35 research outputs found
The effectiveness of using the workplace to identify and address modifiable health risk factors in deprived populations
Objectives To establish whether a programme of targeted health screening, with referral to appropriate interventions, offered to an employed but socioeconomically deprived group was effective in overcoming barriers to uptake of such services and improving a range of surrogate health markers for participants. Methods Low-paid local government employees from socially and economically deprived areas in North-East England were invited to attend a free health check. Health checks were conducted within working hours and close to their worksite, and included assessment of a range of lifestyle and health-related risk factors, including those associated with cardiovascular disease (CVD). A range of additional interventions were offered where indicated. Participants were invited to repeat screening approximately 9 months later. Results 635 (20% response rate) employees in the target age group (≥40 years) attended the first check. Most health risk markers improved in those (N=427) attending both health checks, as did the mean CVD risk score (t=2.86, p=0.004). 269 referrals were made to the intervention programmes. Conclusions This workplace programme had a positive impact on cardiovascular health, but attendance rates were low. These findings suggest that workplace health screening activities may have the potential to improve health in a group often considered hard to reach by other routes, but do not offer a straightforward solution in overcoming barriers to access for such subgroups within the working population
Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
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.Peer reviewe
Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
Background: Human 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. Methods: We 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. Results: All 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 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our 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
The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden
Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Background: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. Methods: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. Findings: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. Interpretation: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. Funding: Bill & Melinda Gates Foundation
Kinetics study and modelling of steam methane reforming process over a NiO/Al<inf>2</inf>O<inf>3</inf> catalyst in an adiabatic packed bed reactor
Kinetic rate data for steam methane reforming (SMR) coupled with water gas shift (WGS) over an 18 wt. % NiO/α-Al2O3 catalyst are presented in the temperature range of 300–700 °C at 1 bar. The experiments were performed in a plug flow reactor under the conditions of diffusion limitations and away from the equilibrium conditions. The kinetic model was implemented in a one-dimensional heterogeneous mathematical model of catalytic packed bed reactor, developed on gPROMS model builder 4.1.0®. The mathematical model of SMR process was simulated, and the model was validated by comparing the results with the experimental values. The simulation results were in excellent agreement with the experimental results. The effect of various operating parameters such as temperature, pressure and steam to carbon ratio on fuel and water conversion (%), H2 yield (wt. % of CH4) and H2 purity was modelled and compared with the equilibrium values
Comparative study of conventional steam-methane-reforming (SMR) and auto-thermal-reforming (ATR) with their hybrid sorption enhanced (SE-SMR & SE-ATR) and environmentally benign process models for the hydrogen production
The paper presents a comparison of steam methane reforming (SMR), sorption enhanced steam methane reforming (SE-SMR), auto-thermal reforming (ATR), and sorption enhanced auto-thermal reforming (SE-ATR) in a fixed bed reformer for hydrogen production. A one-dimensional, unsteady-state heterogeneous reactor model for each process which includes mass and thermal dispersion in the direction of flow and axial pressure distribution, has been simulated using gPROMS® 4.0.1 model builder, while CEA and Aspen Plus® have been employed to analyze the equilibrium performance and simulate the process flowsheets of individual process respectively. The performance of the individual hydrogen production process has been analyzed in terms of CH4 conversion (%), H2 yield (wt. % of CH4), H2 purity and CO2 capture under the various operating conditions of temperature (773–1473 K) and pressure (5–40 bar). The simulation results were also compared with the thermodynamic calculations and literature data. An excellent agreement was observed between our reactor modelling outputs and literature data. The operating conditions of 923 K, 30 bar and S/C of 3.0, O2/CH4 of 0.45 have been chosen. At these conditions, the CH4 conversion for SMR, SE-SMR, ATR, and SE-ATR was found to be 32%, 66%, 51%, and 76% respectively while the composition of hydrogen produced on a dry basis was 55%, 87%, 55%, and 92% respectively. It has been concluded that there are significant advantages of both sorption enhanced processes over conventional reforming in terms of CH4 conversion, H2 purity and the amount of H2 energy produced per unit CH4 energy consumed (MJ)
Assessment of Wind Energy Potential for Small Scale Power Generation at Thatta, Sindh, Pakistan
In this paper, the wind characteristics and wind Power potential for south coast of Thatta, Sindh province, Pakistan are presented. The variation of monthly wind speed at the height of 10m, 20m, 30m, 40m, and 50m are presented. The power density for these heights are calculated employing coefficient of performance Cp as 0.40 and 0.45. Season wise classification of wind speed and power density at these heights indicates a fairly reasonable prospect of wind energy utilization for small scale power generation
Assessment of Wind Energy Potential for Small Scale Power Generation at Thatta, Sindh, Pakistan
In this paper, the wind characteristics and wind Power potential for south coast of Thatta, Sindh province, Pakistan are presented. The variation of monthly wind speed at the height of 10m, 20m, 30m, 40m, and 50m are presented. The power density for these heights are calculated employing coefficient of performance Cp as 0.40 and 0.45. Season wise classification of wind speed and power density at these heights indicates a fairly reasonable prospect of wind energy utilization for small scale power generation