Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background: Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods: Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings: In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005). Interpretation: NCD-related mortality has substantially declined among adolescents in the EU between 1990 and 2019, but the rising trend of YLL attributed to mental disorders and their YLD burden are concerning. Differences by sex, age group, and across EU Member States highlight the importance of preventive interventions and scaling up adolescent-responsive health-care systems, which should prioritise specific needs by sex, age, and location. Funding: Bill & Melinda Gates Foundation

The effectiveness of surgery for adults with hallux valgus deformity: a systematic review protocol

Objective: To establish the effectiveness of surgery compared to conservatory management for adults with hallux valgus. Inclusion criteria: Types of participants: This review will include adults (18 years or older) with hallux valgus deformity, excluding adults with neurological problems causing foot deformities e.g. cerebral palsy, neuropathy, stroke, Multiple Sclerosis. Types of intervention(s)/phenomena of interest: The review will include any type of hallux valgus surgery compared to no surgery, conservative treatment (such as physical therapy, kinesio taping, orthosis, etc.) and comparison among different types of hallux valgus surgeries will also be included. Types of outcomes: The primary outcome: - gait measures: assessed by any validated assessment tool (such as biomechanical movement analysis, etc.). The secondary outcomes: - quality of life: assessed by any validated assessment tool (such as SF-36, etc.), - patient satisfaction using any validated assessment tool, - pain using any validated pain assessment tool (such as the Visual Analogue Scale, Verbal Rating Scale, McGill Pain Questionnaire, etc.), - adverse events. All the above outcomes measured at the following time points: short-term: 1 year after surgery.Jitka Klugarova, Victoria Hood, Fiona Bath-Hextall, Miloslav Klugar, Jana Mareckova, Zuzana Kelnarov

Nástroje hodnocení používané pro sebehodnoceni bolesti u pacienti po mozkové příhodě s komunikačními problémy: scoping review Nástroje hodnocení používané pro sebehodnoceni bolesti u pacienti po mozkové příhodě s komunikačními problémy: scoping review

Abstract Objective: The objective of this scoping review was to identify assessment instruments used for the self-report of pain by hospitalized patients who have had a stroke and who have communication problems. Introduction: Pain assessment in various patient groups has received considerable attention and a variety of pain assessment instruments exists. Nevertheless, there is a lack of consensus regarding which pain assessment instruments are used for self-report of pain in stroke patients with communication problems. Inclusion criteria: This review included articles that focused on hospitalized adults who have had a stroke, have communication problems attributable to a stroke, and describe the use of an assessment instrument for the self-report of pain. The scoping review considered systematic reviews, quantitative and qualitative studies, and mixed method studies. Methods: Ten databases were searched with a search limit of database inception to August 2020, using Embase as the key information source (it yielded 424 sources). Hand-searching of the references of the included articles yielded an additional 12 papers. Papers written in any language were considered. A data extraction table was created to record relevant information in line with the goals and results of each article, the sample studied, and the pain assessment instrument used. Results: Ten papers were included in the review, most of which were descriptive studies. Most papers were from the United Kingdom and the USA. The most common communication problem in stroke patients was aphasia. The participants received care in various hospital settings (eg, rehabilitation units, comprehensive stroke units, palliative care). Eleven different assessment instruments were identified. In most cases, the assessment instruments focused on assessing pain presence and pain intensity. The most frequently used unidimensional pain intensity instrument was the numerical rating scale. Four instruments were multidimensional, of which two assessed health-related quality of life, including pain. The most thorough pain assessment instrument was the ShoulderQ, which contains 10 verbal questions and three visual vertical graphic rating scales that focus on the assessment of stroke-related shoulder pain. Conclusions: A range of both unidimensional and multidimensional self-report pain instruments was identified; however, of all the possible communication problems, most studies focused solely on patients with mild to moderate aphasia. Therefore, further research is recommended, including studies that also enroll patients with various stroke-related communication problems other than aphasia. In addition, the instruments should be translated for research in non-Western countries. Finally, apart from descriptive studies, experimental research with a robust randomized control trial design is needed to examine the effect of pain-inducing procedures on the perceived pain in patients with stroke-related communication problems.Abstraktní Cíl: Cílem tohoto přehledu bylo identifikovat nástroje hodnocení používané pro self-report bolesti u hospitalizovaných pacientu, kteří prodělali cévní mozkovou příhodu a kteří mají problémy s komunikací. Úvod: Hodnocení bolesti u různých skupin pacientů je věnováno značné pozornosti a existuje řada nástrojů pro hodnocení bolesti. Přesto neexistuje shoda ohledně toho, jaké nástroje pro hodnocení bolesti se používají k vlastnímu hlášení bolesti u pacientů s cévní mozkovou příhodou s komunikačními problémy

Developing trustworthy recommendations as part of an urgent response (1-2 weeks): a GRADE concept paper

Objectives: The aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1-2 week) in the clinical, public health, and health systems fields. Study Design and Setting: We conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group. Results: A request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan. Conclusion: An urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest. (C) 2020 The Author(s). Published by Elsevier Inc

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding Bill & Melinda Gates Foundation

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% 47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% 32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% 27.9-42.8] and 33.3% 25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license