Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Jalal Moludi, Sara Momtazmanesh, Maryam Moradi, Masoud Moradi, Farhad Moradpour, Rahmatollah Moradzadeh, Nazanin Mortazavi, Seyede Salehe Mortazavi, Houshang Najafi, Zhila Najafpour, Zuhair S Natto, Javad Nazari, Hasti Nouraei, Fatemeh Nouri, Hassan Okati-Aliabad, Ahmed Omar Bali, Emad Omer, Fatemeh Pashazadeh Kan, Hamidreza Pazoki Toroudi, Zahra Zahid Piracha, AliMohammad Pourbagher-Shahri, Naeimeh Pourtaheri, Mohammad Rabiee, Navid Rabiee, Saber Raeghi, Hassan Rafieemehr, Sima Rafiei, Fakher Rahim, Shahram Rahimi-Dehgolan, Amir Masoud Rahmani, Vahid Rahmanian, Kiana Ramezanzadeh, Chythra R Rao, Vahid Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Azad Rasul, Reza Rawassizadeh, Seyed-Mansoor Rayegani, Nazila Rezaei, Negar Rezaei, Saeid Rezaei, Zahed Rezaei, Mohsen Rezaeian, Forouzan Rezapur-Shahkolai, Sahba Rezazadeh-Khadem, Mohammad Saadati, Siamak Sabour, Basema Saddik, Umar Saeed, Sahar Saeedi Moghaddam, Hamid Safarpour, Mahdi Safdarian, Amirhossein Sahebkar, Payman Salamati, Marwa Rashad Salem, Abdallah M Samy, Nima Sanadgol, Muhammad Arif Nadeem Saqib, Yaser Sarikhani, Arash Sarveazad, Brijesh Sathian, Mehdi Sayyah, Sadaf G Sepanlou, Saeed Shahabi, Masood Ali Shaikh, Elaheh Shaker, Mehran Shams-Beyranvand, Sakineh Sharifian, Mohsen Shati, Hatem Samir Shehata, Ali Sheidaei, Sara Sheikhbahaei, Rahim Ali Sheikhi, Parnian Shobeiri, Soraya Siabani, Gholam Reza Sivandzadeh, Ahmad Sofi-Mahmudi, Ahmad Sohrabi, Seidamir Pasha Tabaeian, Mohammadreza Tabary, Elnaz Tabibian, Ensiyeh Taheri, Majid Taheri, Arash Tehrani-Banihashemi, Amir Tiyuri, Seyed Abolfazl Tohidast, Saif Ullah, Parviz Vahedi, Sahel Valadan Tahbaz, Rohollah Valizadeh, Mehdi Varmaghani, Bay Vo, Yasir Waheed, Seyed Hossein Yahyazadeh Jabbari, Fereshteh Yazdanpanah, Zabihollah Yousefi, Hossein Yusefi, Telma Zahirian Moghadam, Hamed Zandian, Iman Zare, Arash Ziapour, and Ali H Mokdad
Subjects: Aged, 80 and over, Male, Health (social science), Traffic Safety, Injury prevention, Road Safety, Middle Aged, Global Burden of Disease, Older population, Psychiatry and Mental health, Life Expectancy, Socioeconomic Factors, Risk Factors, Humans, Female, Quality-Adjusted Life Years, Geriatrics and Gerontology, Family Practice, Aged
Abstract: BackgroundInjury poses a major threat to health and longevity in adults aged 50 years or older. The increased life expectancy in the Eastern Mediterranean region warrants a further understanding of the ageing population's inevitable changing health demands and challenges. We aimed to examine injury-related morbidity and mortality among adults aged 50 years or older in 22 Eastern Mediterranean countries. MethodsDrawing on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we categorised the population into adults aged 50–69 years and adults aged 70 years and older. We examined estimates for transport injuries, self-harm injuries, and unintentional injuries for both age groups, with sex differences reported, and analysed the percentage changes from 1990 to 2019. We reported injury-related mortality rates and disability-adjusted life-years (DALYs). The Socio-demographic Index (SDI) and the Healthcare Access and Quality (HAQ) Index were used to better understand the association of socioeconomic factors and health-care system performance, respectively, with injuries and health status in older people. Healthy life expectancy (HALE) was compared with injury-related deaths and DALYs and to the SDI and HAQ Index to understand the effect of injuries on healthy ageing. Finally, risk factors for injury deaths between 1990 and 2019 were assessed. 95% uncertainty intervals (UIs) are given for all estimates. FindingsEstimated injury mortality rates in the Eastern Mediterranean region exceeded the global rates in 2019, with higher injury mortality rates in males than in females for both age groups. Transport injuries were the leading cause of deaths in adults aged 50–69 years (43·0 [95% UI 31·0–51·8] per 100 000 population) and in adults aged 70 years or older (66·2 [52·5–75·5] per 100 000 population), closely followed by conflict and terrorism for both age groups (10·2 [9·3–11·3] deaths per 100 000 population for 50–69 years and 45·7 [41·5–50·3] deaths per 100 000 population for ≥70 years). The highest annual percentage change in mortality rates due to injury was observed in Afghanistan among people aged 70 years or older (400·4% increase; mortality rate 1109·7 [1017·7–1214·7] per 100 000 population). The leading cause of DALYs was transport injuries for people aged 50–69 years (1798·8 [1394·1–2116·0] per 100 000 population) and unintentional injuries for those aged 70 years or older (2013·2 [1682·2–2408·7] per 100 000 population). The estimates for HALE at 50 years and at 70 years in the Eastern Mediterranean region were lower than global estimates. Eastern Mediterranean countries with the lowest SDIs and HAQ Index values had high prevalence of injury DALYs and ranked the lowest for HALE at 50 years of age and HALE at 70 years. The leading injury mortality risk factors were occupational exposure in people aged 50–69 years and low bone mineral density in those aged 70 years or older. InterpretationInjuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. FundingBill & Melinda Gates Foundation. We acknowledge the Bill & Melinda Gates Foundation for funding this study.
Published: 2022

46. Does breaking up prolonged sitting improve cognitive functions in sedentary adults? A mapping review and hypothesis formulation on the potential physiological mechanisms

Author: Chythra R Rao, Ashokan Arumugam, Arto J. Pesola, and Baskaran Chandrasekaran
Subjects: Adult, lcsh:Diseases of the musculoskeletal system, Physiology, medicine.medical_treatment, Review, Sitting, Executive functions, 03 medical and health sciences, 0302 clinical medicine, Cognition, Rheumatology, Neurotrophic factors, Neuroplasticity, Medicine, Humans, Orthopedics and Sports Medicine, Effects of sleep deprivation on cognitive performance, Workplace, Exercise, Brain-derived neurotrophic factor, Rehabilitation, business.industry, 030229 sport sciences, Brain health, Standing Position, Cognitive function, lcsh:RC925-935, Sedentary Behavior, business, Neuroscience, 030217 neurology & neurosurgery
Abstract: Background Prolonged (excessive) sitting is detrimentally associated with cardiovascular, metabolic and mental health. Moreover, prolonged sitting has been associated with poor executive function, memory, attention and visuospatial skills, which are important cognitive aspects of work performance. Breaking up prolonged sitting with standing or light-intensity exercises at the workplace is recognized as a potential measure in improving cognition. However, preliminary evidence, primarily from acute laboratory experiments, has enabled formulating hypothesis on the possible mechanistic pathways. Hence, the aim of this mapping review is to gather preliminary evidence and substantiate possible physiological mechanisms underpinning the putative effects of breaking prolonged sitting on improving cognitive function among sedentary office workers. Mapping method We searched four databases to identify relevant studies that explored the effects of uninterrupted sitting on cognitive function. First, we introduce how prolonged sitting increases the risks of hyperglycemia, autonomic stability, inflammation, adverse hormonal changes and restrictions in cerebral blood flow (CBF) and alters cognitive function. Second, we elucidate the direct and indirect effects of breaking up prolonged sitting time that may prevent a decline in cognitive performance by influencing glycaemic variability, autonomic stability, hormones (brain derived neurotrophic factor, dopamine, serotonin), vascular functions, and CBF. We highlight the importance of breaking up prolonged sitting on metabolic, vascular and endocrine functions, which in turn may improve cognitive functions and eventually foster work productivity. Improved synaptic transmission or neuroplasticity due to increased brain glucose and mitochondrial metabolism, increased endothelial shear and CBF, increased brain neurotrophic factors (dopamine) and accelerated anti-inflammatory functions are some of the hypothetical mechanisms underpinning improved cognitive functions. Conclusion We postulate that improving cognitive function by breaking up prolonged sitting periods is biologically plausible with the myriad of (suggested) physiological mechanisms. Future experimental studies to ascertain the aforementioned hypothetical mechanisms and clinical trials to break sedentary behavior and improve cognitive functions in sedentary office workers are warranted.
Published: 2021

47. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Author: Junaid Khan, Blake Angell, Marcel Ausloos, Catherine M. Antony, Elham Ehsani-Chimeh, Edgar Denova-Gutiérrez, Kewal Krishan, Mohamed Kamal Mesregah, Arrigo Francesco Giuseppe Cicero, Simona Cătălina Ştefan, Tanuj Kanchan, Maysaa El Sayed Zaki, Mohamed I Hegazy, Richard James Maude, Salman Rawaf, Viktória Szerencsés, Milena Santric-Milicevic, Martin McKee, Reza Rawassizadeh, Anton C Harle, Neda Milevska Kostova, Hamidreza Pazoki Toroudi, Saravanan Muthupandian, Mohammad Hifz Ur Rahman, Hassan Abolhassani, Christine Mpundu-Kaambwa, Atta Abbas Naqvi, John Dube, Habib Benzian, Cristiano Piccinelli, Kedir Hussein Abegaz, Mohammad Khammarnia, Carlo Eduardo Medina-Solís, Tanvir M. Huda, Fakher Rahim, Modhurima Moitra, Valentin Yurievich Skryabin, Emily Joy Callander, David Laith Rawaf, Saeed Shahabi, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Mohammad Ali Mansournia, Rafael Lozano, Himal Kandel, João Vasco Santos, MA Garcia-Gordillo, Savita Lasrado, Alexey V Breusov, Nicola Luigi Bragazzi, Deepak Dhamnetiya, Mohammad Amin Bahrami, Teroj Abdulrahman Mohamed, Reinhard Busse, Veer Bala Gupta, Ionut Negoi, Xiaochen Dai, Eun-Cheol Park, Trang Huyen Nguyen, Gulrez Shah Azhar, Annie Haakenstad, Asadollah Gholamian, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Ismaeel Yunusa, Hubert Amu, G. K. Mini, Francesco Saverio Violante, Michael Abdelmasseh, Yun Jin Kim, Yousef Moradi, Nataliya Foigt, Afshin Maleki, Pavanchand H Shetty, Mesfin Agachew Woldekidan, Ramesh Holla, Mina Anjomshoa, Seyyed Meysam Mousavi, Azeem Majeed, Bright Opoku Ahinkorah, Hassan Magdy Abd El Razek, Avirup Guha, Telma Zahirian Moghadam, Olayinka Stephen Ilesanmi, Alessandro Arrigo, Neda Kianipour, Marcos Roberto Tovani-Palone, Mosiur Rahman, Tomas Y Ferede, Catalina Liliana Andrei, Alaa Makki, Joseph L Dieleman, Shuhei Nomura, Kanwar Hamza Shuja, Ileana Heredia-Pi, Mukhammad David Naimzada, Ali Kazemi Karyani, Chisom Joyqueenet Akunna, Souranshu Chatterjee, Yonas Akalu, Hanadi Al Hamad, Abdollah Mohammadian-Hafshejani, Hayley N Stutzman, Getinet Ayano, Atte Meretoja, Fahad Alanezi, Aravind Thavamani, Sonu Bhaskar, Claudiu Herteliu, Andreea Mirica, Masood Ali Shaikh, Soewarta Kosen, Nelson J. Alvis-Zakzuk, Emma Elizabeth Spurlock, Ferrán Catalá-López, Samath D Dharmaratne, Stany W. Lobo, Alemayehu Hailu, Sebastian Vollmer, Tarik Ahmed Rashid, Sheikh Mohammed Shariful Islam, Lalit Dandona, Farahnaz Joukar, Jacob Olusegun Olusanya, Befikadu Legesse Wubishet, Sezer Kisa, Songhomitra Panda-Jonas, Nasir Umar, Adrian Otoiu, Yonas Getaye Tefera, Harapan Harapan, Ivo Iavicoli, Jakub Morze, Mihajlo Jakovljevic, Nicholas J K Breitborde, Ian E Cogswell, Mehdi Hosseinzadeh, Sadia Bibi, Stefan Kohler, Florian Fischer, Jagdish Khubchandani, Justice Nonvignon, Salah Eddin Karimi, Yousef Khader, Jan-Walter De Neve, Stanislav S. Otstavnov, Ruoyan Tobe-Gai, Tommi Vasankari, Carlos A Castañeda-Orjuela, Nahlah Elkudssiah Ismail, Khezar Hayat, Chythra R Rao, Priya Rathi, Asma Tahir Awan, Jean Jacques Noubiap, Salime Goharinezhad, Ai Koyanagi, Rafael Tabarés-Seisdedos, Angela E Micah, Rakhi Dandona, Jaykaran Charan, Lorainne Tudor Car, Michael R.M. Abrigo, Kenji Shibuya, Aziz Sheikh, B Reshmi, Rovshan Khalilov, Haroon Ahmed, Andrea Werdecker, Alberto Freitas, Tara Ballav Adhikari, Vasily Vlassov, Risky Kusuma Hartono, Leila Keikavoosi-Arani, Gyu Ri Kim, Ana Laura Manda, Carlos Alberto Marrugo Arnedo, Obinna Onwujekwe, Van C. Lansingh, Miklós Szócska, Gelin Xu, Ted R. Miller, Saad M.A. Dahlawi, Till Bärnighausen, Jagadish Rao Padubidri, Bernhard T. Baune, Fatemeh Pashazadeh Kan, Juan Sanabria, Bruno Ramos Nascimento, Stefano Olgiati, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, V. E. Nwatah, Tesleem Kayode Babalola, Ranil Jayawardena, Robert Kaba Alhassan, Takeshi Fukumoto, Lucero Cahuana-Hurtado, Aparna Ichalangod Narayana, Mohammad Ali Sahraian, Atif Amin Baig, Carl Abelardo T. Antonio, Jost B. Jonas, Dian Kusuma, Priyanga Ranasinghe, Mikhail Sergeevich Zastrozhin, Ali Bijani, Arash Ziapour, Seyed Behzad Jazayeri, Francesco Sanmarchi, Seyed Sina Naghibi Irvani, Allen Seylani, Theo Vos, Tuomo J. Meretoja, Delia Hendrie, Mostafa Amini-Rarani, Manthan D Janodia, Sathish Kumar Jayapal, Sorin Hostiuc, Marjan Ajami, Ali Gholamrezanezhad, Muhammad Aqeel, Muhammed Magdy Abd El Razek, Shaun Wen Huey Lee, Rawlance Ndejjo, Maarten J. Postma, Luis Camera, Chhabi Lal Ranabhat, Sadaf G. Sepanlou, Adnan Kisa, Tahira Ashraf, Tudorel Andrei, Mohammad Ali Jahani, Virginia Bodolica, Chuanhua Yu, Moses K. Muriithi, Pascual R. Valdez, Paul S. F. Yip, Demetris Lamnisos, Amir Masoud Rahmani, Hamed Zandian, Anna Aleksandrovna Skryabina, Yeong Yeh Lee, Sana Salehi, Syed Mohamed Aljunid, Kyle E. Simpson, Sami Almustanyir Almustanyir, Bogdan Oancea, Biswa Prakash Nayak, Omid Dadras, Fariborz Mansour-Ghanaei, Turki Alanzi, Mahaveer Golechha, Bach Xuan Tran, Lal B. Rawal, Shoaib Hassan, Rahul R. Zende, Sandhya Neupane Kandel, Martin Amogre Ayanore, Adam E. Berman, Long Khanh Dao Le, Dragos Virgil Davitoiu, Adithi Shetty, Getinet Kassahun, Birhanu Wubale Yirdaw, Usha Ram, Linh Gia Vu, Emilie R Maddison, Yosef Alemayehu, Ali H. Mokdad, Tomislav Mestrovic, Mavra A Riaz, Muhammad Naveed, Koustuv Dalal, Syed Amir Gilani, Reza Malekzadeh, Nikha Bhardwaj, Desta Debalkie Atnafu, Rohollah Kalhor, Naohiro Yonemoto, Ahmad Ghashghaee, Andre M. N. Renzaho, Amadou Barrow, Christopher J L Murray, Budi Aji, Maitreyi Sahu, Sara D Friedman, Konrad Pesudovs, Robert Reiner, Mohammad Rifat Haider, Mustafa Z. Younis, Aidin Abedi, Sanjay Basu, Nancy Fullman, Darrah McCracken, Rajasekaran Koteeswaran, Falk Schwendicke, Ionela-Roxana Glavan, Mohamed H Hassanein, Sindhura Lakshmi Koulmane Laxminarayana, Javad Nazari, Khurshid Alam, Bulat Idrisov, Nelson Alvis-Guzman, Mokhtar Mohammadi, Golnaz Heidari, Asif Hanif, Ghozali Ghozali, Vijay Kumar Chattu, Leila Doshmangir, Simiao Chen, Maha El Tantawi, Stephen S Lim, Bay Vo, Deepak Saxena, Jasvinder A. Singh, Robert Ancuceanu, Yves Miel H Zuniga, Kamal Hezam, Andrew T Olagunju, Sheikh Jamal Hossain, Lindsey E Wallace, Dejana Braithwaite, Sergio I. Prada, Adolfo Martinez-Valle, Brandon Cunningham, Vivek Gupta, Joseph Salama, Rezaul Karim Ripon, Bing-Fang Hwang, Mokhtar Mahdavi, Tamás Joó, Cristiana Abbafati, Behzad Karami Matin, Tushar Garg, Cyrus Alinia, Yingxi Zhao, Richard G. Wamai, Satoshi Ezoe, Anders Larsson, Seyedeh Zahra Masoumi, Arokiasamy Perianayagam, Sharareh Eskandarieh, Maciej Banach, Billingsley Kaambwa, Nader Jahanmehr, Saeed Amini, Foluke Adetola Ojelabi, Nikolay Ivanovich Briko, Samer Hamidi, Gaetano Isola, Tahereh Javaheri, Gbenga A. Kayode, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, David M. Pereira, Mansour Ghafourifard, Saira Afzal, Ravi Prakash Jha, Erkin M. Mirrakhimov, Ahamarshan Jayaraman Nagarajan, Giang Thu Vu, G Anil Kumar, Vahit Yigit, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Leticia Avila-Burgos, Nastaran Barati, Morteza Arab-Zozani, Eduardo A. Undurraga, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Himanshu Khajuria, Anas M. Saad, Mohammad Rabiee, Abdallah M. Samy, Srinivas Goli, Roman Topor-Madry, Golsum Tsakalos, Mariam Molokhia, Biruk Wogayehu Taddele, Mohammad Ali Moni, E S Abhilash, Timur Aripov, Sepideh Ahmadi, Mehdi Sayyah, Jorge Hugo Villafañe, Peter Andras Gaal, Babayemi O Olakunde, Brijesh Sathian, Anayat Ullah, Ritesh G. Menezes, Samad Azari, Ahmed I. Hasaballah, Soosanna Kumary Chattu, Pankaj Bhardwaj, Sanni Yaya, Zhi-Jiang Zhang, Jalal Arabloo, Saif Ullah, Akshaya Srikanth Bhagavathula, Bahram Mohajer, Ekaterina Vladimirovna Glushkova, Vinay Nangia, Shrikant Pawar, Moslem Soofi, Antonio Reis de Sá-Junior, Simon I. Hay, Miloje Savic, 2. Global Burden of Disease 2020 Health Financing Collaborator Network, Cicero AFG, Network, Global Burden of Disease 2020 Health Financing Collaborator, Bill & Melinda Gates Foundation, Micah, A. E., Cogswell, I. E., Cunningham, B., Ezoe, S., Harle, A. C., Maddison, E. R., Mccracken, D., Nomura, S., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Wallace, L. E., Zhao, Y., Zende, R. R., Abbafati, C., Abdelmasseh, M., Abedi, A., Abegaz, K. H., Abhilash, E. S., Abolhassani, H., Abrigo, M. R. M., Adhikari, T. B., Afzal, S., Ahinkorah, B. O., Ahmadi, S., Ahmed, H., Ahmed, M. B., Ahmed Rashid, T., Ajami, M., Aji, B., Akalu, Y., Akunna, C. J., Al Hamad, H., Alam, K., Alanezi, F. M., Alanzi, T. M., Alemayehu, Y., Alhassan, R. K., Alinia, C., Aljunid, S. M., Almustanyir, S. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Angell, B., Anjomshoa, M., Antonio, C. A. T., Antony, C. M., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arrigo, A., Ashraf, T., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Awan, A. T., Ayano, G., Ayanore, M. A., Azari, S., Azhar, G. S., Babalola, T. K., Bahrami, M. A., Baig, A. A., Banach, M., Barati, N., Barnighausen, T. W., Barrow, A., Basu, S., Baune, B. T., Bayati, M., Benzian, H., Berman, A. E., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bibi, S., Bijani, A., Bodolica, V., Bragazzi, N. L., Braithwaite, D., Breitborde, N. J. K., Breusov, A. V., Briko, N. I., Busse, R., Cahuana-Hurtado, L., Callander, E. J., Camera, L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charan, J., Chatterjee, S., Chattu, S. K., Chattu, V. K., Chen, S., Cicero, A. F. G., Dadras, O., Dahlawi, S. M. A., Dai, X., Dalal, K., Dandona, L., Dandona, R., Davitoiu, D. V., De Neve, J. -W., de Sa-Junior, A. R., Denova-Gutierrez, E., Dhamnetiya, D., Dharmaratne, S. D., Doshmangir, L., Dube, J., Ehsani-Chimeh, E., El Sayed Zaki, M., El Tantawi, M., Eskandarieh, S., Farzadfar, F., Ferede, T. Y., Fischer, F., Foigt, N. A., Freitas, A., Friedman, S. D., Fukumoto, T., Fullman, N., Gaal, P. A., Gad, M. M., Garcia-Gordillo, M. A., Garg, T., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Gholamrezanezhad, A., Ghozali, G., Gilani, S. A., Glavan, I. -R., Glushkova, E. V., Goharinezhad, S., Golechha, M., Goli, S., Guha, A., Gupta, V. B., Gupta, V. K., Haakenstad, A., Haider, M. R., Hailu, A., Hamidi, S., Hanif, A., Harapan, H., Hartono, R. K., Hasaballah, A. I., Hassan, S., Hassanein, M. H., Hayat, K., Hegazy, M. I., Heidari, G., Hendrie, D., Heredia-Pi, I., Herteliu, C., Hezam, K., Holla, R., Hossain, S. J., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Hwang, B. -F., Iavicoli, I., Idrisov, B., Ilesanmi, O. S., Irvani, S. S. N., Islam, S. M. S., Ismail, N. E., Isola, G., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janodia, M. D., Javaheri, T., Jayapal, S. K., Jayawardena, R., Jazayeri, S. B., Jha, R. P., Jonas, J. B., Joo, T., Joukar, F., Jurisson, M., Kaambwa, B., Kalhor, R., Kanchan, T., Kandel, H., Karami Matin, B., Karimi, S. E., Kassahun, G., Kayode, G. A., Kazemi Karyani, A., Keikavoosi-Arani, L., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, J., Khubchandani, J., Kianipour, N., Kim, G. R., Kim, Y. J., Kisa, A., Kisa, S., Kohler, S., Kosen, S., Koteeswaran, R., Koulmane Laxminarayana, S. L., Koyanagi, A., Krishan, K., Kumar, G. A., Kusuma, D., Lamnisos, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Le, L. K. D., Lee, S. W. H., Lee, Y. Y., Lim, S. S., Lobo, S. W., Lozano, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Mahdavi, M. M., Majeed, A., Makki, A., Maleki, A., Malekzadeh, R., Manda, A. L., Mansour-Ghanaei, F., Mansournia, M. A., Marrugo Arnedo, C. A., Martinez-Valle, A., Masoumi, S. Z., Maude, R. J., Mckee, M., Medina-Solis, C. E., Menezes, R. G., Meretoja, A., Meretoja, T. J., Mesregah, M. K., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mohajer, B., Mohamed, T. A., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Moni, M. A., Moradi, Y., Morze, J., Mousavi, S. M., Mpundu-Kaambwa, C., Muriithi, M. K., Muthupandian, S., Nagarajan, A. J., Naimzada, M. D., Nangia, V., Naqvi, A. A., Narayana, A. I., Nascimento, B. R., Naveed, M., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, I., Neupane Kandel, S., Nguyen, T. H., Nonvignon, J., Noubiap, J. J., Nwatah, V. E., Oancea, B., Ojelabi, F. A. O., Olagunju, A. T., Olakunde, B. O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Park, E. -C., Pashazadeh Kan, F., Pawar, S., Pazoki Toroudi, H., Pereira, D. M., Perianayagam, A., Pesudovs, K., Piccinelli, C., Postma, M. J., Prada, S. I., Rabiee, M., Rabiee, N., Rahim, F., Rahimi-Movaghar, V., Rahman, M. H. U., Rahman, M., Rahmani, A. M., Ram, U., Ranabhat, C. L., Ranasinghe, P., Rao, C. R., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Reiner Jr, R. C., Renzaho, A. M. N., Reshmi, B., Riaz, M. A., Ripon, R. K., Saad, A. M., Sahraian, M. A., Sahu, M., Salama, J. S., Salehi, S., Samy, A. M., Sanabria, J., Sanmarchi, F., Santos, J. V., Santric-Milicevic, M. M., Sathian, B., Savic, M., Saxena, D., Sayyah, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Seylani, A., Shahabi, S., Shaikh, M. A., Sheikh, A., Shetty, A., Shetty, P. H., Shibuya, K., Shrime, M. G., Shuja, K. H., Singh, J. A., Skryabin, V. Y., Skryabina, A. A., Soltani, S., Soofi, M., Spurlock, E. E., Stefan, S. C., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Taddele, B. W., Tefera, Y. G., Thavamani, A., Tobe-Gai, R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. X., Tudor Car, L., Ullah, A., Ullah, S., Umar, N., Undurraga, E. A., Valdez, P. R., Vasankari, T. J., Villafane, J. H., Violante, F. S., Vlassov, V., Vo, B., Vollmer, S., Vos, T., Vu, G. T., Vu, L. G., Wamai, R. G., Werdecker, A., Woldekidan, M. A., Wubishet, B. L., Xu, G., Yaya, S., Yazdi-Feyzabadi, V., Yigit, V., Yip, P., Yirdaw, B. W., Yonemoto, N., Younis, M. Z., Yu, C., Yunusa, I., Zahirian Moghadam, T., Zandian, H., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Ziapour, A., Zuniga, Y. M. H., Hay, S. I., Murray, C. J. L., and Dieleman, J. L.
Subjects: Economic growth, Financing, Government, International Cooperation, HN, HM, Global Health, Gross domestic product, International Agencies/economics, 0302 clinical medicine, RA0421, Per capita, Global health, Healthcare Financing, 11 Medical and Health Sciences, 2. Zero hunger, COVID 19, develompment assistance, health financing, projection 1995-250, INCOME, COVID-19, Development assistance, Health financing, COVID-19/economics, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, Articles, General Medicine, 3. Good health, Government Programs, Health Expenditures/statistics & numerical data, 030220 oncology & carcinogenesis, Transparency (graphic), QR180, Economic Development, International development, Life Sciences & Biomedicine, medicine.medical_specialty, Government Programs/economics, Gross Domestic Product, Context (language use), 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, medicine, Humans, Developing Countries/economics, Developing Countries, Government, Science & Technology, Public health, COVID-19, development assistance, global health, Global Burden of Disease 2020 Health Financing Collaborator Network, International Agencies, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Business, Global Health/economics, Health Expenditures, 030217 neurology & neurosurgery, RC, Financing, Government/economics
Abstract: Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(21)01258-7
Published: 2021

48. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990–2019: results from the Global Burden of Disease Study 2019

Author: Akram Pourshams, Mostafa Dianatinasab, Alberto L. García-Basteiro, Seyed Sina Naghibi Irvani, Patrick D. M. C. Katoto, Daiane Borges Machado, Alireza Rafiei, Aziz Rezapour, Khaled Khatab, Chukwudi A Nnaji, Fatemeh Javanmardi, Asrat Arja, Asif Hanif, Arianna Maever L. Amit, Min Seo Kim, Tomislav Mestrovic, Razique Anwer, Gulrez Shah Azhar, Milena Ilic, Jost B. Jonas, Sreenivas Narasimha Swamy, Fisaha Haile Tesfay, Fakher Rahim, Christopher J L Murray, Molly H Biehl, Hesam Alizade, Souranshu Chatterjee, Jalal Arabloo, Mariam Molokhia, Sachin R Atre, Maciej Banach, Ashwin Kamath, Gebiyaw Wudie Tsegaye, Irina Filip, Mohammad Sadegh Rezai, Robert Reiner, Shrikant Pawar, Anasthasia Zastrozhina, Vardhmaan Jain, Shafiu Mohammed, Benn Sartorius, Sindhura Lakshmi Koulmane Laxminarayana, Harapan Harapan, Hiba Jawdat Barqawi, Tahvi Frank, Yasir Waheed, Seyed Hossein Yahyazadeh Jabbari, Shaun Wen Huey Lee, Jorge R. Ledesma, Yosef Alemayehu, Sajjad Ahmad, Deepak Dhamnetiya, Khezar Hayat, Preetam Bhalchandra Mahajan, Ramesh Holla, Atif Amin Baig, Azeem Majeed, Darshan B B, Catherine M. Antony, Allen Seylani, Avinash Kumar, Alimuddin Zumla, Irena Ilic, Sofia Androudi, Liaqat Ali, Rafael Lozano, Carl Abelardo T. Antonio, Sanjay M Pattanshetty, Bach Xuan Tran, Eduarda Fernandes, Marissa B Reitsma, Ramaiah Itumalla, Catrin E. Moore, Amir Masoud Rahmani, Daniel Diaz, Mohsen Naghavi, R V Polibin, Nithin Kumar, Archith Boloor, Norberto Perico, Vahit Yigit, Emma Elizabeth Spurlock, Zaheer-Ud-Din Babar, Veer Bala Gupta, Nima Rezaei, Arief Hargono, Maarten J. Postma, Jitendra Singh, Sandhya Neupane Kandel, Sapna Gupta, Omid Dadras, Takahiro Tabuchi, Sanjeev Misra, Salman Rawaf, Devasahayam J. Christopher, Francisco Rogerlândio Martins-Melo, Omid Shafaat, Florian Fischer, Satish Saroshe, Simon I. Hay, Mosiur Rahman, Mohammad Ali Moni, Sathish Kumar Jayapal, Jalil Jaafari, Walter Mendoza, Sepideh Ahmadi, Deepak Madi, Alexander Kwarteng, Omid Rezahosseini, Segun Emmanuel Ibitoye, Hassan Mehmood Lak, Iván Landires, Mahesh P A, Biniyam Sahiledengle Geberemariyam, Hayimro Edemealem Merie, Himanshu Khajuria, Kathryn H. Jacobsen, Magdalene K. Walters, Ali H. Mokdad, Sharath Burugina Nagaraja, Avina Vongpradith, Mehrnoosh Samaei, Shubha Jayaram, Beriwan Abdulqadir Ali, Giang Thu Vu, Chukwuma David Umeokonkwo, Adnan Kisa, Mehdi Hosseinzadeh, Danilo Buonsenso, Nitin Joseph, G Anil Kumar, Rekha Thapar, Sanjeev Nair, Eyayou Girma Tadesse, Joanna L Whisnant, Amanual Getnet Mersha, Savita Lasrado, Pintu Paul, Burcu Kucuk Bicer, Dharmesh Kumar Lal, Mowafa Househ, Vivek Gupta, Chandrashekhar T Sreeramareddy, Sanjay Basu, Andre M. N. Renzaho, Saira Afzal, Nahlah Elkudssiah Ismail, Akine Eshete Abosetugn, Jennifer M. Ross, Ai Koyanagi, Tushar Garg, Chythra R Rao, Sezer Kisa, Yigizie Yeshaw, Paschalis Steiropoulos, Brijesh Sathian, Zemenu Tamir, Amene Abebe Kerbo, Christine Lin, Dana Bryazka, Jason A. Anderson, Majid Pirestani, Austin Carter, Chuanhua Yu, Berhan Tsegaye, Elvis Enowbeyang Tarkang, Mareli M Claassens, Hmwe H Kyu, Lorenzo Ferro Desideri, Akila Prashant, Smriti Sinha, Linh Phuong Doan, Befikadu Legesse Wubishet, Fabio Barra, Rovshan Khalilov, Joshua A. Salomon, Virginia Núñez-Samudio, Imad I. Tleyjeh, David Laith Rawaf, Mikhail Sergeevich Zastrozhin, Dimas Ria Angga Pribadi, Kamal Hezam, Shilpashree Madhava Kunjathur, Nasir Salam, Wei-Chen Lee, Stephen S Lim, Bay Vo, Mahaveer Golechha, K. M. Saif-Ur-Rahman, Sahel Valadan Tahbaz, Muhammed Elhadi, Fatemeh Pashazadeh Kan, Fares Alahdab, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Boris Bikbov, Addis Aklilu, Ritesh G. Menezes, Amare Belachew Dagnew, Ravi Prakash Jha, Tanuj Kanchan, Siamak Sabour, Theo Vos, Amir Radfar, Amir Emami, João Pedro Silva, Uzma Belgaumi, Vijay Kumar Chattu, Parnaz Daneshpajouhnejad, Ahmed Al Montasir, Oladimeji Adebayo, Rabia Hussain, Masoud Moghadaszadeh, Suma Nair, Ahmed I. Hasaballah, Félix Carvalho, Yun Jin Kim, Hanadi Al Hamad, Valentin Yurievich Skryabin, Mu'awiyyah Babale Sufiyan, Farahnaz Joukar, Krittika Bhattacharyya, Farshad Farzadfar, Hadi Hassankhani, Aso Mohammad Darwesh, Kefyalew Addis Alene, Himal Kandel, Susan M Sawyer, Soosanna Kumary Chattu, Keyghobad Ghadiri, Zahid A Butt, Mokhtar Mohammadi, Belay Tessema, Nikha Bhardwaj, Hossein Samadi Kafil, Kiomars Sharafi, Siyan Yi, Jianing Ma, Denis O Roshchin, Pankaj Bhardwaj, Jagdish Khubchandani, Rajaa Al-Raddadi, Shymaa Enany, Akshaya Srikanth Bhagavathula, Andrew T Olagunju, Parkes J Kendrick, Amador Goodridge, Zhi-Jiang Zhang, Mulusew A Asemahagn, Saeed Amini, Ziad A. Memish, Ruoyan Tobe-Gai, Ali Bijani, Nour Mheidly, Priyanga Ranasinghe, Abdallah M. Samy, Mahfuzar Rahman, Giuseppe Remuzzi, Abdullah T Khoja, Biswa Prakash Nayak, Samer Hamidi, Javad Nazari, Ramakrishnan Parthasarathi, Lalit Dandona, Molly R Nixon, Parvaiz A Koul, Mika Shigematsu, Gbenga A. Kayode, Rachel Feldman, Mohammad Rifat Haider, Nelson Alvis-Guzman, Mesfin Agachew Woldekidan, Deepa Jahagirdar, Kate E. LeGrand, Yusra Ahmed Salih, Nikolay Ivanovich Briko, Xuefeng Liu, Qorinah Estiningtyas Sakilah Adnani, Christian Garcia-Calavaro, Dinh-Toi Chu, Mihaela Hostiuc, Yohannes Tekalegn, Rajan Paudel, Prasanna Mithra, Narinder Kumar, Masood Ali Shaikh, Zubair Kabir, Natalia V. Bhattacharjee, Chisom Joyqueenet Akunna, Masoud Foroutan, Bogdan Oancea, Anayat Ullah, Saurabh Mehta, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Vahid Alipour, Tarik A. Rashid, Melese Abate Reta, Atta Abbas Naqvi, Emilie R Maddison, Mpiko Ntsekhe, Naohiro Yonemoto, Ahmad Ghashghaee, Mohamed Kamal Mesregah, Amadou Barrow, Ismaeel Yunusa, Gholamreza Roshandel, Ahamarshan Jayaraman Nagarajan, Hassan Abolhassani, Ahmad Azam Malik, Xiaochen Dai, Trang Huyen Nguyen, Eyal Oren, Bright Opoku Ahinkorah, Taklo Simeneh Yazie Yazie, Kewal Krishan, Ranjitha S Shetty, Emerito Jose A. Faraon, Jae Il Shin, Shafiul Haque, Veincent Christian Filipino Pepito, Sahar Eftekharzadeh, Bhawna Gupta, Platon D. Lopukhov, Abdiwahab Hashi, Amanda Novotney, Eman Abu-Gharbieh, Oluwakemi Ololade Odukoya, Anna Aleksandrovna Skryabina, Shoaib Hassan, Rakhi Dandona, Jaykaran Charan, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), and Collaborators, GBD 2019 Tuberculosis
Subjects: Male, PNEUMONIA, COUNTRIES, Tuberculosis, Population, HIV Infections, CHILDREN, Genders, Mortalities, Global Health, DIAGNOSIS, Microbiology, Global Burden of Disease, 1117 Public Health and Health Services, Acquired immunodeficiency syndrome (AIDS), Risk Factors, 1108 Medical Microbiology, Sex differences, INFECTION, medicine, Global health, Humans, education, Sex Characteristics, education.field_of_study, Global disease burdens, business.industry, Mortality rate, GBD 2019 Tuberculosis Collaborators, HIV, Bayes Theorem, 1103 Clinical Sciences, DIABETES-MELLITUS, medicine.disease, Verbal autopsy, Tuberculosis treatment, PREVALENCE, Infectious Diseases, Attributable risk, Coinfection, Female, INJURIES, GENDER, HEALTH, business, Demography
Abstract: Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Findings Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08–1·29) deaths due to tuberculosis and 8·50 million (7·45–9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000–279 000) deaths due to tuberculosis and 1·15 million (1·01–1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000–425 000) more deaths and 1·01 million (0·82–1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820–11 400) more deaths and 81 100 (63 300–100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69–5·02), 6·17 (5·48–7·02), and 1·17 (1·07–1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03–2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05–1·08) times greater among females than males. Interpretation As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. Funding Bill & Melinda Gates Foundation.
Published: 2021

49. Hearing loss prevalence and years lived with disability, 1990-2019: findings from the Global Burden of Disease Study 2019

Author: Rezaul Karim Ripon, Lydia M. Haile, Richard C. Franklin, Virginia Núñez-Samudio, Sonali G. Choudhari, Chythra R Rao, Maria Inês Schmidt, Jeff T. Zhao, Hanadi Al Hamad, Bing-Fang Hwang, Christopher R. Cederroth, Howard J. Hoffman, Naohiro Yonemoto, Rajaa Al-Raddadi, Avina Vongpradith, David Laith Rawaf, Valentin Yurievich Skryabin, Maja Pasovic, Ismail Tareque, Alessandra Lugo, Theo Vos, Rabia Hussain, Golnaz Heidari, Tarik A. Rashid, Ghozali Ghozali, Stephen S Lim, Bay Vo, Emma Elizabeth Spurlock, Himal Kandel, Jitendra Singh, Adrian Davis, Pankaj Bhardwaj, Houman Sotoudeh, Arif Mohammed, Rekha Thapar, Mohammad Rabiee, Florian Fischer, Deepika Singhal, Haroon Ahmed, Irina Filip, Michael Ekholuenetale, Amirhossein Sahebkar, Abdallah M. Samy, Fatemeh Pashazadeh Kan, Sathish Kumar Jayapal, Ionela-Roxana Glavan, Mikhail Sergeevich Zastrozhin, Bruce Bartholow Duncan, Aziz Rezapour, Jalal Arabloo, Sahel Valadan Tahbaz, Chuanhua Yu, Huong Lan Thi Nguyen, Vahid Rashedi, Shrikant Pawar, Shelly Chadha, Mahaveer Golechha, Bach Xuan Tran, Jaimie D Steinmetz, Deepak Dhamnetiya, Olayinka Stephen Ilesanmi, Masood Ali Shaikh, Charlie Ashbaugh, Stany W. Lobo, Akshaya Srikanth Bhagavathula, Biruk Wogayehu Taddele, Baye Dagnew, Walter Mendoza, Morteza Arab-Zozani, Turki Alanzi, Sandhya Neupane Kandel, Kebadnew Mulatu Mihretie, Zaheer-Ud-Din Babar, Jasvinder A. Singh, Veer Bala Gupta, Maheswar Satpathy, Ali H. Mokdad, Simon I. Hay, Sadia Bibi, Louis Jacob, Christopher J L Murray, Liaqat Ali, Keyvan Pakshir, Allen Seylani, Andre M. N. Renzaho, Eman Abu-Gharbieh, Till Bärnighausen, Segun Emmanuel Ibitoye, Voilet Rodrigues, Vahit Yigit, Mohammed Shannawaz, Mohammad Ali Moni, Ali Yadollahpour, Rose G Bender, Victor M. Oguoma, Rohollah Kalhor, Saif Ullah, Mohammad Zamani, Anna Aleksandrovna Skryabina, Mowafa Househ, Milena Santric-Milicevic, Juwel Rana, Fakher Rahim, Soraya Siabani, Mokhtar Mohammadi, Bolajoko O. Olusanya, Khezar Hayat, Teroj Abdulrahman Mohamed, Palash Chandra Banik, Nikha Bhardwaj, Brijesh Sathian, Fahad Alanezi, Jean Jacques Noubiap, Jagadish Rao Padubidri, Hans Orru, Nawzad K. Al-Salihi, Navid Rabiee, Xuefeng Liu, Iván Landires, Paul S Briant, Jost B. Jonas, Mayowa O. Owolabi, Zhi Jiang Zhang, Farhad Ghamari, Vahid Alipour, Sowmya J. Rao, Mehdi Hosseinzadeh, Desta Debalkie Atnafu, Lalit Dandona, Molly R Nixon, Rovshan Khalilov, Ai Koyanagi, Silvano Gallus, Saad M.A. Dahlawi, Salman Rawaf, Mohammad Abdollahi, Ted R. Miller, Masao Iwagami, Amanual Getnet Mersha, Savita Lasrado, Marcos Roberto Tovani-Palone, Umar Saeed, Fares Alahdab, Vafa Rahimi-Movaghar, Ivo Iavicoli, Yonas Akalu, Amir Masoud Rahmani, Kathleen Pillsbury Hopf, Assefa Desalew, Sheikh Mohammed Shariful Islam, Amare Belachew Dagnew, Ravi Prakash Jha, Jacob Olusegun Olusanya, Jingkai Wei, Mandira Lamichhane Dhimal, Kaloyan Kamenov, Anasthasia Zastrozhina, Samer Hamidi, Gbenga A. Kayode, Katrin Burkart, Anjali Singal, Shahina Pardhan, Rakhi Dandona, Jaykaran Charan, Akram Pourshams, Xiaochen Dai, Meghnath Dhimal, Kerrie E. Doyle, Seyed Sina Naghibi Irvani, Shilpa Gaidhane, Francesco Saverio Violante, Monika Sawhney, Animut Tagele Tamiru, Hai Quang Pham, Atif Amin Baig, Hubert Amu, Judie Arulappan, Ayele Semachew Kasa, Alaa Makki, Syed Amir Gilani, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Abhay Gaidhane, Birhanu Wubale Yirdaw, Ismaeel Yunusa, Ali Bijani, Billy Randall Hammond, Neeti Rustagi, Bogdan Oancea, Ahmad Ghashghaee, Amadou Barrow, Mosiur Rahman, Ashkan Afshin, Yigizie Yeshaw, Mahalaqua Nazli Khatib, Amir Radfar, Winfried Schlee, Andrew T Olagunju, Dinh-Toi Chu, Vasily Vlassov, Ejaz Ahmad Khan, Sanjeev Misra, Rosa A. S. Couto, Marina Pinheiro, Mohammad Hifz Ur Rahman, Amir Abdoli, Bárbara Niegia Garcia de Goulart, Wondimeneh Shibabaw Shiferaw, Seyed Hossein Yahyazadeh Jabbari, Aislyn U. Orji, Vivek Gupta, Giang Thu Vu, G Anil Kumar, Haile L.M., Kamenov K., Briant P.S., Orji A.U., Steinmetz J.D., Abdoli A., Abdollahi M., Abu-Gharbieh E., Afshin A., Ahmed H., Rashid T.A., Akalu Y., Alahdab F., Alanezi F.M., Alanzi T.M., Al Hamad H., Ali L., Alipour V., Al-Raddadi R.M., Amu H., Arabloo J., Arab-Zozani M., Arulappan J., Ashbaugh C., Atnafu D.D., Babar Z.-U.-D., Baig A.A., Banik P.C., Barnighausen T.W., Barrow A., Bender R.G., Bhagavathula A.S., Bhardwaj N., Bhardwaj P., Bibi S., Bijani A., Burkart K., Cederroth C.R., Charan J., Choudhari S.G., Chu D.-T., Couto R.A.S., Dagnew A.B., Dagnew B., Dahlawi S.M.A., Dai X., Dandona L., Dandona R., Desalew A., Dhamnetiya D., Dhimal M.L., Dhimal M., Doyle K.E., Duncan B.B., Ekholuenetale M., Filip I., Fischer F., Franklin R.C., Gaidhane A.M., Gaidhane S., Gallus S., Ghamari F., Ghashghaee A., Ghozali G., Gilani S.A., Glavan I.-R., Golechha M., Goulart B.N.G., Gupta V.B., Gupta V.K., Hamidi S., Hammond B.R., Hay S.I., Hayat K., Heidari G., Hoffman H.J., Hopf K.P., Hosseinzadeh M., Househ M., Hussain R., Hwang B.-F., Iavicoli I., Ibitoye S.E., Ilesanmi O.S., Irvani S.S.N., Islam S.M.S., Iwagami M., Jacob L., Jayapal S.K., Jha R.P., Jonas J.B., Kalhor R., Al-Salihi N.K., Kandel H., Kasa A.S., Kayode G.A., Khalilov R., Khan E.A., Khatib M.N., Kosen S., Koyanagi A., Kumar G.A., Landires I., Lasrado S., Lim S.S., Liu X., Lobo S.W., Lugo A., Makki A., Mendoza W., Mersha A.G., Mihretie K.M., Miller T.R., Misra S., Mohamed T.A., Mohammadi M., Mohammadian-Hafshejani A., Mohammed A., Mokdad A.H., Moni M.A., Kandel S.N., Nguyen H.L.T., Nixon M.R., Noubiap J.J., Nunez-Samudio V., Oancea B., Oguoma V.M., Olagunju A.T., Olusanya B.O., Olusanya J.O., Orru H., Owolabi M.O., Padubidri J.R., Pakshir K., Pardhan S., Kan F.P., Pasovic M., Pawar S., Pham H.Q., Pinheiro M., Pourshams A., Rabiee N., Rabiee M., Radfar A., Rahim F., Rahimi-Movaghar V., Ur Rahman M.H., Rahman M., Rahmani A.M., Rana J., Rao C.R., Rao S.J., Rashedi V., Rawaf D.L., Rawaf S., Renzaho A.M.N., Rezapour A., Ripon R.K., Rodrigues V., Rustagi N., Saeed U., Sahebkar A., Samy A.M., Santric-Milicevic M.M., Sathian B., Satpathy M., Sawhney M., Schlee W., Schmidt M.I., Seylani A., Shaikh M.A., Shannawaz M., Shiferaw W.S., Siabani S., Singal A., Singh J.A., Singh J.K., Singhal D., Skryabin V.Y., Skryabina A.A., Sotoudeh H., Spurlock E.E., Taddele B.W., Tamiru A.T., Tareque M.I., Thapar R., Tovani-Palone M.R., Tran B.X., Ullah S., Tahbaz S.V., Violante F.S., Vlassov V., Vo B., Vongpradith A., Vu G.T., Wei J., Yadollahpour A., Jabbari S.H.Y., Yeshaw Y., Yigit V., Yirdaw B.W., Yonemoto N., Yu C., Yunusa I., Zamani M., Zastrozhin M.S., Zastrozhina A., Zhang Z.-J., Zhao J.T., Murray C.J.L., Davis A.C., Vos T., Chadha S., Haile, Lydia M, Kamenov, Kaloyan, Briant, Paul Svitil, Orji, Aislyn U, Steinmetz, Jaimie D, Abdoli, Amir, Abdollahi, Mohammad, Abu-Gharbieh, Eman, Afshin, Ashkan, Ahmed, Haroon, Ahmed Rashid, Tarik, Akalu, Yona, Alahdab, Fare, Alanezi, Fahad Mashhour, Alanzi, Turki M, Al Hamad, Hanadi, Ali, Liaqat, Alipour, Vahid, Al-Raddadi, Rajaa M, Amu, Hubert, Arabloo, Jalal, Arab-Zozani, Morteza, Arulappan, Judie, Ashbaugh, Charlie, Atnafu, Desta Debalkie, Babar, Zaheer-Ud-Din, Baig, Atif Amin, Banik, Palash Chandra, Bärnighausen, Till Winfried, Barrow, Amadou, Bender, Rose G, Bhagavathula, Akshaya Srikanth, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bibi, Sadia, Bijani, Ali, Burkart, Katrin, Cederroth, Christopher R, Charan, Jaykaran, Choudhari, Sonali Gajanan, Chu, Dinh-Toi, Couto, Rosa A S, Dagnew, Amare Belachew, Dagnew, Baye, Dahlawi, Saad M A, Dai, Xiaochen, Dandona, Lalit, Dandona, Rakhi, Desalew, Assefa, Dhamnetiya, Deepak, Dhimal, Mandira Lamichhane, Dhimal, Meghnath, Doyle, Kerrie E, Duncan, Bruce B, Ekholuenetale, Michael, Filip, Irina, Fischer, Florian, Franklin, Richard Charle, Gaidhane, Abhay Motiramji, Gaidhane, Shilpa, Gallus, Silvano, Ghamari, Farhad, Ghashghaee, Ahmad, Ghozali, Ghozali, Gilani, Syed Amir, Glavan, Ionela-Roxana, Golechha, Mahaveer, Goulart, Bárbara Niegia Garcia, Gupta, Veer Bala, Gupta, Vivek Kumar, Hamidi, Samer, Hammond, Billy Randall, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Hoffman, Howard J, Hopf, Kathleen Pillsbury, Hosseinzadeh, Mehdi, Househ, Mowafa, Hussain, Rabia, Hwang, Bing-Fang, Iavicoli, Ivo, Ibitoye, Segun Emmanuel, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Iwagami, Masao, Jacob, Loui, Jayapal, Sathish Kumar, Jha, Ravi Prakash, Jonas, Jost B, Kalhor, Rohollah, Kameran Al-Salihi, Nawzad, Kandel, Himal, Kasa, Ayele Semachew, Kayode, Gbenga A, Khalilov, Rovshan, Khan, Ejaz Ahmad, Khatib, Mahalaqua Nazli, Kosen, Soewarta, Koyanagi, Ai, Kumar, G Anil, Landires, Iván, Lasrado, Savita, Lim, Stephen S, Liu, Xuefeng, Lobo, Stany W, Lugo, Alessandra, Makki, Alaa, Mendoza, Walter, Mersha, Amanual Getnet, Mihretie, Kebadnew Mulatu, Miller, Ted R, Misra, Sanjeev, Mohamed, Teroj Abdulrahman, Mohammadi, Mokhtar, Mohammadian-Hafshejani, Abdollah, Mohammed, Arif, Mokdad, Ali H, Moni, Mohammad Ali, Neupane Kandel, Sandhya, Nguyen, Huong Lan Thi, Nixon, Molly R, Noubiap, Jean Jacque, Nuñez-Samudio, Virginia, Oancea, Bogdan, Oguoma, Victor Maduabuchi, Olagunju, Andrew T, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Orru, Han, Owolabi, Mayowa O, Padubidri, Jagadish Rao, Pakshir, Keyvan, Pardhan, Shahina, Pashazadeh Kan, Fatemeh, Pasovic, Maja, Pawar, Shrikant, Pham, Hai Quang, Pinheiro, Marina, Pourshams, Akram, Rabiee, Navid, Rabiee, Mohammad, Radfar, Amir, Rahim, Fakher, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur, Rahman, Mosiur, Rahmani, Amir Masoud, Rana, Juwel, Rao, Chythra R, Rao, Sowmya J, Rashedi, Vahid, Rawaf, David Laith, Rawaf, Salman, Renzaho, Andre M N, Rezapour, Aziz, Ripon, Rezaul Karim, Rodrigues, Voilet, Rustagi, Neeti, Saeed, Umar, Sahebkar, Amirhossein, Samy, Abdallah M, Santric-Milicevic, Milena M, Sathian, Brijesh, Satpathy, Maheswar, Sawhney, Monika, Schlee, Winfried, Schmidt, Maria Inê, Seylani, Allen, Shaikh, Masood Ali, Shannawaz, Mohammed, Shiferaw, Wondimeneh Shibabaw, Siabani, Soraya, Singal, Anjali, Singh, Jasvinder A, Singh, Jitendra Kumar, Singhal, Deepika, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sotoudeh, Houman, Spurlock, Emma Elizabeth, Taddele, Biruk Wogayehu, Tamiru, Animut Tagele, Tareque, Md Ismail, Thapar, Rekha, Tovani-Palone, Marcos Roberto, Tran, Bach Xuan, Ullah, Saif, Valadan Tahbaz, Sahel, Violante, Francesco S, Vlassov, Vasily, Vo, Bay, Vongpradith, Avina, Vu, Giang Thu, Wei, Jingkai, Yadollahpour, Ali, Yahyazadeh Jabbari, Seyed Hossein, Yeshaw, Yigizie, Yigit, Vahit, Yirdaw, Birhanu Wubale, Yonemoto, Naohiro, Yu, Chuanhua, Yunusa, Ismaeel, Zamani, Mohammad, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhao, Jeff T, Murray, Christopher J L, Davis, Adrian C, Vos, Theo, and Chadha, Shelly
Subjects: Hearing aid, Male, Hearing loss, medicine.medical_treatment, Psychological intervention, 030204 cardiovascular system & hematology, Affect (psychology), Health Services Accessibility, Global Burden of Disease, 03 medical and health sciences, Tinnitus, Medicine, General & Internal, 0302 clinical medicine, Neonatal Screening, Hearing Aids, Acquired immunodeficiency syndrome (AIDS), Hearing, General & Internal Medicine, Health care, otorhinolaryngologic diseases, Prevalence, Medicine, Humans, Age Factor, Disabled Persons, 030212 general & internal medicine, Hearing Loss, Hearing Lo, 11 Medical and Health Sciences, Science & Technology, business.industry, Infant, Newborn, Age Factors, Infant, GBD 2019 Hearing Loss Collaborators, General Medicine, Articles, medicine.disease, Otitis, Hearing Aid, Cytomegalovirus Infections, Disabled Person, Female, medicine.symptom, business, Life Sciences & Biomedicine, Human, Demography
Abstract: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods: We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings: An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation: As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings. Funding: Bill & Melinda Gates Foundation and WHO.
Published: 2020

50. Utility of oral mucosa as a substrate for the serodiagnosis of pemphigus: A descriptive analysis

Author: Satish B Pai, Chythra R Rao, Raghavendra Rao, and Anuradha Jindal
Subjects: Adult, Male, Pathology, medicine.medical_specialty, Human skin, Enzyme-Linked Immunosorbent Assay, Dermatology, Desmoglein, Antibodies, medicine, Humans, Oral mucosa, Esophagus, Fluorescent Antibody Technique, Indirect, Pemphigus foliaceus, integumentary system, biology, Desmoglein 3, business.industry, Desmoglein 1, Pemphigus vulgaris, Mouth Mucosa, medicine.disease, Pemphigus, Infectious Diseases, medicine.anatomical_structure, Case-Control Studies, biology.protein, Female, Antibody, business
Abstract: Background: The indirect immunofluorescence test is useful in the serodiagnosis of pemphigus. As indirect immunofluorescence titers correlate with disease activity in pemphigus, it is often used as a monitoring tool. The sensitivity of indirect immunofluorescence depends on the substrate used, and the preferred substrates are monkey esophagus for pemphigus vulgaris and normal human skin for pemphigus foliaceus. Aims: We evaluated oral mucosa as a substrate for indirect immunofluorescence in pemphigus. Methods: Fifty patients with pemphigus (40 with pemphigus vulgaris and ten with pemphigus foliaceus) and 50 controls were enrolled for study. Demographic and clinical details were recorded and indirect immunofluorescence using two substrates (oral mucosa and normal human skin) was carried out in serial dilution. Desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay was also evaluated simultaneously. Results: Indirect immunofluorescence was positive in 40 patients (80%) with oral mucosa substrate and 34 patients (68%) with normal human skin substrate. Circulating antibodies were detected with oral mucosa in 33 (82.5%) of the 40 pemphigus vulgaris patients and in 26 (65%) patients using normal human skin. Antibodies were detected in eight of the ten pemphigus foliaceus patients (80%) with normal human skin and in seven (70%) patients with oral mucosa. Dsg enzyme-linked immunosorbent assay was positive in 45 (90%) patients, and 37 of these were also indirect immunofluorescence positive with oral mucosa. In the five Dsg enzyme-linked immunosorbent assay-negative patients, indirect immunofluorescence with oral mucosa was positive in three. Limitations: A comparison of oral mucosa with monkey esophagus could not be performed. Conclusion: Oral mucosa is a suitable and sensitive substrate for indirect immunofluorescence in pemphigus. Further studies comparing the sensitivity of indirect immunofluorescence using oral mucosa with monkey esophagus are recommended.
Published: 2020

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