Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

The relation between climatic factors and malaria incidence in Kerman, South East of Iran

Background and objectives: Malaria is among the most important parasitic diseases, and is one of the endemic diseases in Iran. This disease is often known as a disease related to climate changes. Due to the health and economic burden of malaria and the location of Kerman province in an area with high incidence of malaria, the present study aimed to evaluate the effects of climatic factors on the incidence of this disease. Material and methods: Data on the incidence of malaria in Kerman province was inquired from Kerman and Jiroft Medical Universities and climatic variables were inquired from the meteorological organization of Kerman. The data was analyzed monthly from 2000 to 2012. Variations in incidence of malaria with climatic factors were assessed with negative binomial regression model in STATA11software. In order to determine the delayed effects of meteorological variables on malaria incidence, cross-correlation analysis was done with Minitab16. Results: The most effective meteorological factor on the incidence of malaria was temperature. As the mean, maximum, and minimum of monthly temperature increased, the incidence rate raised significantly. The multivariate negative binomial regression model indicates that a 1 °C increase in maximum temperature in a given month was related to a 15% and 19% increase on malaria incidence on the same and subsequent month, respectively (p-value = 0.001). Humidity and Rainfall were not significant in the adjusted model. Conclusion: Temperature is among the effective climatic parameters on the incidence of malaria which should be considered in planning for control and prevention of the disease

The Effectiveness of Solution-Focused Brief Therapy (SFBT) on Reducing Couple Burnout and Improvement of the Quality of Life of Married Women

Background & Aim: Solution-focused brief therapy is one of the postmodern therapeutic approaches in the area of family and marriage, which puts emphasis on finding solutions by the client in cooperation with the therapist. The current research was conducted by the aim of investigating the effectiveness of solution-focused brief therapy on reducing couple burnout and improvement of the quality of life of married women. Methods: The current research is an interventional and quasi-experimental study which uses pretest-posttest with control group. The population of this research included all the women who attended the center of mental health helpers in bojnoord city during the summer of 1393 (2014), which were seeking to attend the treatment plan in order to resolve their marital problems. Based on available sampling and after the initial screening, 30 women who were qualified to participate in the research and who gained one standard deviation below the mean in the questionnaire were selected and they were placed in two groups of experiment and control through random assignment. The research tools were Pains couple burnout measurement 1996 (CBM) and the world health organization quality of life questionnaire 1996 (WHOQOL), that were completed by the participants in pretest and posttest stages. The treatment sessions of solution-focused brief therapy were performed in 7 two-hour sessions in groups and step-by-step for the participants of the experiment group, but the control group did not receive any intervention and they were put on the waiting list. The data were analyzed through MANCOVA (multivariate analysis of covariance) in the statistical software of SPSS, version 18. Results: The results indicated that after performing the solution-focused intervention, marital burnout among the women in the experiment group has reduced and their quality of life has been improved.no significance change was seen in the control group. Conclusion: The solution-focused brief therapy is effective in reducing marital problems. This brief therapeutic method can be used in counseling centers and family education classes in order to improve marital problems of the clients

Comparative Use of Electromyography in the Evaluation of Electroacupuncture and Transcutaneous Electrical Neural Stimulation (TENS) Effect on Regeneration of Sciatic Nerve in Dog

Abstract Objective-To determine the effect of Electroacupuncture and Transcutaneous Electrical Neural Stimulation on Regeneration of Sciatic Nerve in Dog Design -Experimental in vivo study. Animals -A total of 15 adult male mixed bred dogs, weighing 26±2.6 Kg/BW with aging of 42±6 months, which were divided into three groups of 5 dogs. Procedures-Under general anesthesia, the right sciatic nerves were exposed and completely crushed using artery forceps within 5 seconds in each dog. No treatment was given to control group, dogs in experimental group (I) were subjected to electro-acupuncture treatment daily for 10 minutes for a period of 15 days by locating BL60, SP9, GB30,and ST36 acupoints using 4 Hwato needles of 0.3×40 mm with 50Hz frequency and 30 to100 mA intensity and dogs in experimental group (II) were subjected to transcutaneous electrical stimulation daily for 10 minutes using four superficial electrodes with 100 Hz frequency and intensity of 80 µs (2.8 ±1.6 mA). Clinical signs were recorded for two months and electromyography was recorded from right semi-membranous, semitendinous, extensors and flexors groups of muscles in normal after crush and on 14, 28, and 45 days. Results-The right hind limb paralysis was observed in all dogs of three groups immediately after full recovery from anaesthesia. The positive effect of electro-acupuncture and transcutaneous electrical stimulation were observed on second week on skin wound healing and increasing physical activity by improvement and changes in weight bearing and coordination on 3 rd week and normal coordination and full weight bearing on 5 th week in all dogs of experimental groups. Significant changes in reduction of amplitude in all muscles * Corresponding Author

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

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

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children