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  • GBD 2015 Eastern Mediterranean Reg (2018)
    To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.
  • Markkula, N.; Lehti, V.; Adhikari, P.; Pena, S.; Heliste, J.; Mikkonen, E.; Rautanen, M.; Salama, E.; Guragain, B. (2019)
    Background. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. Methods. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35-60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. Results. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4-50.4)]. The difference in BDI scores at T2 between PSY and EUC was -7.43 (95% CI -9.71 to -5.14). Conclusions. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.
  • James, Spencer L.; Lucchesi, Lydia R.; Bisignano, Catherine; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Henry, Nathaniel J.; McCracken, Darrah; Roberts, Nicholas L. S.; Sylte, Dillon O.; Ahmadi, Alireza; Ahmed, Muktar Beshir; Alahdab, Fares; Alipour, Vahid; Andualem, Zewudu; Antonio, Carl Abelardo T.; Arabloo, Jalal; Badiye, Ashish D.; Bagherzadeh, Mojtaba; Banstola, Amrit; Baernighausen, Till Winfried; Barzegar, Akbar; Bayati, Mohsen; Bhaumik, Soumyadeep; Bijani, Ali; Bukhman, Gene; Carvalho, Felix; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Nasab, Mostafa Dianati; Hoa Thi Do; Huyen Phuc Do; Endries, Aman Yesuf; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Fukumoto, Takeshi; Gebremedhin, Ketema Bizuwork Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gilani, Syed Amir; Haagsma, Juanita A.; Hamidi, Samer; Hostiuc, Sorin; Househ, Mowafa; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Jayatilleke, Achala Upendra; Kahsay, Amaha; Kapoor, Neeti; Kasaeian, Amir; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Ejaz Ahmad; Khazaee-Pool, Maryam; Kokubo, Yoshihiro; Lopez, Alan D.; Madadin, Mohammed; Majdan, Marek; Maled, Venkatesh; Malekzadeh, Reza; Manafi, Navid; Manafi, Ali; Mangalam, Srikanth; Massenburg, Benjamin Ballard; Meles, Hagazi Gebre; Menezes, Ritesh G.; Meretoja, Tuomo J.; Miazgowski, Bartosz; Miller, Ted R.; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Morrison, Shane Douglas; Negoi, Ionut; Trang Huyen Nguyen; Son Hoang Nguyen; Cuong Tat Nguyen; Nixon, Molly R.; Olagunju, Andrew T.; Olagunju, Tinuke O.; Padubidri, Jagadish Rao; Polinder, Suzanne; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rahimi-Movaghar, Vafa; Rawaf, Salman; Rawaf, David Laith; Rezapour, Aziz; Rickard, Jennifer; Roro, Elias Merdassa; Roy, Nobhojit; Safari-Faramani, Roya; Salamati, Payman; Samy, Abdallah M.; Satpathy, Maheswar; Sawhney, Monika; Schwebel, David C.; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Shigematsu, Mika; Soheili, Amin; Stokes, Mark A.; Tohidinik, Hamid Reza; Bach Xuan Tran; Valdez, Pascual R.; Wijeratne, Tissa; Yisma, Engida; Zaidi, Zoubida; Zamani, Mohammad; Zhang, Zhi-Jiang; Hay, Simon; Mokdad, Ali H. (2020)
    Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
  • Ala-Nikkola, Taina; Pirkola, Sami; Kaila, Minna; Joffe, Grigori; Kontio, Raija; Oranta, Olli; Sadeniemi, Minna; Wahlbeck, Kristian; Saarni, Samuli I. (2018)
    The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
  • Lahti-Pulkkinen, Marius; Bhattacharya, Sohinee; Räikkönen, Katri; Osmond, Clive; Norman, Jane E.; Reynolds, Rebecca M. (2018)
    While previous studies have shown intergenerational transmission of birth weight from mother to child, whether the continuity persists across 3 generations has rarely been assessed. We used the Aberdeen Maternity and Neonatal Data-bank (United Kingdom) to examine the intergenerational correlations of birth weight, birth weight adjusted for gestational age and sex, and small- and large-for-gestational-age births across 3 generations among 1,457 grandmother-mother-child triads. All participants were born between 1950 and 2015. The intergenerational transmission was examined with linear regression analyses. We found that grandmaternal birth weight was associated with grandchild birth weight, independently of prenatal and sociodemographic covariates and maternal birth weight (B = 0.12 standard deviation units, 95% confidence interval: 0.07, 0.18). Similar intergenerational continuity was found for birth weight adjusted for sex and gestational age as well as for small-for-gestational-age births. In conclusion, birth weight and fetal growth showed intergenerational continuity across 3 generations. This supports the hypothesis that the developmental origins of birth weight and hence later health and disease are already present in earlier generations.
  • Dent, E.; Morley, J. E.; Cruz-Jentoft, A. J.; Woodhouse, L.; Rodriguez-Manas, L.; Fried, L. P.; Woo, J.; Aprahamian; Sanford, A.; Lundy, J.; Landi, F.; Beilby, J.; Martin, F. C.; Bauer, J. M.; Ferrucci, L.; Merchant, R. A.; Dong, B.; Arai, H.; Hoogendijk, E. O.; Won, C. W.; Abbatecola, A.; Cederholm, T.; Strandberg, T.; Gutierrez Robledo, L. M.; Flicker, L.; Bhasin, S.; Aubertin-Leheudre, M.; Bischoff-Ferrari, H. A.; Guralnik, J. M.; Muscedere, J.; Pahor, M.; Ruiz, J.; Negm, A. M.; Reginster, J. Y.; Waters, D. L.; Vellas, B. (2019)
    Objective The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
  • Vesel, Linda; Manu, Alexander; Lohela, Terhi; Gabrysch, Sabine; Okyere, Eunice; ten Asbroek, Augustinus H. A.; Hill, Zelee; Agyemang, Charlotte Tawiah; Owusu-Agyei, Seth; Kirkwood, Betty R. (2013)
  • NCD Risk Factor Collaboration; Bixby, Honor; Auvinen, Juha; Eriksson, Johan G.; Jääskeläinen, Tuija; Laatikainen, Tiina; Järvelin, Marjo-Riitta; Korpelainen, Raija; Puhakka, Soile E.; Sebert, Sylvain; Juolevi, Anne; Kajantie, Eero O.; Koskinen, Seppo; Kuulasmaa, Kari; Lundqvist, Annamari; Peltonen, Markku; Salomaa, Veikko; Tolonen, Hanna K.; Herrala, Sauli; Jokelainen, Jari; Keinänen-Kiukaanniemi, Sirkka; Mursu, Jaakko; Tuomainen, Tomi-Pekka; Virtanen, Jyrki K.; Voutilainen, Ari; Voutilainen, Sari; Kujala, Urho M.; Lehtimäki, Terho; Raitakari, Olli; Salonen, Jukka T.; Saramies, Jouko L.; Uusitalo, Hannu M. T.; Vlasoff, Tiina (2019)
    Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
  • GlobalSurg Collaborative; Drake, Thomas M.; Tolonen, Matti; Leppäniemi, Ari; Sallinen, Ville; Sund, Malin (2020)
    Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
  • Nesbitt, Robin C.; Lohela, Terhi J.; Soremekun, Seyi; Vesel, Linda; Manu, Alexander; Okyere, Eunice; Grundy, Chris; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Kirkwood, Betty R.; Gabrysch, Sabine (2016)
    Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regression to assess the influence of distance and several quality dimensions on place of delivery. Women lived a median of 3.3 km from the closest delivery facility, and 58% delivered in a facility. The probability of facility delivery ranged from 68% among women living 1 km from their closest facility to 22% among those living 25 km away, adjusted for confounders. Measured quality of care at the closest facility was not associated with use, except that facility delivery was lower when the closest facility provided substandard care on the EmOC dimension. These results do not imply, however, that we should increase geographic accessibility of care without improving facility quality. While this may be successful in increasing facility deliveries, such care cannot be expected to reduce maternal and neonatal mortality.
  • Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M.; Hardcastle, Timothy; Abu-Zidan, Fikri M.; Adesunkanmi, Abdulrashid K.; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J.; Beltran, Marcelo A.; Ben-Ishay, Offir; Biffl, Walter L.; Birindelli, Arianna; Cainzos, Miguel A.; Catalini, Gianbattista; Ceresoli, Marco; Jusoh, Asri Che; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Cortese, Francesco; Demetrashvili, Zaza; Di Saverio, Salomone; Diaz, Jose J.; Egiev, Valery N.; Ferrada, Paula; Fraga, Gustavo P.; Ghnnam, Wagih M.; Lee, Jae Gil; Gomes, Carlos A.; Hecker, Andreas; Herzog, Torsten; Kim, Jae Il; Inaba, Kenji; Isik, Arda; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W.; Kluger, Yoram; Koike, Kaoru; Kong, Victor Y.; Leppäniemi, Ari; Machain, Gustavo M.; Maier, Ronald V.; Marwah, Sanjay; McFarlane, Michael E.; Montori, Giulia; Moore, Ernest E.; Negoi, Ionut; Olaoye, Iyiade; Omari, Abdelkarim H.; Ordonez, Carlos A.; Pereira, Bruno M.; Pereira Junior, Gerson A.; Pupelis, Guntars; Reis, Tarcisio; Sakakhushev, Boris; Sato, Norio; Lohse, Helmut A. Segovia; Shelat, Vishal G.; Soreide, Kjetil; Uhl, Waldemar; Ulrych, Jan; Van Goor, Harry; Velmahos, George C.; Yuan, Kuo-Ching; Wani, Imtiaz; Weber, Dieter G.; Zachariah, Sanoop K.; Catena, Fausto (2017)
    Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.