Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

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

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries

Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study

Orientation of public and physicians to the complementary and alternative medicine (CAM) is one<br />of the most prominent symbols of structural changes in the health service system. The aim of his study was a<br />determination of knowledge, attitude, and practice of general practitioners in complementary and alternative<br />medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire<br />was used for collecting data including four information parts: population information, physicians’ attitude and<br />knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised<br />the population of study according to the deputy of treatment’s report of Qazvin University of Medical Sciences.<br />A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter<br />questionnaires’ data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all<br />responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.<br />96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of<br />practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little<br />information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine<br />for treatment. Although there was little knowledge among practitioners about traditional medicine and<br />complementary approaches, a significant percentage of them had attitude higher than the lower limit

Viewpoints of Patients in Qazvin Towards Complementary and Alternative Medicine

Background: We have little information on the degree of individuals’ in Iran and their use of complementary and alternative medicine, its variations and the causes of people’s tendency towards the treatments used in the methods mentioned above. Objectives: In 2012, we set out to study the viewpoints of patients in Qazvin, Iran, examining how they feel about complementary and alternative medicine. Patients and Methods: In a cross-sectional study, data were collected through the use of a questionnaire. A total of 293 patients who had been referred to the complementary and alternative medicine centers were surveyed. These centers practice methods such as cupping, homeopathy and acupuncture. The questionnaire was divided in two parts, demographic questions and main questions, in this particular study. The data were analyzed using SPSS software version 19 with P < 0.05. Results: The mean age of the participants was 37.2 ± 13.3, and 60.8 percent of them were men. In all, 70.6 percent and 24.4 percent of respondents were married and single, respectively. About 58 percent had completed their undergraduate education. The cause of 31.3 percent of the participants’ visits was mental sicknesses, 20.2 percent attended due to rheumatologic diseases, and 8.2 percent applied to the mentioned treatment centers seeking relief from skin-related diseases. Ninety-one percent of the participants reported using alternative and complementary medicine for its efficiency. The levels of high satisfaction they reported gaining from the center’s homeopathy, acupuncture, and phlebotomy services were 17.2%, 16.5%, and 18.2%, respectively. In addition, 70 percent of the patients found the new treatment method to be quite successful, while 27 percent found it to be less effective than other approaches they had tried. Conclusions: The people were receptive to the use of alternative and complementary medicine and their satisfaction level was high. Keywords: Homeopathy, Acupuncture, Phlebotom

Nail disorder among patients on maintenance hemodialysis

Background/Objective: Chronic renal failure can lead to nail disorders. The aim of this study was to investigate nail disorders and laboratory data in patients on constant hemodialysis (HD) in a hospital in Qazvin, Iran. Methods: A case-controlled study was performed. End stage renal disease patients (n = 149) undergoing regular HD and 147 randomly selected individuals were examined for nail disorder. All participants were examined by two trained students and a single dermatologist. Specific investigations such as nail biopsy, potassium hydroxide mount, and fungal culture were done if necessary. Laboratory data were completed for HD patients. Demographic characteristics, the causes of end stage renal disease, and laboratory data were tested in a multivariate analysis. Results: In this study, 62 HD patients had at least one nail disorder, with leukonychia being the most common in both groups. Clinical onychomycosis, absent lunula and half and half nail were the other common findings in HD patients. Positive mycological culture was noted in four HD patients and in none of the control individuals. The mean duration of HD was a significant predictor associated with the positive clinical onychomycosis (p < 0.05). Although there was no significant correlation between nail disorders and hypertension or heart failure, multiple logistic regression analysis indicated that gender, age ≥ 65 years, and diabetes mellitus (DM) were associated with nail disorder. Conclusion: The prevalence of nail disorder in this study was correlated with age, DM, and gender. To decrease the prevalence of nail disorder, attention to duration of HD, age, male sex, and DM is very important

Comparison of Topical Sucralfate and Silver Sulfadiazine Cream in Second Degree Burns in Rats

Background. The most prevalent topical treatment for partial thickness burns is silver sulfadiazine 1% (SSD). Recent studies have shown that the healing of partial thickness burns is delayed with the use of SSD. One of the potential burn dressings is sucralfate. Objectives. With this study the authors have aimed to analyze comparatively the effects of sucralfate and SSD on second degree burn wounds in rats. Material and Methods. Forty-eight male rats were divided into three equal groups. A burn model was constituted on the back of all rats. The burned areas in the first, second and third groups were covered daily with sucralfate, SSD and cold cream (control), respectively. At the end of the 7th, 14th, 21st and 28th day, the rats were anesthetized and the burned skin tissue samples were collected for histopathological examination. Results. At the end of the study, the epidermis and horny layer was completely formed in the SSD and sucralfate group; however the appendix of skin was just formed in the sucralfate group. Also the percentage of wound healing was calculated at 76%, 91% and 100% respectively in the control, silver sulfadiazine and sucralfate groups. Conclusions. Sucralfate is known to have multiple beneficial effects on wound healing. Using topical sucralfate accelerates the burn wound healing process in comparison with both the control and SSD groups and can be used as an adjunctive or alternative agent in the future (Adv Clin Exp Med 2013, 22, 4, 481–487)

Acoustical and Thermal Characterization of Insulating Materials Made from Wool and Sugarcane Bagasse

Utilizing agricultural waste and natural fibers minimizes environmental impact and can improve the acoustic and thermal conditions of buildings. Natural fibers can be an alternative to non-biodegradable synthetic sound-absorbing materials. This study aimed to investigate the acoustic and thermal properties of insulating materials made from wool and sugarcane bagasse. Thermal conductivity, thermal resistance, acoustic and moisture absorption, and fire properties of five insulating materials made from sheep wool, goat fiber, camel wool as well as pith and fiber bundles of sugarcane bagasse were determined. The measurement of the sound absorption coefficient was performed in an impedance tube. The thermal resistance and thermal conductivity coefficient were measured according to the ASTM D5334–08 Standard. The findings show that camel wool has the highest sound-absorbing performance, thermal insulation, and fire-resistant properties. The lowest value of the noise reduction coefficient (NRC) was 0.52 for goat fiber, and the highest was 0.74 for camel wool. The maximum sound absorption coefficient of camel wool was 0.95 at a frequency above 1000 Hz. Thermal conductivity varies between 0.038–0.046W/(M.K). Hence, all materials tested can be considered thermally insulating. The results showed insulating materials made from wool, especially camel wool, had better performance than fiber and pith of sugarcane bagasse

Assessment of Vitamin D Plasma Levels in Patients with Vitiligo Vulgaris

Vitiligo Vulgaris is a pigment disorder as the lack of skin pigmentation which its most prevalent cause is autoimmune. Vitamin D has various effects on the natural and acquired immune of the body because of its effectiveness on the T cells and B cells, macrophages and dendritic cells.The object of this study was assessment of the Vitamin D in patients with vitiligo vulgaris in dermatologic clinics in Qazvin in 2012. The 100 patients with Vitiligo were studied through a cross-sectional study. The required data were collected by the questionnaire (age, gender, job, family background, consumption of the dairies and vitamin D supplements), examination (type of skin) and para clinical test (measurement of the serum 25-hydroxyvitamin D level). The 42 (42%) and 58 (58%) people of the population under study were respectively male and female. The mean age of the population under study was 28.7±1.17. The mean serum of 25-hydroxyvitamin D level was 42±24.14 which had a significance difference with a normal level (p<0.04). The mean serum 25-hydroxyvitamin D level among patients with Vitiligo had a significance difference with a normal level