Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders 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.MethodsWe 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.FindingsGlobally, 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.InterpretationAs 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

I can see that you’re suffering : The nurse’s encounter of relatives who lost a family member due to sudden death

Bakgrund: Sjuksköterskan är den person som är närmast patienten, och är den som oftast är med när en patient avlider. De anhöriga som lämnas kvar drabbas alltid av förlusten efter en död, och det är sjuksköterskans ansvar att sköta omvårdnaden av dessa anhöriga. I Sverige dör årligen cirka 90 000 personer, varav 11600 räknas som plötsliga dödsfall. När döden kommer plötsligt orsakar den ett enormt trauma som riskerar att inverka negativt på de efterlevandes hälsa, om de inte får rätt omhändertagande. Syfte: Syftet med studien var att identifiera och beskriva sjuksköterskans bemötande av anhöriga som förlorat en familjemedlem i plötslig död. Design: Allmän litteraturstudie med systematiskt tillvägagångssätt. Metod: Litteratur söktes i databaserna CINAHL, PubMed, PsychINFO, Scopus, Eric och Swemed+. Under sökningen användes svenska Mesh-termer, booleska söktermer, fri sökning och thesaurus-sökning. 16 artiklar kvalitetsgranskades, varav 13 artiklar gick vidare för analys. Av dessa var 12 av kvalitativ art, och en av kvantitativ. Resultat: Bemötandet av anhöriga innefattar många områden. Följande huvudkategorier identifierades: Egenvård, att skapa en relation, att ge utrymme, att delge, att vara professionell, samt att lämna situationen. Konklusion: Då en patient har avlidit är det viktigt att sjuksköterskan är kompetent att ta hand om de sörjande anhöriga. Sjuksköterskan behöver vara relationsfokuserad i sitt bemötande av dessa, för att kunna se deras behov och ge dem rätt omvårdnad. De anhöriga är i akut behov av information för att skapa sig en förståelse och acceptans för det plötsliga dödsfallet

Designing and Testing a Pattern of Professional Competencies for Teachers of Applied Science University

Considering developments and advances in technology and the future needs of teaching skills based on changes in labor markets and the need to respond, there is a need to design a model of competencies required for effective job performance of instructors. Thus, the present study was conducted with the aim of designing and testing the model of professional competencies of instructors in the comprehensive university of applied-science. The research method was applied in terms of aim, and quantitative in terms of method. Inferential analysis method and data description and factor analysis (exploratory and confirmatory) were used to analyze the questionnaire data and present the results. Due to confirmation of questions by the experts, the content validity of the questionnaire was confirmed. The statistical population of the study included 54000 people and the sample consisted of 391 university instructors. Cochran's formula was used to calculate the sample size. Cronbach's alpha coefficient of the questionnaire was obtained at .90 and the used instrument showed a good reliability. The collected data were analyzed using SPSS 16 and Smart PLS software. The tested factors included leadership, assessment, perceptual, classroom management, technological and virtual, educational, obligation, positive perfectionism, ethical, and global mindset. These factors were evaluated through a questionnaire and factor loads were assessed using factor analysis. Since in all components, both the factor load and their path coefficient were more than .30, and the whole model was significant, no component was removed from the path analysis and all their components and indicators were accepted as components of the model of professional competencies of instructors

Experimental Study of Smear Layer and Debris Remaining Following the Use of Four Root Canal Preparation Systems Using Scanning Electron Microscopy

Background and Aim: Since the use of rotary nickel titanium instruments is an essential part of endodontic treatment, itis important to compare the root canal cleaning ability of these instruments. The aim of this study was to compare the amount of smear layer and debris remaining following the use of four rotary instruments: MTwo , Pro Taper , Race and BioRaCe .   Materials and Methods : A total of120 mesiobuccal canals of extracted human first molars with apical root curvature of 10 ° to 20 ° were selected. Working length of all roots was 19 mm. The roots were randomly divided into four groups of 30 specimens. After the preparation of access cavity, the roots were instrumented using rotary instruments according to the manufacturer’s instructions. After each file, the root canal was irrigated with 2.5%sodium hypochlorite. Then the roots were studied under scanning electron microscope. The smear layer and debris scoreswere evaluated by 2 endodontistsusing Schafer and Schlingemann classification. Kruskal -Wallis and Dunn tests were used for statistical analysis of results .   Results: The amount of smear layer produced by MTwo was lower than the other instrumentation techniques and it was significantly lower than that inBioRaCe system (p<0.05). The amount of debris was also lower in the mentioned group but the difference in this respect between groups was not significant. BioRaCe system had the highest level of remained smear layer while Pro Taper had the highest amount of remained debris .   Conclusion: Within the limitations of this study, it was revealed that MTwo instruments had greater capability of removing smear layer and debris than theBioRaCe system

Comparison of the Therapeutic Effect of Combination of Flutamide-Cyproterone Compound with Flutamide-Doxycycline in Severe Female Acne

&nbsp; Background & objectives: In recent years, the hypothesis of using anti-androgens has been increasingly addressed in the treatment of acne in women. One of these drugs is flutamide, which there is no strong evidence of its efficacy in treatment of acne in women. The aim of this study was to compare the effect of combination therapy of flutamide-cyproterone compound with flutamide-doxycycline in severe type of acne in women. Methods: In an interventional study, patients were divided in to two groups. One group (n=30) received flutamide - cyproterone compound and another group (n=30) received flutamide-doxycycline which were followed for six months. Both groups also received 1% topical clindamycin twice a day. Counting the number of lesions, changes in severity index and grading of acne were used to evaluate the patients. Patient satisfaction was also evaluated. Results: The mean age in the flutamide-doxycycline group was 19.4&plusmn;4.67 and in the flutamide-cyproterone compound group was 19.06&plusmn;11.3. This difference was not statistically significant. The mean of the acne severity index at the onset of intervention between the two groups was not significant (p= 0.7). The mean of the acne severity index at the start of treatment in the flutamide-doxycycline group was 306.07&plusmn;155.46 and at the end of treatment reached to 19.18&plusmn;19.5, and also in the flutamide-cyproterone compound group, decreased from 293.21&plusmn;15.21 to 10.5&plusmn;21.8 at the end of treatment. This difference was not statistically significant (p=0.1). Conclusion: Both therapeutic regimen were effective in the treatment of severe type of acne and can possibly be used as an alternative treatment for severe acne