Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Clinical update : conservative management of carpometacarpal joint osteoarthritis [letter to the editor]

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Responsiveness of the bridge maneuvers in subjects with symptomatic lumbar spondylolisthesis: A prospective cohort study

Background and Purpose: To date no study was made on the responsiveness of Bridge tests (BTs) in subjects with low back pain and spondylolisthesis (SPL) submitted to a physical therapy program. The objective of this study is to examine the responsiveness of the BTs in subjects with symptomatic lumbar SPL. Methods: One hundred twenty patients with symptomatic SPL received physical therapy treatments for a number of sessions depending on the individual patient's needs. Each session included supervised exercises and the teaching of home exercises aiming to improve the lumbar stability, for about 1 hr in total. At the beginning and immediately after the last session of treatment, participants completed the Oswestry Disability Index - Italian version and the Pain Numerical Rating Scale, and performed the supine bridging (SBT) and the prone bridging (PBT). The global perception of effectiveness was measured with a seven-point Likert scale Global Perceived Effect questionnaire. Results: The mean post-treatment change score (95% confidence interval [CI]) was 18.2 s (14.5; 21.9) for the PBT and 43.9 s (35.1; 52.8) for the SBT, all p < .001. The area under the receiver operating characteristic curve for the PBT was 0.83 (95% CI 0.74-0.91) and for the SBT was 0.703 (95% CI 0.61-0.80). The optimal cutoff points were 19.5 s for the PBT and 62.5 s for the SBT. Logistic regression revealed that PBT (odds ratio = 0.952) was associated with the type of SPL. The final regression model explained 36.4% (R2 = 0.36; p = .001) of the variability. Discussion: Bridge maneuvers proved to be responsive, because their results were significantly related to pain and disability changes. BTs may be suggested to detect clinical changes after physical therapy treatment in symptomatic SPL

Finite element analysis and cadaveric cinematic analysis of fixation options for anteriorly implanted trabecular metal interbody cages

Purpose To assess, with finite element analysis and an in vitro biomechanical study in cadaver, whether the implementation of an anterior interbody cage made of hedrocel with nitinol shape memory staples in compression increases the stiffness of the stand-alone interbody cage and to compare these constructs' stiffness to other constructs common in clinical practice. Methods A biomechanical study with a finite element analysis and cadaveric testing assessed the stiffness of different fixation modes for the L4-L5 functional spinal unit: intact spine, destabilized spine with discectomy, posterior pedicle-screw fixation, anterior stand-alone interbody cage, anterior interbody cage with bilateral pedicle screws and anterior interbody cage with two shape memory staples in compression. These modalities of vertebral fixation were compared in four loading modes (flexion, extension, lateral bending, and axial rotation). Results The L4-L5 spinal unit with an anterior interbody cage and two stapleswas stiffer than the stand-alone cage. The construct stiffness was similar to that of a model of posterior pedicular stabilization. The stiffness was lower than that of the anterior cage plus bilateral pedicle-screw fixation. Conclusion The use of an anterior interbody implant with shape memory staples in compression may be an alternative to isolated posterior fixation and to anterior isolated implants, with increased stiffness.Berjano, P.; Francisco Blanco, J.; Rendon, D.; Villafane, JH.; Pescador, D.; Atienza Vicente, CM. (2015). Finite element analysis and cadaveric cinematic analysis of fixation options for anteriorly implanted trabecular metal interbody cages. European Spine Journal. 24:S918-S923. doi:10.1007/s00586-015-4277-3SS918S92324Cecchinato R, Berjano P, Damilano M, Lamartina C (2014) Spinal osteotomies to treat post-traumatic thoracolumbar deformity. Eur Spine J 24(Suppl 1):S31–S37Berjano P, Lamartina C (2014) Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J 23:1815–1824Berjano P, Lamartina C (2011) Minimally invasive lateral transpsoas approach with advanced neurophysiologic monitoring for lumbar interbody fusion. Eur Spine J 20:1584–1586Berjano P, Langella F, Damilano M, Pejrona M, Buric J, Ismael M et al (2015) Fusion rate following extreme lateral lumbar interbody fusion. Eur Spine J 24(Suppl 3):369–371Berjano P, Cecchinato R, Sinigaglia A, Damilano M, Ismael MF, Martini C et al (2015) Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J 24(Suppl 3):433–438Eysel P, Hopf C, Diop A, Lavaste F (1995) Multi-segment ventral stabilization of the lumbar spine: a comparative biomechanical study. Z Orthop Ihre Grenzgeb 133:242–248Oxland TR, Lund T (2009) Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9(Suppl 1):S95–S101Cecchinato R, Berjano P, Bassani R, Lamartina C (2015) Osteotomies in proximal junctional kyphosis in the cervicothoracic area. Eur Spine J 24(Suppl 1):S31–S37Gautschi OP, Garbossa D, Tessitore E, Langella F, Pecoraro MF, Marengo N et al (2015) Maximal access surgery for posterior lumbar inter body fusion (PLIF) with divergent, cortical bone trajectory (CBT) pedicle-screws: a good option for minimize spine access and maximize the field for nerve decompression. J Neurosurg Sci [Epub ahead of print]Goins ML, Wimberley DW, Yuan PS, Fitzhenry LN, Vaccaro AR (2005) Nucleus pulposus replacement: an emerging technology. Spine J 5:317S–324SDeb A, Majumder S, Roychowdhury A (2008) Biomechanical study of the lumbar spine with and without implant: a finite element approach. JJ Long Term Eff Med Implants 18:257–267Zhang QH, Teo EC (2008) Finite element application in implant research for treatment of lumbar degenerative disc disease. Med Eng Phys 30:1246–1256Buttermann GR, Kahmann RD, Lewis JL, Bradford DS (1991) An experimental method for measuring force on the spinal facet joint: description and application of the method. J Biomech Eng 113:375–386Goel VK, Lim TH, Gwon J, Chen JY, Winterbottom JM, Park JB et al (1991) Effects of stiffness of an internal fixation device. A comprehensive biomechanical investigation. Spine 16:S155–S161Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE (1998) Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Sci 16:766–770Nissan M, Gilad I (1986) Dimensions of human lumbar vertebrae in the sagittal plane. J Biomech 19:753–758Panjabi MM, Goel V, Oxland T, Takata K, Duranceau J, Krag M et al (1992) Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine 17:299–306Xu R, Burgar A, Ebraheim NA, Yeasting RA (1999) The quantitative anatomy of the laminas of the spine. Spine 24:107–113Lavaste F, Skalli W, Robin S, Roy-Camille R, Mazel C (1992) Three-dimensional geometrical and mechanical modelling of the lumbar spine. J Biomech 25:1153–1164Totoribe K, Tajima N, Chosa E (1999) A biomechanical study of posterolateral lumbar fusion using a three-dimensional nonlinear finite element method. J Orthop Sci 4:115–126Schleicher P, Gerlach R, Schar B, Cain CM, Achatz W, Pflugmacher R et al (2008) Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion. Eur Spine J 17:1757–1765Cecchinato R, Berjano P, Aguirre MF, Lamartina C (2015) Asymmetrical pedicle subtraction osteotomy in the lumbar spine in combined coronal and sagittal imbalance. Eur Spine J 24(Suppl 1):S66–S71Berjano P, Damilano M, Ismael M, Formica C, Garbosa D (2015) Minimally invasive PLIF with divergent, cortical trajectory pedicle screws. Eur Spine J 24(Suppl 5):S654–S655Kok D, Donk RD, Wapstra FH, Veldhuizen AG (2012) The memory metal minimal access cage: a new concept in lumbar interbody fusion-a prospective, noncomparative study to evaluate the safety and performance. Adv Orthop 2012:898606Kok D, Grevitt M, Wapstra F, Veldhuizen A (2012) The memory metal spinal system in a posterior lumbar interbody fusion (PLIF) procedure: a prospective, non-comparative study to evaluate the safety and performance. Open Orthop J 6:220–225Betz RR, Kim J, D’Andrea LP, Mulcahey MJ, Balsara RK, Clements DH (2003) An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety, and utility study. Spine 28:S255–S265Pejrona M, Berjano P, Cecchinato R, Casella A, Lamartina C (2014) Posterior surgery or lateral lumbar interbody fusion for degenerative deformity? Comparative data. 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Turk Neurosurg 21:296–303Formica M, Berjano P, Cavagnaro L, Zanirato A, Piazzolla A, Formica C (2014) Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23(Suppl 6):S684–S69

Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study

Purpose: To determine the impact of smartphone use on neck impairment and functional limitation in university students. Methods: A cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017. The inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18e30 years. Participants completed questionnaires that measured general characteristics of smartphone use and demographic characteristics. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); and cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device. Results: A total of 238 volunteers were recruited (22.4 ± 2.2 years of age, 53.4% males), 35.9% of whom were overweight (&gt;25 BMI). Regarding neck pain, 42.4% reported mild pain, 8.4% had moderate pain, and the remaining 49.2% had no pain. NDI-I and VAS were 3.8 ± 3.8 and 13.6 ± 18.4 mm, respectively. The pain categories did not influence the variables. No significant correlations were observed between the number of hours spent and posture (CROM) while using a smartphone and neck pain and NDI-I. Conclusion: While half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA