Publications
354 results found
Rawaf S, Rawaf DL, 2019, Medico de familia e communidade na saudi publica, Tratado de medicina de família e comunidade: princípios, formação e prática. Ediciao 2, Editors: Gusso, Lopes, Dias, Publisher: Porto Alegre: Artmed, Pages: 20-27, ISBN: 9788582715352
Dubois E, McNally L, Andrews L, et al., 2019, Developing and implementing health systems policy to improve the delivery of brief tobacco interventions, Strengthening health systems for treating tobacco dependence in primary care: building capacity for tobacco control, WHO Technical Report Series, ISSN: 0512-3054
James SL, Theadom A, Ellenbogen RG, et al., 2019, Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet Neurology, Vol: 18, Pages: 56-87, ISSN: 1474-4422
BackgroundTraumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury.MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility.FindingsIn 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SC
Feigin VL, Nguyen G, Cercy K, et al., 2018, Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016, New England Journal of Medicine, Vol: 379, Pages: 2429-2437, ISSN: 0028-4793
BackgroundThe lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.MethodsWe used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.ResultsThe estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle–SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calcul
Barbazee E, Pedersen HB, Birtanov Y, et al., 2018, Ten evidence-based policy accelerators for transforming primary health care in the WHO European Region, Public Health Panorama, Vol: 4, ISSN: 2412-544X
Rawaf S, 2018, Erratum: Department of error., The Lancet, Vol: 392, Pages: 2170-2170, ISSN: 0140-6736
[This corrects the article DOI: 10.1016/S0140-6736(18)32203-7.].
Majeed A, 2018, GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in;195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017 (vol 392, pg 1736, 2018), LANCET, Vol: 392, Pages: 2170-2170, ISSN: 0140-6736
Stanaway JD, Afshin A, Gakidou E, et al., 2018, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1923-1994, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.MethodsWe used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risk
Kyu HH, Abate D, Abate KH, et al., 2018, Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1859-1922, ISSN: 0140-6736
BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1&ndash
Roth GA, Abate D, Abate KH, et al., 2018, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1736-1788, ISSN: 0140-6736
BackgroundGlobal development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.MethodsThe causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.FindingsAt the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest f
James SL, Abate D, Abate KH, et al., 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1789-1858, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.MethodsWe estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calcula
Lozano R, Fullman N, Abate D, et al., 2018, Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 2091-2138, ISSN: 0140-6736
BackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected fo
Murray CJL, Callender CSKH, Kulikoff XR, et al., 2018, Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1995-2051, ISSN: 0140-6736
BackgroundPopulation estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.MethodsWe estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migrat
Dicker D, Nguyen G, Abate D, et al., 2018, Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1684-1735, ISSN: 0140-6736
BackgroundAssessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally.MethodsThe GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different compone
Steel N, Ford JA, Newton JN, et al., 2018, Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol: 392, Pages: 1647-1661, ISSN: 0140-6736
BackgroundPrevious studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.MethodsWe extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.FindingsThe leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD.
Fitzmaurice C, Akinyemiju TF, Al Lami FH, et al., 2018, Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016. A systematic analysis for the global Burden of disease study, JAMA: Journal of the American Medical Association, Vol: 4, Pages: 1553-1568, ISSN: 0098-7484
Importance The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.Objective To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.Evidence Review Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.Findings In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, −1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or terri
Rawaf S, Allen L, Dubois E, et al., 2018, Primary health care: closing the gap between public health and primary care through integration, WHO Technical Report Series, ISSN: 0512-3054
Alshaikh MK, Rawaf S, Quezada-Yamamoto H, 2018, Cardiovascular risk and fruit and vegetable consumption among women in KSA. A cross-sectional study, Journal of Taibah University Medical Sciences, Vol: 13, Pages: 444-451, ISSN: 1658-3612
ObjectivesThis study aims to assess fruit and vegetable consumption among Saudi women to identify perceived benefits and barriers associated with a healthy diet in cardiovascular disease (CVD) risk prevention and to correlate Framingham risk scores (FRSs) with the perceived barriers.MethodsA questionnaire adapted from the Health Beliefs Related to Cardiovascular Disease Scale was administered to women attending a primary care centre in KSA. In addition to descriptive statistics, a chi-square test and multiple linear regression analysis were used to determine the association between perceptions of benefit and barriers with FRS categories and between mean FRS and perceived barriers.ResultsA total of 503 women were included in this study, and 75% of the women were older than 45 years. More than 60% of women were obese, and 97% consumed 1–3 fruit and vegetable servings per day, whereas only 1.4% consumed fruits and vegetables 5 or more times per day. The majority of women were aware of the benefits of a healthy diet in CVD prevention. No significant difference between FRS and perceived benefits or barriers was observed. Barriers across the low- to high-risk groups included a lack of knowledge about a ‘healthy diet’, insufficient time to cook, food affordability, and having more important problems. Women who disagreed on barriers had negative beta coefficients for the mean FRS (p < 0.03).ConclusionsIn this study cohort, fruit and vegetable intake was lower than the recommended guidelines. Despite awareness of the benefits of a healthy diet in CVD prevention, very few women understood the true meaning of ‘healthy diet’. A direct association between FRS and perceptions/barriers could not be validated. Perceived barriers could be addressed by integrating innovative educational campaigns to existing models of the Healthy Food Plan.
Blanchet K, El-Zein A, Langer A, et al., 2018, Support for UNRWA’s survival, The Lancet, Vol: 392, Pages: 1009-1010, ISSN: 0140-6736
Griswold MG, Fullman N, Hawley C, et al., 2018, Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol: 392, Pages: 1015-1035, ISSN: 0140-6736
BackgroundAlcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.MethodsUsing 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.FindingsGlobally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. F
Shaikhan F, Rawaf S, Majeed A, et al., 2018, Knowledge, attitude, perception and practice towards antimicrobial use in upper respiratory tract infections in Qatar: a systematic review, JRSM Short Reports, Vol: 9, ISSN: 2042-5333
Background: The emergence and spread of resistance related to the inappropriate use of antimicrobials is a global public health problem. A substantial proportion of all antimicrobials are prescribed in the community, and Upper Respiratory Tract Infection (URTI) is one of the commonest conditions in health care settings for which antimicrobial prescriptions are widely used. We assessed knowledge, attitude, perception and practice towards antibiotic use for URTIs in patients visiting healthcare settings in Qatar. Aim: To explore the knowledge, attitude, perception and practice towards antimicrobial use in upper respiratory tract infections in patients visiting healthcare settings in Qatar. Methodology: Systematic review was performed using a predetermined protocol and in accordance with standardized reporting guidelines. MEDLINE, PubMed, EMBASE, Global Health and PsycINFO were searched for relevant published studies using relevant MESH terms and key words. Results: Three articles were included, one in a primary care setting, one in a secondary care settingand one in the private sector. Overprescribing was noted in all settings. Our findings demonstrate low expectations to receive antibiotics, among the Qatari population, in primary care (28.1%). In fact, the majority of patients would be satisfied with reassurance rather than receiving antimicrobials. Many patients were satisfied with explanation from physicians andcounselling. Private sector registered high prevalence of antimicrobial misuse for respiratory tract infections (RTIs) in which 85% deemed inappropriate. This finding was also noted at a medical intensive care unit (MICU) which showed high antimicrobial use (76%) and RTIs accounted for 57% of prescriptions. Conclusions: Studies are needed to determine factors and population based rates of antimicrobial use in all health care settings. There
Marczak LB, Kutz M, Shackelford KA, et al., 2018, Global mortality from firearms, 1990-2016, JAMA: Journal of the American Medical Association, Vol: 320, Pages: 792-814, ISSN: 0098-7484
Importance Understanding global variation in firearm mortality rates could guide prevention policies and interventions.Objective To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.Design, Setting, and Participants This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.Exposures Firearm ownership and access.Main Outcomes and Measures Cause-specific deaths by age, sex, location, and year.Results Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (−0.2% [95% UI, −0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate
Tyrovolas S, Kassebaum NJ, Stergachis A, et al., 2018, The burden of disease in Greece, health loss, risk factors, and health nancing, 2000–16: an analysis of the Global Burden of Disease Study 2016, Lancet Public Health, Vol: 3, Pages: e395-e406, ISSN: 2468-2667
BackgroundFollowing the economic crisis in Greece in 2010, the country's ongoing austerity measures include a substantial contraction of health-care expenditure, with reports of subsequent negative health consequences. A comprehensive evaluation of mortality and morbidity is required to understand the current challenges of public health in Greece.MethodsWe used the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to describe the patterns of death and disability among those living in Greece from 2000 to 2010 (pre-austerity) and 2010 to 2016 (post-austerity), and compared trends in health outcomes and health expenditure to those in Cyprus and western Europe. We estimated all-cause mortality from vital registration data, and we calculated cause-specific deaths and years of life lost. Age-standardised mortality rates were compared using the annualised rate of change (ARC). Mortality risk factors were assessed using a comparative risk assessment framework for 84 risk factors and clusters to calculative summary exposure values and population attributable fraction statistics. We assessed the association between trends in total, government, out-of-pocket, and prepaid public health expenditure and all-cause mortality with a segmented correlation analysis.FindingsAll-age mortality in Greece increased from 944·5 (95% uncertainty interval [UI] 923·1–964·5) deaths per 100 000 in 2000 to 997·8 (975·4–1018) in 2010 and 1174·9 (1107·4–1243·2) in 2016, with a higher ARC after 2010 and the introduction of austerity (2·72% [1·65 to 3·74] for 2010–16) than before (0·55% [0·24 to 0·85] for 2000–10) or in western Europe during the same period (0·86% [0·54 to 1·17]). Age-standardised reduction in ARC approximately halved from 2000–10 (−1·61 [95% UI −1·91 to −1·3
Noormal B, Eltayeb E, Al Nsour M, et al., 2018, Sixth EMPHNET regional conference: innovative approaches to improve public health practice in the Eastern Mediterranean Region, Publisher: Society of Petroleum Engineers, Inc.
Public health professionals in the Eastern Mediterranean Region (EMR) have limited access to continuing education, including workshops and conferences in public health. Held under the theme ‘Innovative Approaches: Adapting to the Current EMR Context’, the Eastern Mediterranean Public Health Network (EMPHNET) organized and conducted the Sixth EMPHNET Regional Conference Mar 26- 29, 2018. This manuscript summarizes the key activities including workshops, roundtable discussions, oral and poster presentations, keynote speeches, and side meetings. Prior to the opening, five pre-conference workshops were held: "FETP Accreditation"; "Innovative Public Health Surveillance"; "Human and Animal Brucellosis"; "Rapid Response Teams"; and "Polio Transition and Routine Immunization". The conference hosted six roundtable discussions: "Consolidation of the FETP Network"; "One Health to Achieve Global Health Security"; "Polio Eradication Efforts and Transition Planning for Measles Elimination"; "Mobile Data Collection and other Innovative Tools to Enhance Decision Making"; "Confronting Candida auris: An Emerging Multidrug-resistant Global Pathogen"; and "Functioning and Sustainable Country Public Health Emergency Response Operation Framework". One of the conference’s key objectives was to provide a space for FETP residents, graduates, and public health professionals to showcase achievements. A total of 421 abstracts were submitted and after professionalreview, 147 (34.9%) were accepted (111 for oral presentations and 36 for poster presentations) and published by Iproceeding. The conference met the primary objectives of showcasing the public health accomplishments and contributions of EMR, encouraging the exchange of ideas and coordination among stakeholders, and engaging cross sectoral workforce in producing recommendations for approaching regional and globa
GBD 2016 Healthcare Access and Quality Collaborators, 2018, Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016, Lancet, Vol: 391, Pages: 2236-2271, ISSN: 0140-6736
BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derive
Aljuaid M, Elmontsri M, Edvardsson D, et al., 2018, Psychometric evaluation of the Arabic language person-centred climate questionnaire – staff version, Journal of Nursing Management, Vol: 26, Pages: 449-456, ISSN: 0966-0429
AimTo evaluate the psychometric properties of the Arabic language person‐centred climate questionnaire—staff version.BackgroundThere have been increasing calls for a person‐centred rather than a disease‐centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person‐centred manner, and none of these tools have been validated for us in Arab settings.MethodThe validated form of the person‐centred climate questionnaire—staff version was translated into Arabic and distributed to 152 health care staff in teaching and non‐teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation.ResultsItems on the Arabic form of the person‐centred climate questionnaire—staff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub‐scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good.ConclusionArabic form of the person‐centred climate questionnaire—staff version provides a valid and reliable way to measure the degree of perceived person‐centredness.
Moradi-Lakeh M, Rawaf DL, Rawaf S, et al., 2018, Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study, International Journal of Public Health, Vol: 63, Pages: 177-186, ISSN: 1661-8564
Objectives We used findings from the Global Burden ofDisease 2015 study to update our previous publication onthe burden of diabetes and chronic kidney disease due todiabetes (CKD-DM) during 1990–2015.Methods We extracted GBD 2015 estimates for prevalence,mortality, and disability-adjusted life years(DALYs) of diabetes (including burden of low vision dueto diabetes, neuropathy, and amputations and CKD-DM for22 countries of the EMR from the GBD visualization tools.Results In 2015, 135,230 (95% UI 123,034–148,184) individualsdied from diabetes and 16,470 (95% UI 13,977–18,961)from CKD-DM, 216 and 179% increases, respectively, comparedto 1990. The total number of people with diabetes was42.3 million (95% UI 38.6–46.4 million) in 2015. DALY ratesof diabetes in 2015 were significantly higher than the expectedrates based on Socio-demographic Index (SDI).Conclusions Our study showed a large and increasing burdenof diabetes in the region. There is an urgency in dealingwith diabetes and its consequences, and these efforts shouldbe at the forefront of health prevention and promotion
Tehrani-Banihashemi A, Moradi-Lakeh M, El Bcheraoui C, et al., 2018, Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study, International Journal of Public Health, Vol: 63, Pages: 137-149, ISSN: 1661-8556
Objectives: To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990–2015. Methods: We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. Results: A total of 1.4 million CVD deaths (95% UI: 1.3–1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. Conclusions: The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.
Khalil I, El Bcheraoui C, Charara R, et al., 2018, Burden of diarrhea in the Eastern Mediterranean Region, 1990–2015: Findings from the Global Burden of Disease 2015 study, International Journal of Public Health, Vol: 63, Pages: 109-121, ISSN: 1661-8556
Objectives: Diarrheal diseases (DD) are an important cause of disease burden, especially in children in low-income settings. DD can also impact children’s potential livelihood through growth faltering, cognitive impairment, and other sequelae. Methods: As part of the Global Burden of Disease study, we estimated DD burden, and the burden attributable to specific risk factors and etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2015. We calculated disability-adjusted life-years (DALYs)—the sum of years of life lost and years lived with disability—for both sexes and all ages. Results: We estimate that over 103,692 diarrhea deaths occurred in the EMR in 2015 (95% uncertainty interval: 87,018–124,692), and the mortality rate was 16.0 deaths per 100,000 persons (95% UI: 13.4–19.2). The majority of these deaths occurred in children under 5 (63.3%) (65,670 deaths, 95% UI: 53,640–79,486). DALYs per 100,000 ranged from 304 (95% UI 228–400) in Kuwait to 38,900 (95% UI 25,900–54,300) in Somalia. Conclusions: Our findings will guide evidence-based health policy decisions for interventions to achieve the ultimate goal of reducing the DD burden.
El Bcheraoui C, Rawaf S, Mokdad AH, et al., 2018, Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study, International Journal of Public Health, Vol: 63, Pages: 165-176, ISSN: 1661-8564
ObjectivesWe used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR).MethodsWe estimated the prevalence of overweight and obesity among children (2–19 years) and adults (≥20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach.ResultsThe prevalence of obesity increased for adults from 15.1% (95% UI 13.4–16.9) in 1980 to 20.7% (95% UI 18.8–22.8) in 2015. It increased from 4.1% (95% UI 2.9–5.5) to 4.9% (95% UI 3.6–6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages.ConclusionsThis is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.
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