Level of Patients’ Satisfaction from Emergency Medical Services in Markazi Province; a Cross sectional Study

مقدمه: یکی از روش های ارزشیابی خدمات، سنجش میزان رضایتمندی از کیفیت ارائه آنها می باشد. رضایتمندی بیمار مفهومی است که امروزه در مراقبت های پزشکی اهمیت بسیار ویژه ای یافته است  و این امر در سیستم اورژانس پیش بیمارستانی از اهمیت بیشتری برخوردار است. لذا این مطاله با هدف بررسی میزان رضایتمندی از خدمات اورژانس پیش بیمارستانی شهرستانهای تابعه دانشگاه علوم پزشکی اراک انجام شده است. روش کار: در این مطالعه مقطعی جهت بررسی رضایتمندی بیماران از پرسشنامه پایا و روای مقیاس رضایتمندی مراقبت های اورژانسی استفاده شد. این پرسشنامه  متشکل از 33 سوال بود که 9 سوال جهت بررسی اطلاعات دموگرافیک و مابقی در حیطه های مختلف شامل وضعیت وسیله آمبولانس، نحوه برخورد تکنسین ها، میزان حرفه ای بودن، عملکرد تکنسین ها، کارایی اورژانس و یک سوال درباره میزان رضایت کلی از خدمات اورژانس پیش بیمارستانی بود. در نهایت اطلاعات جمع آوری شده با استفاده از نرم افزار SPSS و آماره های توصیفی و تست های مناسب مورد تجزیه و تحلیل آماری قرار گرفتند. يافته ها: کل ماموریتهای انجام شده در این مقطع زمانی 12564 مورد بود. بیشترین ماموریتها متعلق به شهرستان اراک (65%) و کمترین آنها متعلق به شهرستان آشتیان (9/%) بود. تعداد 366 نفر در این مطالعه شرکت کردند. اکثر بیماران شرکت کننده در این مطالعه (59%) مرد بوده و بیشتر آنها (56%) مدرک تحصیلی زیر دیپلم داشتند. همچنین اکثر (52%) آنها سابقه بستری در بیمارستان نداشته و تعداد متاهل ها بیش از مجرد ها بوده است (71%). نمره کل رضایتمندی با جنس (001/0 > p)، وضعیت تاهل (001/0 > p)، سطح تحصیلات (001/0 > p)، محل زندگی (001/0 > p) و سابقه برخورد با اورژانس (015/0 = p) ارتباط دارد. بر این اساس زنان، متاهلین، افراد دارای سطح تحصیلات پایین تر و کسانی که دارای سابقه برخورد با اورژانس بودند، نمره رضایتمندی بیشتری را گزارش کرده بودند. میانگین نمره رضایتمندی  اورژانس دانشگاه علوم پزشکی اراک در قسمت اتومبیل آمبولانس5/14 ± 7/0، نحوه برخورد تکنسین ها با بیمار و همراهان 5/15±7/83، حرفه ای بودن تکنسین ها 15±4/83، عملکرد تکنسین ها 14 ± 7/82، کارایی اورژانس پیش بیمارستانی 4 ± 7/89 و در نهایت نظر کلی بیمار 14 ± 5/82 بود. نمره کلی رضایتمندی در شهرستانهای تابعه دانشگاه علوم پزشکی اراک دارای تفاوت معناداری بود (001/0 > p) . نتيجه گيری: نتایج مطالعه حاضر نشان داد میزان رضایتمندی بیماران از خدمات اورژانس پیش بیمارستانی در حد مطلوب می باشد که این میزان در زنان، متاهلین، افراد دارای تحصیلات پایین تر، بیماران ترومایی و در پایگاه های شهری بیشتر از سایرین بود. بیشترین میزان رضایتمندی مربوط به حیطه عملکرد حرفه ای و کمترین میزان مربوط به حیطه کارآیی تکنسین های بود.Introduction: One way of evaluating medical services is through assessment of patient satisfaction. Patient satisfaction is a concept that has become so important in medical care nowadays and is even more important in pre-hospital emergency. Therefore, the present study was carried out aiming to evaluate patient satisfaction from pre-hospital emergency services in cities under supervision of Arak University of Medical Sciences. Methods: In this cross-sectional study to evaluate patient satisfaction, a valid and reliable questionnaire of satisfaction scale from pre-hospital emergency care was used. The questionnaire consisted of 33 questions, 9 of which evaluated demographic data and the rest assessed satisfaction in various fields including condition of the ambulance, behavior, expertise and performance of the technicians, efficiency of care, and one question regarding the overall satisfaction with pre-hospital emergency care. Finally, gathered data were analyzed using SPSS and descriptive statistics and proper tests. Results: During the study period, 12564 missions were accomplished. The highest frequency belonged to Arak city (65%) and lowest frequency belonged to Ashtian city (9%). 366 patients participated in this study, most of which were male (59%) and had an education level less than high school diploma. In addition, most (52%) had no history of hospitalization and the number of those who were married was higher than singles (71%). The overall satisfaction score correlated with sex (p = ), marital status (p = ), education level (p = ), place of living (p = ), and history of using emergency services. Based on the results, women, those who were married, less educated people and those who had used emergency services before had reported a higher satisfaction rate. Mean satisfaction score from emergency service of Arak University of Medical Sciences was 0.7 ± 14.5 regarding condition of the ambulance, 83.7 ± 15.5 for technician behavior, 83.4 ± 15 for their expertise, 82.7 ± 14 for performance of the technicians, 89.7 ± 4 for efficiency of care, and the overall satisfaction score was 82.5 ± 14. The overall satisfaction score in cities under supervision of Arak University of Medical Sciences varied significantly (p < 0.001). Conclusion: The results of the present study showed that patient satisfaction rate from pre-hospital emergency service, was desirable. This rate was higher in women, married people, less educated people, trauma patients and in city bases compared to others. The highest satisfaction rate belonged to the professional performance and the lowest belonged to efficiency of technicians.

Evaluating the Timing of Emergency Department Services in Hospitals of Arak City

مقدمه: بخش اورژانس یکی از مهمترین بخش های بیمارستان است که عملکرد آن می تواند تاثیر فراوانی بر کارکرد سایر بخش ها و میزان رضایت مندی بیماران داشته باشد. لذا سرعت ارائه خدمات در بخش اورژانس جهت کاستن از مرگ و میر و معلولیت ها از اهمیت ویژه ای برخوردار است. بنابراین مطالعه حاضر با هدف بررسی زمان ارائه خدمات در دو بیمارستان آموزشی شهر اراک انجام شد. روش کار: در این پژوهش مقطعی، پژوهشگران با حضور در بیمارستان های مربوطه به مدت سه ماه در شیفت های کاری مختلف، زمان ورود بیماران به بخش تریاژ را ثبت کرده و با استفاده از چک لیست مربوطه زمان های مربوط به ویزیت پزشک، ارسال نمونه های آزمایش و دریافت جواب آنها، انجام رادیوگرافی و تعیین تکلیف بیماران را با استفاده از کرونومتر ثبت کردند. يافته ها: در مطالعه حاضر 200 بیمار با میانگین سنی 5/2±8/45 وارد مطالعه شدند (5/53 درصد مرد). نتایج مطالعه نشان داد متوسط زمان تریاژ تا ویزیت پزشک، 3/4±1/8 دقیقه، فاصله ویزیت تا اولین اقدام درمانی 3/2±7/8دقیقه، زمان درخواست آزمایش تا دریافت نتیجه 5/17±9/60 دقیقه، زمان درخواست تا دریافت نتیجه رادیوگرافی 1/18±4/55 دقیقه، فاصله درخواست تا انجام نوار قلب 3/2±4/5 دقیقه و میانگین مدت زمان حضور بیمار در بخش اورژانس 3/3±9/6 ساعت می باشد. نتيجه گيری: به نظر می رسد که زمان ارایه خدمات مورد بررسی در بخش اورژانس بیمارستان های مورد مطالعه، هرچند در بعضی موارد کمتر از سایر مطالعات مشابه می باشد، اما با استانداردهای جهانی فاصله دارد.Introduction: Emergency department (ED) is one of the most important wards in a hospital and its function can deeply affect the function of other wards and patient satisfaction. Therefore, the speed of providing services in ED is of great importance in order to decrease mortality and disabilities. Thus, the present study was done with the aim of evaluating timing of services in 2 teaching hospitals in Arak. Methods: In this cross-sectional study, researchers were present in the hospitals for 3 months in various working shifts and recorded the time of the patients’ presentation to triage unit. They also recorded the times of physician’s visit, sending samples to laboratory and receiving their results, radiography performance, and decision making in a checklist using a chronometer. Results: In the present study, 200 patients with the mean age of 45.8 ± 2.5 years participated (53.5% male). The findings of the study showed that mean time interval between triage and physician’s visit was 8.1 ± 4.3 minutes, time between visit and the first treatment measure was 8.7 ± 2.3 minutes, time between ordering a test and receiving results was 60.9 ± 17.5 minutes, time between ordering radiography and getting the results was 55.4 ± 18.1 minutes, time between ordering electrocardiography and getting the results was 5.4 ± 2.3 minutes and the patient’s length of stay in ED was 6.9 ± 3.3 hours. Conclusion: It seems that although the timing of providing the studied services is less than similar studies in some cases, it is still far from the international standards.

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial

Background: Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. Materials and Methods: A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. Results: There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05). Conclusions: Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Background: The global burden of lower respiratory infections (LRI) and corresponding risk factors in children older than five years and adults has not been studied as comprehensively as in children under five years old. We assessed the burden and trends of LRI and risk factors across all age groups by sex for 204 countries and territories. Methods: We used clinician-diagnosed pneumonia or bronchiolitis as our case definition for lower respiratory infections. We included ICD9 codes 073.0-073.6, 079.82, 466-469, 480-489, 513.0, and 770.0 and ICD10 codes A48.1, J09-J22, J85.1, P23-P23.9, and U04. We used the Cause of Death Ensemble modelling strategy to analyse 23,109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic review, population-based surveys, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Results: Globally, we estimated LRI episodes of 257 million (95% UI 240–275) for males and 232 million (217–248) for females in 2019. In the same year, LRI accounted for 1.3 million (1.2–1.4) deaths among males and 1.2 million (1.1–1.3) deaths among females. Age-standardised incidence and mortality rates were 1.2 times and 1.3 times greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups while an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older experiencing the highest increase in LRI episodes (126.0% [121.4–131.1]) and deaths (100.0% [83.4–115.9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for mortality among males under the age of five (70.7% [61.8–77.3]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths among males and females younger than five years were attributable to child wasting, and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution in 2019. For males aged 15–49, 50–69, and 70 years and older, 20.4 (15.4-25.2), 30.5% (24.1–36.9), and 21.9% (16.8–27.3), respectively, of estimated LRI deaths were attributable to smoking in the same year. For females aged 15–49 and 50–69 years, 21.1% (14.5–27.9) and 7.9% (5.5–10.5) of estimated LRI deaths were attributable to household air pollution in 2019. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11.7% (8.2–15.8) of LRI deaths in the same year.Interpretation: The patterns and progress in reducing the burden of LRI and key risk factors varied across age groups and sexes.. The progress seen in under five children was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to achieving multiple Sustainable Development Goals targets, including promoting well-being at all ages and reducing inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would mean preventable deaths and millions of lives saved, as well as reduced health disparities

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories : a systematic analysis for the global burden of disease study 2019

Abstract Importance: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. Objective: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. Evidence review: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. Findings: In 2019, 370 000 (95% uncertainty interval [UI], 338 000‐401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000‐180 000) cases and 114 000 (95% UI, 103 000‐126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0‐6.0 million) and 3.2 million (95% UI, 2.9‐3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%‐62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%‐21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%‐48.6%] and 40.2% [95% UI, 33.3%‐46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%‐33.8%]), driven by high risk-attributable burden in South and Southeast Asia. Conclusions and relevance: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Summary Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury