Browsing by Subject "GLOBAL BURDEN"

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  • Levola, Jonna M.; Sailas, Eila S.; Saamanen, Timo S.; Turunen, Leena M.; Thomson, Annika C. (2019)
    Background: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits. Methods: A cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) -codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. Results: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 -codes were inadequately documented. Conclusions: Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.
  • Toivonen, Anne; Eriksson, Mari; Friberg, Nathalie; Hautala, Timo; Kääriäinen, Sohvi; Leppaaho-Lakka, Jaana; Mikkola, Janne; Nieminen, Tuomas; Oksi, Jarmo; Salonen, Juha H.; Suomalainen, Pekka; Vanttinen, Markku; Jarva, Hanna; Jääskeläinen, Annemarjut J. (2021)
    Background Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland. Methods We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected. Results A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients. Conclusions To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.
  • Kivimies, Kristiina; Repo-Tiihonen, Eila; Kautiainen, Hannu; Tiihonen, Jari (2018)
    BackgroundSubstance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.MethodsThe study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.ResultsOf the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1-28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3-32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p=0.022).ConclusionsOpioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.Trial registrationOur study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.
  • Lohela, Terhi J.; Nesbitt, Robin C.; Pekkanen, Juha; Gabrysch, Sabine (2019)
    Facility delivery should reduce early neonatal mortality. We used the Slope Index of Inequality and logistic regression to quantify absolute and relative socioeconomic inequalities in early neonatal mortality (0 to 6 days) and facility delivery among 679,818 live births from 72 countries with Demographic and Health Surveys. The inequalities in early neonatal mortality were compared with inequalities in postneonatal infant mortality (28 days to 1 year), which is not related to childbirth. Newborns of the richest mothers had a small survival advantage over the poorest in unadjusted analyses (-2.9 deaths/1,000; OR 0.86) and the most educated had a small survival advantage over the least educated (-3.9 deaths/1,000; OR 0.77), while inequalities in postneonatal infant mortality were more than double that in absolute terms. The proportion of births in health facilities was an absolute 43% higher among the richest and 37% higher among the most educated compared to the poorest and least educated mothers. A higher proportion of facility delivery in the sampling cluster (e.g. village) was only associated with a small decrease in early neonatal mortality. In conclusion, while socioeconomically advantaged mothers had much higher use of a health facility at birth, this did not appear to convey a comparable survival advantage.
  • Rantonen, J.; Karppinen, J.; Vehtari, A.; Luoto, S.; Viikari-Juntura, E.; Hupli, M.; Malmivaara, A.; Taimela, S. (2016)
    Background: Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study. Methods: A cohort of employees (N = 312, aged Results: Compared to NC, the Booklet reduced HC costs by 196(sic) and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107(sic), 0.4 days, and 54 %, respectively. PHI decreased in both interventions. Conclusions: Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.
  • Andersen, Petter I.; Ianevski, Aleksandr; Lysvand, Hilde; Oksenych, Valentyn; Bjørås, Magnar; Telling, Kaidi; Lutsar, Irja; Dampis, Uga; Irie, Yasuhiko; Tenson, Tanel; Kantele, Anu; Kainov, Denis (2020)
    Viral diseases are one of the leading causes of morbidity and mortality in the world. Virus-specific vaccines and antiviral drugs are the most powerful tools to combat viral diseases. However, broad-spectrum antiviral agents (BSAAs, i.e. compounds targeting viruses belonging to two or more viral families) could provide additional protection of the general population from emerging and re-emerging viral diseases, reinforcing the arsenal of available antiviral options. Here, we review discovery and development of BSAAs and summarize the information on 120 safe-in-man agents in a freely accessible database ( Future and ongoing pre-clinical and clinical studies will increase the number of BSAAs, expand the spectrum of their indications, and identify drug combinations for treatment of emerging and re-emerging viral infections as well as co-infections. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
  • Rantonen, J.; Karppinen, J.; Vehtari, A.; Luoto, S.; Viikari-Juntura, E.; Hupli, M.; Malmivaara, A.; Taimela, S. (2018)
    Background: We assessed the effectiveness of three interventions that were aimed to reduce non-acute low back pain (LBP) related symptoms in the occupational health setting. Methods: Based on a survey (n = 2480; response rate 71%) on LBP, we selected a cohort of 193 employees who reported moderate LBP (Visual Analogue Scale VAS > 34 mm) and fulfilled at least one of the following criteria during the past 12 months: sciatica, recurrence of LBP >= 2 times, LBP >= 2 weeks, or previous sickness absence. A random sample was extracted from the cohort as a control group (Control, n = 50), representing the natural course of LBP. The remaining 143 employees were invited to participate in a randomised controlled trial (RCT) of three 1:1:1 allocated parallel intervention arms: multidisciplinary rehabilitation (Rehab, n = 43); progressive exercises (Physio, n = 43) and self-care advice (Advice, n = 40). Seventeen employees declined participation in the intervention. The primary outcome measures were physical impairment (PHI), LBP intensity (Visual Analogue Scale), health related quality of life (QoL), and accumulated sickness absence days. We imputed missing values with multiple imputation procedure. We assessed all comparisons between the intervention groups and the Control group by analysing questionnaire outcomes at 2 years with ANOVA and sickness absence at 4 years by using negative binomial model with a logarithmic link function. Results: Mean differences between the Rehab and Control groups were - 3 [95% CI -5 to - 1] for PHI, - 13 [- 24 to - 1] for pain intensity, and 0.06 [0.00 to 0.12] for QoL. Mean differences between the Physio and Control groups were - 3 [95% CI -5 to - 1] for PHI, -13 [- 29 to 2] for pain intensity, and 0.07 [0.01 to 0.13] for QoL. The main effects sizes were from 0.4 to 0.6. The interventions were not effective in reducing sickness absence. Conclusions: Rehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed.
  • Dudel, Christian; Myrskylä, Mikko (2020)
    Background Markov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the expected number and length of episodes spent in a state. Methods The approach we propose is based on Markov chains with rewards. It allows us to identify the number of entries into a state and to calculate the average length of episodes as total time in a state divided by the number of entries. For sampling variance estimation, we employ the block bootstrap. Two case studies that are based on published literature illustrate how our methods can provide new insights into disability dynamics. Results The first application uses a classic textbook example on prednisone treatment and liver functioning among liver cirrhosis patients. We replicate well-known results of no association between treatment and survival or recovery. Our analysis of the episodes of normal liver functioning delivers the new insight that the treatment reduced the likelihood of relapse and extended episodes of normal liver functioning. The second application assesses frailty and disability among elderly people. We replicate the prior finding that frail individuals have longer life expectancy in disability. As a novel finding, we document that frail individuals experience three times as many episodes of disability that were on average twice as long as the episodes of nonfrail individuals. Conclusions We provide a simple analytical approach for calculating the number and length of episodes in Markov chain models. The results allow a description of the transition dynamics that goes beyond the results that can be obtained using standard tools for Markov chains. Empirical applications using published data illustrate how the new method is helpful in unraveling the dynamics of the modeled process.
  • Haagsma, Juanita A.; Olij, Branko F.; Majdan, Marek; van Beeck, Ed F.; Vos, Theo; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Aremu, Olatunde; Baernighausen, Till Winfried; Borzi, Antonio M.; Briggs, Andrew M.; Carrero, Juan J.; Cooper, Cyrus; El-Khatib, Ziad; Ellingsen, Christian Lycke; Fereshtehnejad, Seyed-Mohammad; Filip, Irina; Fischer, Florian; Haro, Josep Maria; Jonas, Jost B.; Kiadaliri, Aliasghar A.; Koyanagi, Ai; Lunevicius, Raimundas; Meretoja, Tuomo J.; Mohammed, Shafiu; Pathak, Ashish; Radfar, Amir; Rawaf, Salman; Rawaf, David Laith; Riera, Lidia Sanchez; Shiue, Ivy; Vasankari, Tommi Juhani; James, Spencer L.; Polinder, Suzanne (2020)
    Introduction Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. Methods We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. Results In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. Conclusions From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.
  • Int Stroke Genetics Consortium; NINDS-SiGN Consortium; Maguire, Jane M.; Bevan, Steve; Stanne, Tara M.; Strbian, Daniel; Tatlisumak, Turgut; Lindgren, Arne (2017)
    Introduction: Genome-wide association studies have identified several novel genetic loci associated with stroke risk, but how genetic factors influence stroke outcome is less studied. The Genetics of Ischaemic Stroke Functional outcome network aims at performing genetic studies of stroke outcome. We here describe the study protocol and methods basis of Genetics of Ischaemic Stroke Functional outcome. Methods: The Genetics of Ischaemic Stroke Functional outcome network has assembled patients from 12 ischaemic stroke projects with genome-wide genotypic and outcome data from the International Stroke Genetics Consortium and the National Institute of Neurological Diseases Stroke Genetics Network initiatives. We have assessed the availability of baseline variables, outcome metrics and time-points for collection of outcome data. Results: We have collected 8831 ischaemic stroke cases with genotypic and outcome data. Modified Rankin score was the outcome metric most readily available. We detected heterogeneity between cohorts for age and initial stroke severity (according to the NIH Stroke Scale), and will take this into account in analyses. We intend to conduct a first phase genome-wide association outcome study on ischaemic stroke cases with data on initial stroke severity and modified Rankin score within 60-190 days. To date, we have assembled 5762 such cases and are currently seeking additional cases meeting these criteria for second phase analyses. Conclusion: Genetics of Ischaemic Stroke Functional outcome is a unique collection of ischaemic stroke cases with detailed genetic and outcome data providing an opportunity for discovery of genetic loci influencing functional outcome. Genetics of Ischaemic Stroke Functional outcome will serve as an exploratory study where the results as well as the methodological observations will provide a basis for future studies on functional outcome. Genetics of Ischaemic Stroke Functional outcome can also be used for candidate gene replication or assessing stroke outcome non-genetic association hypotheses.
  • Global Burden Dis Hlth Financing; Micah, Angela E.; Su, Yanfang; Bachmeier, Steven D.; Meretoja, Tuomo J.; Meretoja, Atte (2020)
    Background Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7.9 trillion (95% uncertainty interval 7.8-8.0) in 2017 and is expected to increase to $11.0 trillion (10.7-11.2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20.2 billion (17.0-25.0) and on tuberculosis it was $10.9 billion (10.3-11.8), and in malaria-endemic countries spending on malaria was $5.1 billion (4.9-5.4). Development assistance for health was $40.6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81.6% (81.6-81.7) in 2015 to 83.1% (82.8-83.3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
  • Karpov, B.; Joffe, G.; Aaltonen, K.; Suvisaari, J.; Baryshnikov, I.; Naatanen, P.; Koivisto, M.; Melartin, T.; Oksanen, J.; Suominen, K.; Heikkinen, M.; Isometsa, E. (2017)
    Background: Major mental disorders are highly disabling conditions that result in substantial socioeconomic burden. Subjective and objective measures of functioning or ability to work, their concordance, or risk factors for them may differ between disorders. Methods: Self-reported level of functioning, perceived work ability, and current work status were evaluated among psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) within the Helsinki University Psychiatric Consortium Study. Correlates of functional impairment, subjective work disability, and occupational status were investigated using regression analysis. Results: DD patients reported the highest and SSA patients the lowest perceived functional impairment. Depressive symptoms in all diagnostic groups and anxiety in SSA and BD groups were significantly associated with disability. Only 5.3% of SSA patients versus 29.3% or 33.0% of BD or DD patients, respectively, were currently working. About half of all patients reported subjective work disability. Objective work status and perceived disability correlated strongly among BD and DD patients, but not among SSA patients. Work status was associated with number of hospitalizations, and perceived work disability with current depressive symptoms. Conclusions: Psychiatric care patients commonly end up outside the labour force. However, while among patients with mood disorders objective and subjective indicators of ability to work are largely concordant, among those with schizophrenia or schizoaffective disorder they are commonly contradictory. Among all groups, perceived functional impairment and work disability are coloured by current depressive symptoms, but objective work status reflects illness course, particularly preceding psychiatric hospitalizations. (C) 2017 Elsevier Masson SAS. All rights reserved.
  • Deshpande, Aniruddha; Miller-Petrie, Molly K.; Lindstedt, Paulina A.; Baumann, Mathew M.; Johnson, Kimberly B.; Blacker, Brigette F.; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abegaz, Kedir Hussein; Abejie, Ayenew Negesse; Abreu, Lucas Guimaraes; Abrigo, Michael R. M.; Abualhasan, Ahmed; Accrombessi, Manfred Mario Kokou; Adamu, Abdu A.; Adebayo, Oladimeji M.; Adedeji, Isaac Akinkunmi; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adetokunboh, Olatunji O.; Adhikari, Tara Ballav; Afarideh, Mohsen; Agudelo-Botero, Marcela; Ahmadi, Mehdi; Ahmadi, Keivan; Ahmed, Muktar Beshir; Ahmed, Anwar E.; Akalu, Temesgen Yihunie; Akanda, Ali S.; Alahdab, Fares; Al-Aly, Ziyad; Alam, Samiah; Alam, Noore; Alamene, Genet Melak; Alanzi, Turki M.; Albright, James; Albujeer, Ammar; Alcalde-Rabanal, Jacqueline Elizabeth; Alebel, Animut; Alemu, Zewdie Aderaw; Ali, Muhammad; Alijanzadeh, Mehran; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi, Ali; Almasi-Hashiani, Amir; Al-Mekhlafi, Hesham M.; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J.; Amini, Saeed; Amit, Arianna Maever L.; Amul, Gianna Gayle Herrera; Andrei, Catalina Liliana; Anjomshoa, Mina; Ansariadi, Ansariadi; Antonio, Carl Abelardo T.; Antony, Benny; Antriyandarti, Ernoiz; Arabloo, Jalal; Aref, Hany Mohamed Amin; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Aryal, Krishna K.; Arzani, Afsaneh; Asadi-Aliabadi, Mehran; Asmelash, Daniel; Atalay, Hagos Tasew; Athari, Seyyede Masoume; Athari, Seyyed Shamsadin; Atre, Sachin R.; Ausloos, Marcel; Awasthi, Shally; Awoke, Nefsu; Quintanilla, Beatriz Paulina Ayala; Ayano, Getinet; Ayanore, Martin Amogre; Aynalem, Yared Asmare; Azari, Samad; Azman, Andrew S.; Babaee, Ebrahim; Badawi, Alaa; Bagherzadeh, Mojtaba; Bakkannavar, Shankar M.; Balakrishnan, Senthilkumar; Banach, Maciej; Banoub, Joseph Adel Mattar; Barac, Aleksandra; Barboza, Miguel A.; Barnighausen, Till Winfried; Basu, Sanjay; Vo Dinh Bay; Bayati, Mohsen; Bedi, Neeraj; Beheshti, Mahya; Behzadifar, Meysam; Behzadifar, Masoud; Ramirez, Diana Fernanda Bejarano; Bell, Michelle L.; Bennett, Derrick A.; Benzian, Habib; Berbada, Dessalegn Ajema; Bernstein, Robert S.; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bijani, Ali; Bikbov, Boris; Bin Sayeed, Muhammad Shahdaat; Biswas, Raaj Kishore; Bohlouli, Somayeh; Boufous, Soufiane; Brady, Oliver J.; Briko, Andrey Nikolaevich; Briko, Nikolay Ivanovich; Britton, Gabrielle B.; Brown, Alexandria; Nagaraja, Sharath Burugina; Butt, Zahid A.; Camera, Luis Alberto; Campos-Nonato, Ismael R.; Rincon, Julio Cesar Campuzano; Cano, Jorge; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Castro, Franz; Cerin, Ester; Chalise, Binaya; Chattu, Vijay Kumar; Chin, Ken Lee; Christopher, Devasahayam J.; Chu, Dinh-Toi; Cormier, Natalie Maria; Costa, Vera Marisa; Cromwell, Elizabeth A.; Dadi, Abel Fekadu Fekadu; Dahiru, Tukur; Dahlawi, Saad M. A.; Dandona, Rakhi; Dandona, Lalit; Dang, Anh Kim; Daoud, Farah; Darwesh, Aso Mohammad; Darwish, Amira Hamed; Daryani, Ahmad; Das, Jai K.; Das Gupta, Rajat; Dash, Aditya Prasad; Davila-Cervantes, Claudio Alberto; Weaver, Nicole Davis; De la Hoz, Fernando Pio; De Neve, Jan-Walter; Demissie, Dereje Bayissa; Demoz, Gebre Teklemariam; Denova-Gutierrez, Edgar; Deribe, Kebede; Desalew, Assefa; Dharmaratne, Samath Dhamminda; Dhillon, Preeti; Dhimal, Meghnath; Dhungana, Govinda Prasad; Diaz, Daniel; Dipeolu, Isaac Oluwafemi; Hoa Thi; Dolecek, Christiane; Doyle, Kerrie E.; Dubljanin, Eleonora; Duraes, Andre Rodrigues; Edinur, Hisham Atan; Effiong, Andem; Eftekhari, Aziz; El Nahas, Nevine; Zaki, Maysaa El Sayed; El Tantawi, Maha; Elhabashy, Hala Rashad; El-Jaafary, Shaimaa; El-Khatib, Ziad; Elkout, Hajer; Elsharkawy, Aisha; Enany, Shymaa; Endalew, Daniel Adane; Eshrati, Babak; Eskandarieh, Sharareh; Etemadi, Arash; Ezekannagha, Oluchi; Faraon, Emerito Jose A.; Fareed, Mohammad; Faro, Andre; Farzadfar, Farshad; Fasil, Alebachew Fasil; Fazlzadeh, Mehdi; Feigin, Valery L.; Fekadu, Wubalem; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Flohr, Carsten; Foigt, Nataliya A.; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Franklin, Richard Charles; Frostad, Joseph Jon; Fukumoto, Takeshi; Gad, Mohamed M.; Garcia, Gregory M.; Gatotoh, Augustine Mwangi; Gayesa, Reta Tsegaye; Gebremedhin, Ketema Bizuwork; Geramo, Yilma Chisha Dea; Gesesew, Hailay Abrha; Gezae, Kebede Embaye; Ghashghaee, Ahmad; Sherbaf, Farzaneh Ghazi; Gill, Tiffany K.; Gill, Paramjit Singh; Ginindza, Themba G.; Girmay, Alem; Gizaw, Zemichael; Goodridge, Amador; Gopalani, Sameer Vali; Goulart, Barbara Niegia Garcia; Goulart, Alessandra C.; Grada, Ayman; Green, Manfred S.; Gubari, Mohammed Ibrahim Mohialdeen; Gugnani, Harish Chander; Guido, Davide; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Rajeev; Gupta, Rahul; Ha, Giang Hai; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haile, Dessalegn H.; Haile, Michael Tamene; Hall, Brian J.; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haririan, Hamidreza; Hariyani, Ninuk; Hasaballah, Ahmed; Hasan, Mehedi; Hasanzadeh, Amir; Hassen, Hamid Yimam; Hayelom, Desta Haftu; Hegazy, Mohamed; Heibati, Behzad; Heidari, Behnam; Hendrie, Delia; Henok, Andualem; Herteliu, Claudiu; Heydarpour, Fatemeh; de Hidru, Hagos Degefa; Hird, Thomas R.; Chi Linh Hoang; Hollerich, Gillian; Hoogar, Praveen; Hossain, Naznin; Hosseinzadeh, Mehdi; Househ, Mowafa; Hu, Guoqing; Humayun, Ayesha; Hussain, Syed Ather; Hussen, Mamusha Aman A.; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Milena D.; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Iwu, Chinwe Juliana; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalali, Amir; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S.; Jonas, Jost B.; Jozwiak, Jacek Jerzy; Kabir, Ali; Kabir, Zubair; Kanchan, Tanuj; Karch, Andre; Karki, Surendra; Kasaeian, Amir; Kasahun, Gebremicheal Gebreslassie; Kasaye, Habtamu Kebebe; Kassa, Gebrehiwot G.; Kassa, Getachew Mullu; Kayode, Gbenga A.; Kebede, Mihiretu M.; Keiyoro, Peter Njenga; Ketema, Daniel Bekele; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Nuruzzaman; Khatab, Khaled; Khater, Mona M.; Khater, Amir M.; Khayamzadeh, Maryam; Khazaei, Mohammad; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Ali; Kim, Yun Jin; Kimokoti, Ruth W.; Kisa, Sezer; Kisa, Adnan; Kochhar, Sonali; Kolola, Tufa; Komaki, Hamidreza; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Krishan, Kewal; Defo, Barthelemy Kuate; Kugbey, Nuworza; Kumar, Pushpendra; Kumar, G. Anil; Kumar, Manasi; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lal, Aparna; Lal, Dharmesh Kumar; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van Charles; Lasrado, Savita; Lebedev, Georgy; Lee, Paul H.; LeGrand, Kate E.; Leili, Mostafa; Lenjebo, Tsegaye Lolaso; Leshargie, Cheru Tesema; Levine, Aubrey J.; Lewycka, Sonia; Li, Shanshan; Linn, Shai; Liu, Shiwei; Lopez, Jaifred Christian F.; Lopukhov, Platon D.; Abd El Razek, Muhammed Magdy; Prasad, D. R. Mahadeshwara; Mahasha, Phetole Walter; Mahotra, Narayan B.; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A.; Manafi, Navid; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Martinez, Gabriel; Martini, Santi; Martins-Melo, Francisco Rogerlandio; Mathur, Manu Raj; Mayala, Benjamin K.; Mazidi, Mohsen; McAlinden, Colm; Meharie, Birhanu Geta; Mehndiratta, Man Mohan; Nasab, Entezar Mehrabi; Mehta, Kala M.; Mekonnen, Teferi; Mekonnen, Tefera Chane; Meles, Gebrekiros Gebremichael; Meles, Hagazi Gebre; Memiah, Peter T. N.; Memish, Ziad A.; Mendoza, Walter; Menezes, Ritesh G.; Mereta, Seid Tiku; Meretoja, Tuomo J.; Mestrovic, Tomislav; Metekiya, Workua Mekonnen; Miazgowski, Bartosz; Miller, Ted R.; Mini, G. K.; Mirrakhimov, Erkin M.; Moazen, Babak; Mohajer, Bahram; Mohammad, Yousef; Mohammad, Dara K.; Mezerji, Naser Mohammad Gholi; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohammed, Hassen; Mohebi, Farnam; Mokdad, Ali H.; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Joo, Mohammad; Moraga, Paula; Morales, Linda; Mosapour, Abbas; Mosser, Jonathan F.; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffor, Miliva; Munro, Sandra B.; Muriithi, Moses K.; Murray, Christopher J. L.; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Naik, Gurudatta; Nangia, Vinay; Nascimento, Bruno Ramos; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Netsere, Henok Biresaw; Ngunjiri, Josephine W.; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Nguyen, QuynhAnh P.; Nigatu, Solomon Gedlu; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Nojomi, Marzieh; Norheim, Ole F.; Noubiap, Jean Jacques; Oancea, Bogdan; Ogbo, Felix Akpojene; Oh, In-Hwan; Olagunju, Andrew T.; Olusanya, Jacob Olusegun; Olusanya, Bolajoko Olubukunola; Onwujekwe, Obinna E.; Ortega-Altamirano, Doris; Osarenotor, Osayomwanbo; Osei, Frank B.; Owolabi, Mayowa O.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pana, Adrian; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Patle, Ajay; Paulos, Kebreab; Pepito, Veincent Christian Filipino; Perico, Norberto; Pervaiz, Aslam; Pescarini, Julia Moreira; Pesudovs, Konrad; Pham, Hai Quang; Pigott, David M.; Pilgrim, Thomas; Pirsaheb, Meghdad; Poljak, Mario; Pollock, Ian; Postma, Maarten J.; Pourmalek, Farshad; Pourshams, Akram; Prada, Sergio; Preotescu, Liliana; Quintana, Hedley; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rahman, Mohammad Hifz Ur; Rajati, Fatemeh; Ranabhat, Chhabi Lal; Rao, Puja C.; Rasella, Davide; Rath, Goura Kishor; Rawaf, Salman; Rawal, Lal; Rawasia, Wasiq Faraz; Remuzzi, Giuseppe; Renjith, Vishnu; Renzaho, Andre M. N.; Resnikoff, Serge; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Rickard, Jennifer; Roever, Leonardo; Ronfani, Luca; Rubagotti, Enrico; Rubino, Salvatore; Saad, Anas M.; Sabour, Siamak; Sadeghi, Ehsan; Moghaddam, Sahar Saeedi; Safari, Yahya; Sagar, Rajesh; Sahraian, Mohammad Ali; Sajadi, S. Mohammad; Salahshoor, Mohammad Reza; Salam, Nasir; Saleem, Ahsan; Salem, Hosni; Salem, Marwa Rashad; Salimi, Yahya; Salimzadeh, Hamideh; Samy, Abdallah M.; Sanabria, Juan; Santos, Itamar S.; Santric-Milicevic, Milena M.; Sao Jose, Bruno Piassi; Saraswathy, Sivan Yegnanarayana Iyer; Sarrafzadegan, Nizal; Sartorius, Benn; Sathian, Brijesh; Sathish, Thirunavukkarasu; Satpathy, Maheswar; Sawhney, Monika; Sayyah, Mehdi; Sbarra, Alyssa N.; Schaeffer, Lauren E.; Schwebel, David C.; Senbeta, Anbissa Muleta; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Servan-Mori, Edson; Shafieesabet, Azadeh; Shaheen, Amira A.; Shahid, Izza; Shaikh, Masood Ali; Shalash, Ali S.; Shams-Beyranvand, Mehran; Shamsi, MohammadBagher; Shamsizadeh, Morteza; Shannawaz, Mohammed; Sharafi, Kiomars; Sharma, Rajesh; Sheikh, Aziz; Shetty, B. Suresh Kumar; Shiferaw, Wondimeneh Shibabaw; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Shirkoohi, Reza; Shivakumar, K. M.; Si, Si; Siabani, Soraya; Siddiqi, Tariq Jamal; Silva, Diego Augusto Santos; Singh, Virendra; Singh, Narinder Pal; Singh, Balbir Bagicha Singh; Singh, Jasvinder A.; Singh, Ambrish; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Skiadaresi, Eirini; Smith, David L.; Filho, Adauto Martins Soares; Sobhiyeh, Mohammad Reza; Sokhan, Anton; Soriano, Joan B.; Sorrie, Muluken Bekele; Soyiri, Ireneous N.; Spurlock, Emma Elizabeth; Sreeramareddy, Chandrashekhar T.; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Suleria, Hafiz Ansar Rasul; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabuchi, Takahiro; Tadesse, Degena Bahrey; Tarigan, Ingan Ukur; Taye, Bineyam; Tefera, Yonatal Mesfin; Tehrani-Banihashemi, Arash; Tekelemedhin, Shishay Wahdey; Tekle, Merhawi Gebremedhin; Temsah, Mohamad-Hani; Tesfay, Berhe Etsay; Tesfay, Fisaha Haile; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; ThekkePurakkal, Akhil Soman; Thomas, Nihal; Thompson, Robert L.; Thomson, Alan J.; Topor-Madry, Roman; Tovani-Palone, Marcos Roberto; Traini, Eugenio; Bach Xuan Tran; Khanh Bao Tran; Ullah, Irfan; Unnikrishnan, Bhaskaran; Usman, Muhammad Shariq; Uthman, Olalekan A.; Uzochukwu, Benjamin S. Chudi; Valdez, Pascual R.; Varughese, Santosh; Veisani, Yousef; Violante, Francesco S.; Vollmer, Sebastian; Whawariat, Feleke Gebremeskel; Waheed, Yasir; Wallin, Mitchell Taylor; Wang, Yuan-Pang; Wang, Yafeng; Wangdi, Kinley; Weiss, Daniel J.; Weldesamuel, Girmay Teklay; Werkneh, Adhena Ayaliew; Westerman, Ronny; Wiangkham, Taweewat; Wiens, Kirsten E.; Wijeratne, Tissa; Wiysonge, Charles Shey; Wolde, Haileab Fekadu; Wondafrash, Dawit Zewdu; Wonde, Tewodros Eshete; Worku, Getasew Taddesse; Yadollahpour, Ali; Jabbari, Seyed Hossein Yahyazadeh; Yamada, Tomohide; Yaseri, Mehdi; Yatsuya, Hiroshi; Yeshaneh, Alex; Yilma, Mekdes Tigistu; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z.; Yousof, Hebat-Allah Salah A.; Yu, Chuanhua; Yusefzadeh, Hasan; Zadey, Siddhesh; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zar, Heather J.; Zerfu, Taddese Alemu; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Zuniga, Yves Miel H.; Hay, Simon; Reiner, Robert C. (2020)
    Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
  • Local Burden Dis Diarrhoea; Wiens, Kirsten E.; Lindstedt, Paulina A.; Blacker, Brigette F.; Meretoja, Tuomo J.; Shiri, Rahman (2020)
    Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  • Local Burden Dis Educ Attainment C; Graetz, Nicholas; Woyczynski, Lauren; Wilson, Katherine F.; Meretoja, Tuomo J. (2021)
    BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
  • Lahelma, Eero; Pietilainen, Olli; Rahkonen, Ossi; Lahti, Jouni; Lallukka, Tea (2016)
    Background: Mental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates. Methods: Baseline mail survey data from 2000-02 included employees, aged 40-60, of the City of Helsinki, Finland ( n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version ( GHQ-12) and the Short Form 36 mental component summary ( MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland ( n = 242) and linked individually to survey data pending consent ( n = 6605). Hazard ratios ( HR) and 95 % confidence intervals ( 95 % CI) were calculated using Cox regression analysis. Results: For all-cause mortality, only MCS showed a weak association before adjustments. For natural mortality, no associations were found. For unnatural mortality ( n = 21), there was a sex adjusted association with GHQ ( HR = 1.96, 95 % CI = 1.45-2.64) and MCS ( 2.30, 95 % CI = 1.72-3.08). Among unnatural causes of death suicidal mortality ( n = 11) was associated with both GHQ ( 2.20, 95 % CI = 1.47-3.29) and MCS ( 2.68, 95 % CI = 1.80-3.99). Of the covariates limiting long-standing illness modestly attenuated the associations. Conclusions: Two established measures of mental symptoms, i.e. GHQ-12 and SF-36 MCS, were both associated with subsequent unnatural, i.e. accidental and violent, as well as suicidal mortality. No associations were found for natural mortality due to diseases. These findings need to be corroborated in further populations. Supporting mental health through workplace measures may help counteract subsequent suicidal and other unnatural mortality among midlife employees.
  • Saavalainen, L.; But, A.; Tiitinen, A.; Härkki, P.; Gissler, M.; Haukka, J.; Heikinheimo, O. (2019)
    STUDY QUESTION Is all-cause and cause-specific mortality increased among women with surgically verified endometriosis? SUMMARY ANSWER The all-cause and cause-specific mortality in midlife was lower throughout the follow-up among women with surgically verified endometriosis compared to the reference cohort. WHAT IS KNOWN ALREADY Endometriosis has been associated with an increased risk of comorbidities such as certain cancers and cardiovascular diseases. These diseases are also common causes of death; however, little is known about the mortality of women with endometriosis. STUDY DESIGN, SIZE, DURATION A nationwide retrospective cohort study of women with surgically verified diagnosis of endometriosis was compared to the reference cohort in Finland (1987-2012). Follow-up ended at death or 31 December 2014. During the median follow-up of 17years, 2.5 million person-years accumulated. PARTICIPANTS/MATERIALS, SETTING, METHODS Forty-nine thousand nine hundred and fifty-six women with at least one record of surgically verified diagnosis of endometriosis in the Finnish Hospital Discharge Register between 1987 and 2012 were compared to a reference cohort of 98824 age- and municipality-matched women. The age (meanstandard deviation) of the endometriosis cohort was 36.49.0 and 53.612.1years at the beginning and at the end of the follow-up, respectively. By using the Poisson regression models the crude and adjusted all-cause and cause-specific mortality rate ratios (MRR) and 95% confidence intervals (CI) were assessed. Calendar time, age, time since the start of follow-up, educational level, and parity adjusted were considered in the multivariate analyses. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1656 and 4291 deaths occurred in the endometriosis and reference cohorts, respectively. A lower all-cause mortality was observed for the endometriosis cohort (adjusted MRR, 0.73 [95% CI 0.69 to 0.77])-there were four deaths less per 1000 women over 10years. A lower cause-specific mortality contributed to this: the adjusted MRR was 0.88 (95% CI 0.81 to 0.96) for any cancer and 0.55 (95% CI 0.47 to 0.65) for cardiovascular diseases, including 0.52 (95% CI 0.42 to 0.64) for ischemic heart disease and 0.60 (95% CI 0.47 to 0.76) for cerebrovascular disease. Mortality due to alcohol, accidents and violence, respiratory, and digestive disease-related causes was also decreased. LIMITATIONS, REASONS FOR CAUSATION These results are limited to women with endometriosis diagnosed by surgery. In addition, the study does not extend into the oldest age groups. The results might be explained by the characteristics and factors related to women's lifestyle, and/or increased medical attention and care received, rather than the disease itself. WIDER IMPLICATIONS OF THE FINDINGS These reassuring data are valuable to women with endometriosis and to their health care providers. Nonetheless, more studies are needed to address the causality. STUDY FUNDING/COMPETING INTEREST This research was funded by the Hospital District of Helsinki and Uusimaa and The Finnish Medical Foundation. None of the authors report any competing interest in relation to the present work; all the authors have completed the disclosure form.
  • Heikkila, Pia; But, Anna; Sorsa, Timo; Haukka, Jari (2018)
    Periodontitis, a multifactorial infection-induced low-grade chronic inflammation, can influence the process of carcinogenesis. We studied with 10 years follow-up of 68,273 adults-based cohort the involvement of periodontitis as a risk factor for cancer mortality. Periodontal status was defined based on procedure codes of periodontal treatment. Rate ratios and absolute differences of overall and cancer mortality rates were assessed with respect to periodontal status using multiplicative and additive Poisson regression models, respectively. We adjusted for effect of age, sex, calendar time, socio-economic status, oral health, dental treatments and diabetes. Data about smoking or alcohol consumption were not available. Altogether 797 cancer deaths occurred during 664,020 person-years accumulated over a mean 10.1-year follow-up. Crude cancer mortality rate per 10,000 person-years for participants without and with periodontitis was 11.36 (95% CI 10.47-12.31) and 14.45 (95% CI 12.51-16.61), respectively. Crude rate ratios for periodontitis indicated an increased risk of overall (RR 1.27, 95% CI 1.08-1.39) and pancreatic cancer (RR 1.69, 95% CI 1.04-2.76) mortality. After adjustment, the results showed even stronger associations of periodontitis with increased overall (RR 1.33, 95% CI 1.10-1.58) and pancreatic cancer (RR 2.32, 95% CI 1.31-3.98) mortality. A higher pancreatic cancer mortality among individuals with periodontitis contributed considerably to the difference in overall cancer mortality, but this difference was not due to pancreatic cancer deaths alone. What's new? Periodontitis is characterized by infection-driven inflammation, a type of inflammation that is a factor in about 15% of human tumors. It remains unclear, however, whether periodontitis increases cancer risk or influences cancer mortality. In this study, long-term follow-up on a large cohort of dental patients in Finland suggests that periodontitis is associated with increased overall cancer mortality, especially increased mortality from pancreatic cancer. The findings suggest that the prevention and treatment of periodontitis can help reduce the risk of systemic adverse events, such as death, from cancer.
  • Vousoura, Eleni; Gergov, Vera; Tulbure, Bogdan Tudor; Camilleri, Nigel; Saliba, Andrea; Garcia-Lopez, Luisjoaquin; Podina, Ioana R.; Prevendar, Tamara; Loffler-Stastka, Henriette; Chiarenza, Giuseppe Augusto; Debbane, Martin; Markovska-Simoska, Silvana; Milic, Branka; Torres, Sandra; Ulberg, Randi; Poulsen, Stig (2021)
    Background: Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. Methods: The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. Discussion: This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people.
  • Larsson, Martin; Castren, Maaret; Lindström, Veronica; von Euler, Mia; Patrone, Cesare; Wahlgren, Nils; Nathanson, David (2019)
    Objectives Hyperglycemia is a predictor for poor stroke outcome. Hyperglycemic stroke patients treated with thrombolysis have an increased risk of intracranial hemorrhage. Insulin is the gold standard for treating hyperglycemia but comes with a risk of hypoglycemia. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are drugs used in type 2 diabetes that have a low risk of hypoglycemia and have been shown to exert neuroprotective effects. The primary objective was to determine whether prehospital administration of the GLP-1RA exenatide could lower plasma glucose in stroke patients. Secondary objective was to study tolerability and safety. Materials & Methods Randomized controlled trial comparing exenatide administrated prehospitally with a control group receiving standard care for hyperglycemia. Patients with Face Arm Speech Test >= 1 and glucose >= 8 mmol/L were randomized. Glucose was monitored for 24 hours. All adverse events were recorded. Results Nineteen patients were randomized, eight received exenatide. An interim recruitment failure analysis with subsequent changes of the protocol was made. The study was stopped prematurely due to slow inclusion. No difference was observed in the main outcome of plasma glucose at 4 hours, control vs exenatide (mean, SD); 7.0 +/- 1.9 vs 7.6 +/- 1.6; P = .56). No major adverse events were reported. Conclusions We found no evidence that prehospital exenatide had effect on hyperglycemia. However, it was given without adverse events in this study with limited sample size that was prematurely stopped due to slow inclusion.