Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Modern approach to numerical modelling of anchored protective structures

radu je opisan suvremeni pristup numeričkom modeliranju sidrenih zaštitnih konstrukcija s osvrtom na iskustva u primjeni računalnog programa Plaxis 2D i modela tla s izotropnim očvršćivanjem. Objašnjena su osnovna obilježja u ponašanju tla u dreniranim i nedreniranim uvjetima za naprezanja koja se pojavljuju pri iskopu građevne jame. Prikazan je primjer simulacije sidrene zaštitne konstrukcije i dane su smjernice za strategiju odabira parametara materijala HSs modela tla.modern approach to numerical modelling of anchored protective structures is presented in the paper, and an overview is given of experience gained in the use of the Plaxis 2D computer program, and soil model with isotropic strengthening. Basic properties of soil in drained and undrained conditions, due to stress occurring during foundation pit excavation, are explained. An example involving simulation of an anchored protective structure is presented, and guidelines for the selection of soil materials for the HSs soil model are given

Studi Sistem Pengelolaan PLTS 15 kW Stand Alone Dengan Metode Kano Di Dusun Yeh Mampeh Kabupaten Bangli

Management of PLTS 15 kW stand alone at Yeh mampeh village, bangli regency implemented for PLTS can be utilized optimally and sustainable. Sistem management referring to the results of PLTS component with life time of that and results of the questionnaire. Questionnaire were taken by using Kano Method with 50respondent. Kano categoryused in this study are one dimensional, attractive, must be, indiferent, reverse. This method produces the desired management system of PLTS customers are workers will work twince in one week to four hours every day working with two workers, each employee is given a saary of Rp.300.000, PLTS depreciation is Rp. 3.896.000, with the expected quantity of PLTS customer 150th , so the contribution of each customer every mount is Rp. 28.000. If this sistem can be running by society of Yeh Mampeh Village, then PLTS will be utilized optimally and sustainable

Analisis Rugi Daya Pada Penyulang Bangli Dengan Beroperasinya PLTS Kayubihi

Analisis rugi daya pada Penyulang Bangli dilakukan untuk mengetahui perbanding an rugi daya pada jaringan distribusi setelah penempatan pembangkit tersebar jenis PLTS berkapasitas 1 MWp. Lokasi penempatan PLTS ditentukan berdasarkan analisis sensitivitas bus. Nilai sensitivitas bus(?)didapat dengan cara membandingkan nilai rugi daya pada sistem dengan total beban yang terhubung pada bus. Penelitian ini menggunakan simulasi aliran daya dengan metode aliran daya Newton-Raphson. Hasil penelitian menunjukkan bus TK 0041 memiliki sensitivitas terbesar dengan nilai ?= 0,178. Dari hasil simulasi aliran daya, penempatan PLTS 1MWp pada lokasi alternatif 1 menghasilkan rugi daya minimum pada Penyulang Bangli yaitu 103,1 kW atau 3,3% dari total suplai daya 3071 kW. Pemasangan PLTS dapat menurunkan rugi daya pada Penyulang Bangli sebesar 57 kW dari total rugi daya pada kondisi tanpa PLTS yaitu 160,1 kW. Bila dibandingkan dengan kondisi eksisting, penem patan PLTS pada lokasi alternatif 1 memiliki selisih rugi daya 7,3 kW lebih kecil dari total rugi daya yang dihasilkan kondisi eksisting sebesar 110,4kW

Sistem Informasi Edukasi Pengenalan Budaya dan Tempat Wisata di Kabupaten Tojo Una-Una Berbasis Android

Pesatnya perkembangan teknologi di era sekarang ini memberikan banyak dampak besar bagi kehidupan manusia, terutama ingin mendapatkan informasi secara cepat dan instan. Perkembangan teknologi saat ini sangat dibutuhkan, apalagi dibidang Budaya dan Parawisata. Karena di era sekarang ini banyak orang yang masih awam dengan budayanya sendiri apalagi wisatawan yang berlibur dan bukan hanya sekedar berlibur, tapi mereka juga ingin mengenal budaya ditempat yang mereka singgahi. Sekarang pun mencari informasi budaya masih sangat sulit. Mereka kadang mendapatkan informasi budaya hanya dari Buku, Sosmed dan lain lain. Berangkat dari pemasalahan di atas, maka penulis mengusulkan sebuah Sistem. Aplikasi Edukasi versi Android ini tujuannya untuk mempermudah wisatawan dan masyarakat untuk menggalih informasi budaya. Aplikasi ini juga akan menampilkan Edukasi seperti kamus bahasa yang ada di Kabupaten tersebut. Metode penelitian menggunakan metode Research and Developmen, sumber data yang digunakan adalah data-data primer dan sekunder dengan metode pengumpulan data melalui observasi dan interview. Dalam merancang aplikasi ini menggunakan bahasa UML (Unified Modelling Language) dan diimplementasikan dengan menggunakan bahasa pemrograman DART, Web service dan database MySQL. Pengujian yang digunakan adalah whitebox dan blackbox. Hasil pengujian whitebox pada salah satu proses dalam sistem ini yaitu pada modul penginputan tempat wisata dengan perolehan hasil yang seimbang yaitu Cyclomatic Complexity (CC) = 3, maka sistem ini dinyatakan dapat berjalan dengan baik. Sedangkan hasil pengujian blackbox dengan beberapa sampel pengujian menghasilkan sistem dapat berjalan sesuai dengan yang diharapkan dan efisien sesuai dengan tujuan dari penelitian ini