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

Language Sample Analysis in Children With Cleft Lip and Palate

Objectives: Cleft Palate (CP) with or without Cleft Lip (CL/P) are the most common craniofacial birth defects. Cleft Lip and Palate (CLP) can affect children’s communication skills. The present study aimed to evaluate language production skills concerning morphology and syntax (morphosyntactic) in children with CLP. Methods: In the current cross-sectional study, 58 Persian-speaking children (28 children with CLP & 30 children without craniofacial anomalies=non-clefts) participated. Gathering the language samples of the children was conducted using the picture description method. The 50 consecutive intelligible utterances of children were analyzed by the Persian Developmental Sentence Scoring (PDSS), as a clinical morphosyntactic measurement tool. Results: The PDSS total scores of children with CLP were lower than those of the non-clefts children. A significant difference was found between the studied children with CLP and children without craniofacial anomalies in the mean value of PDSS total scores (P=0.0001).  Discussion: Children with CLP demonstrate a poor ability for using morphosyntactic elements. Therefore, it should be considered how children with CLP use the grammatical components

The Relationship Between Acoustic Characteristics and Personality Dimensions in Patients With Dysphonia

Objectives: Voice is influenced by personality. However, it is still questionable which acoustic features are influenced by personality traits. This study aimed to investigate the relationship between acoustic characteristics and personality dimensions. Methods: Thirty-three participants with dysphonia and 33 participants without dysphonia were recruited to take part in this cross-sectional study. Personality dimensions were evaluated by the revised NEO personality inventory, and acoustic characteristics by using the Praat software. The tasks included prolongation of the vowel /a/, expression of declarative and interrogative sentences, reading, and connected speech. The acoustic features included fundamental frequency range, jitter, shimmer, harmonic-to-noise ratio, intensity, and duration. SPSS V. 23 was used for statistical analysis. For correlation analysis, the Pearson and Spearman correlation coefficients were employed. Results: In individuals with dysphonia, a significant relationship was observed between personality dimensions and the following acoustic features: A. extraversion and intensity in connected speech (P=0.045) and the reading task (P=0.036); B. openness and shimmer in /a/ vowel prolongation (P=0.003); C. openness and the harmonic-to-noise ratio in /a/ the vowel prolongation task (P=0.017); and D. agreeableness and duration in expressing interrogative sentences (P=0.019). Discussion: In Persian-speaking participants with and without dysphonia, some acoustic characteristics were significantly correlated with the mean score of the personality test (revised NEO personality inventory). It seems that each voice feature is influenced by personality dimensions. This finding indicates that changes in acoustic characteristics of voice due to personality can be evaluated in laboratory and hearing examinations

Syntax Comprehension in 4-6 Year Old Foster Children

Background & Objectives: The educational environment and family are of the most important factors in the growth and development of linguistic and verbal skills of a child. Certain conditions such as environment can influence the linguistic characteristics of the child. This study aimed to examine the syntax comprehension of Persian language speaking children among foster families and typically-developing children.  Methods: 72 Persian speaking children living in orphanages between the ages 4 to 6 and 75 typically-developing 4 to 6 year-old children were assessed by the Persian syntax comprehension test. This test measures 24 syntactic constructs of Persian language in 96 items. Also, the Mann-Whitney Test was used to compare the groups.  Results: Given the results of the Persian syntax comprehension test, the mean syntax compression score of children living in orphanages were significantly lower than those of typically-developing children (P<0.05).  Conclusion:The foster children should be more paid attention to, in order to particularly enhance their syntax comprehension

Family history of the cancer on the survival of the patients with gastrointestinal cancer in northern Iran, using frailty models

Abstract Background Gastrointestinal (GI) tract cancer is one of the common causes of the mortality due to cancer in most developing countries such as Iran. The digestive tract is the major organ involved in the cancer. The northern part of the country, surrounded the Caspian Sea coast, is well known and the region with highest regional incidence of the GI tract cancer. In this paper our aim is to study the most common risk factors affecting the survival of the patients suffering from GI tract cancer using parametric models with frailty. Methods This research was a prospective study. Information of 484 cases with GI cancer was collected from Babol Cancer Registration Center during 1990-1991. The risk factors we studied are age, sex, family history of cancer, marital status, smoking status, occupation, race, medication status, education, residence (urban, rural), type of cancer, migration status (indigenous, non-native). The studied cases were followed up until 2006 for 15 years. Hazard ratio was used to interpret the death risk. The effect of the factors in the study on the patients survival are studied under a family of parametric models including Weibull, Exponential, Log-normal, and the Log-logistic model. The models are fitted using with and without frailty. The Akaike information criterion (AIC) was considered to compare between competing models. Results Out of 484 patients in the study, 321 (66.3%) were males and 163 (33.7%) were females. The average age of the patient at the time of the diagnosis was 59 yr and 55 yr for the males and females respectively. Furthermore, 359 (74.2%) patients suffered from esophageal, 110 (22.7%) patients recognized with gastric, and 15 (3.1%) patients with colon cancer. Survival rates after 1, 3, and 5 years of the diagnosis were 24%, 16%, and 15%, respectively. We found that the family history of the cancer is a significant factor on the death risk under all statistical models in the study. The comparison of AIC using the Cox and parametric models showed that the overall fitting was improved under parametric models (with and without frailty). Among parametric models, we found better performance for the log-logistic model with gamma frailty than the others. Using this model, gender and the family history of the cancer were found as significant predictors. Conclusions Results suggested that the early preventative care for patients with family history of the cancer may decrease the risk of the death in the patients with GI cancer. The gender appeared to be an important factor as well so that men experiencing lower risk of death than the women in the study. Since the proportionality assumption of the Cox model was not held (p = 0.0014), the Cox regression model was not an appropriate choice for analysing our data.</p

Smoothing Transition from High School to Medical School Through E-Learning Module

Background: Numerous medical students feel that they are not ready to study medicine at the beginning of entering university. One way to reduce the challenges of entering the university is to provide opportunities to familiarize students with the university. Objectives: This study was conducted to design an educational e-learning module for freshman medical students to help a successful transition to university life. Methods: This study was a single-group study with a post-test design at Tehran University of Medical Sciences, Tehran, Iran, within 2018-2019. The transitional e-learning module included content regarding academic integration, social integration, and information integration.The e-learning module for new medical students was implemented as a 20-day course at the beginning of their attendance at the university. After the students completed the e-Learning course or module, a questionnaire was completed to assess students’ attitudes toward the quality of the transitional e-learning module. The data were analyzed using SPSS software (version 22.0). Results: Out of 209 questionnaires, 135 questionnaires were returned. The findings showed that more than 65% of the students believed that the program could prepare them for academic integration into the institution. In total, the highest (8.62±1.15) and lowest (7.07±2.39) scores belonged to the "information integration” and “social integration” sections, respectively. Conclusion: The e-learning module was implemented to provide students with practical support to adapt to the university. The survey findings showed that it helped freshman medical students prepare for academic and information integration into the university. Keywords: Curriculum, Medical Education, Virtual, Transitio