The burden of unintentional drowning: Global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

__Background:__ Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. __Methods:__ Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. __Results:__ Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. __Conclusions:__ There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low-and middle-income countries

Global mortality from dementia : Application of a new method and results from the Global Burden of Disease Study 2019

Introduction Dementia is currently one of the leading causes of mortality globally, and mortality due to dementia will likely increase in the future along with corresponding increases in population growth and population aging. However, large inconsistencies in coding practices in vital registration systems over time and between countries complicate the estimation of global dementia mortality. Methods We meta-analyzed the excess risk of death in those with dementia and multiplied these estimates by the proportion of dementia deaths occurring in those with severe, end-stage disease to calculate the total number of deaths that could be attributed to dementia. Results We estimated that there were 1.62 million (95% uncertainty interval [UI]: 0.41–4.21) deaths globally due to dementia in 2019. More dementia deaths occurred in women (1.06 million [0.27–2.71]) than men (0.56 million [0.14–1.51]), largely but not entirely due to the higher life expectancy in women (age-standardized female-to-male ratio 1.19 [1.10–1.26]). Due to population aging, there was a large increase in all-age mortality rates from dementia between 1990 and 2019 (100.1% [89.1–117.5]). In 2019, deaths due to dementia ranked seventh globally in all ages and fourth among individuals 70 and older compared to deaths from other diseases estimated in the Global Burden of Disease (GBD) study. Discussion Mortality due to dementia represents a substantial global burden, and is expected to continue to grow into the future as an older, aging population expands globally

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public

Expectation of fairness: a turning point in the professional satisfaction of Iranian nurses

Introduction: The professional satisfaction of staff is one of the most challenging organizational concepts that can enhance the efficiency level of organizations. In a similar vein, the professional satisfaction of nurses is of considerable importance, in that, professional dissatisfaction among nurses could result in emotional detachment, depression, anger, evasion from work, and inefficacy and would negatively impact the organization’s work rate. The aim of this study was to understand Iranian nurses’ experiences of the concept of professional satisfaction. Methods: This was a qualitative study conducted with a targeted sampling of 10 nurses (4 men and 6 women) in 2015. The data were collected through conducting in-depth interviews, and textual data were analyzed subsequently using the Qualitative Content Analysis (QCA) method. Results: The findings of this study pointed to “fair conduct,” which was comprised of three sub-categories, i.e., expectation of fairness in social-professional settings, expectation of fairness in receiving professional benefits, and expectation of fairness in the area of professional interactions. Conclusions: There are various ups and downs in nursing due to the challenging nature of the profession, from the initial education at the university until retirement. According to the findings of this study, a lack of fairness in social-professional settings, a lack of fairness in receiving professional benefits, and a lack of fairness in the area of professional interactions were among the factors that have great impacts on the degree of professional dissatisfaction among nurse

The study of work-family conflict and job satisfaction among nurses’ state hospitals in Tehran city

Introduction: Since nurses work in various wards, job satisfaction evaluation and work-family conflict investigation among them regarding the ward they work in is highly crucial, because on one hand, there are ample requests for changes in wards, shifts, hospitals, and even job abandonment, and on the other hand, family conflicts and clashes have increased among nurses. Methods: This correlational research was conducted on 280 nurses who worked in special and general wards of state hospitals in Tehran in 2015. In this study, samples were selected randomly among state hospitals subsidiary to Tehran and Shahid Beheshti universities and social security hospitals in Tehran. Data were collected by means of demographic questionnaire, Smith’s job satisfaction questionnaire, and Net Mayer and Mc Marian's Work- Family conflict questionnaire. In order to analyze the data, SPSS version 21 software was employed and also descriptive statistics methods, correlation coefficient, t-test, regression, and ANOVA were applied. Results: According to the study’s findings, job satisfaction average scores in the supervisor dimension in special and general wards were medium (44.15, 43.868) (p=0.771), job satisfaction average scores in the work dimension in both special and general wards were relatively medium (30.869, 31.520), job satisfaction scores in promotion opportunity aspect in both special and general wards were weak (14.31, 14.187), also work-family conflict average score was 26.07 in special wards and 25.51 in general wards (p=0.519), and work-family conflict average scores in special wards was 15.71 and in general wards was 14.87 (p=0.420), these differences were not significant. Conclusion: The study outcomes reveal that nurses’ job satisfaction is at the medium level. It is noteworthy that the highest percentage of nurses’ job satisfaction in both general wards and special wards are associated with being satisfied with their head nurse, and work-family conflict is equal in both sets of wards (general and special). It is recommended that more studies in the realm of nurses’ job satisfaction and work-family conflict should be done

Refractive Error and Ocular Biometric Changes in the Treatment of Diabetes Mellitus

Background and Objectives: Evaluation of changes in refractive errors and biometric parameters in the process of glycemic control in people with type 2 diabetes during three-month treatment. Methods: Patients with the first diagnosis of type 2 diabetes or a history of poor glycemic control (hemoglobin glycate more than 7.5%) and without any systemic disease other than diabetes were included. Hemoglobin glycate, refractive error, and biometric parameters were evaluated before treatment and one and a half and three months after treatment, and their changes were examined by generalized estimating equation (GEE) analysis. Results: A total of 60 eyes of 30 patients with a mean age of 51.63±6.79 years were evaluated. Hemoglobin glycate decreased by an average of 1.028% compared to the baseline measurement in the third month (P<0.001). Mean spherical (P=0.554), spherical equivalent (P=0.340), axial length (P=0.147), and anterior chamber depth (P=0.336) did not show a significant difference between the three examinations. In contrast, the lens thickness showed a significant decrease during treatment (P=0.001). Finally, generalized estimating equation (GEE) analysis showed that a 1% decrease in hemoglobin glycate increased by 0.226 mm. (P=0.002) in the axial length. It should be mentioned in tables FU1means Follow-up 1.5 months and FU2 means Follow-up 3 months. Conclusion: The present study shows that refractive errors and most ocular biometric parameters do not change significantly compared to the baseline levels in the period of one and a half and three months after the start of glycemic control

Burden of transport-related injuries in the eastern mediterranean region: A systematic analysis for the global burden of disease study 2017

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). Results: In 2017, there were 5.5 million (UI 4.9–6.2) transport-related incident cases in the EMR – a substantial increase from 1990 (2.8 million; UI 2.5–3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5–876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3–1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8–200.6) transport-related fatalities in the EMR – a substantial increase since 1990 (140.4 thousand; UI 118.7–156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1–31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8–47.3). In 2017, Somalia (54; UI 30–77.4) and Lebanon (7.1; UI 4.8–8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5–1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1–2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). Conclusion: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). Results: In 2017, there were 5.5 million (UI 4.9–6.2) transport-related incident cases in the EMR – a substantial increase from 1990 (2.8 million; UI 2.5–3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5–876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3–1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8–200.6) transport-related fatalities in the EMR – a substantial increase since 1990 (140.4 thousand; UI 118.7–156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1–31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8–47.3). In 2017, Somalia (54; UI 30–77.4) and Lebanon (7.1; UI 4.8–8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5–1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1–2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). Conclusion: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently. </jats:p