37 research outputs found
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data through updated systematic reviews and through the contribution of unpublished data sources from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 specifi cally.
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 disabilityadjusted
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 aff ecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure aff ected 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 fi ndings,
we call for increased investment in health in the region in addition to reducing the confl icts
Epigenetic modification with trichostatin A does not correct specific errors of somatic cell nuclear transfer at the transcriptomic level; highlighting the non-random nature of oocyte-mediated reprogramming errors
Pre- and post- implantation development. Effect of TSA treatment on in vitro and in vivo development of cloned embryos compared to fertilized counterparts. (DOCX 18Â kb
Acute symptoms related to air pollution in urban areas: a study protocol
BACKGROUND: The harmful effects of urban air pollution on general population in terms of annoying symptoms are not adequately evaluated. This is in contrast to the hospital admissions and short term mortality. The present study protocol is designed to assess the association between the level of exposure to certain ambient air pollutants and a wide range of relevant symptoms. Awareness of the impact of pollution on the population at large will make our estimates of the pertinent covert burden imposed on the society more accurate. METHODS/DESIGN: A cross sectional study with spatial analysis for the addresses of the participants was conducted. Data were collected via telephone interviews administered to a representative sample of civilians over age four in the city. Households were selected using random digit dialling procedures and randomization within each household was also performed to select the person to be interviewed. Levels of exposure are quantified by extrapolating the addresses of the study population over the air pollution matrix of the city at the time of the interview and also for different lag times. This information system uses the data from multiple air pollution monitoring stations in conjunction with meteorological data. General linear models are applied for statistical analysis. DISCUSSION: The important limitations of cross-sectional studies on acute effects of air pollution are personal confounders and measurement error for exposure. A wide range of confounders in this study are controlled for in the statistical analysis. Exposure error may be minimised by employing a validated geographical information system that provides accurate estimates and getting detailed information on locations of individual participants during the day. The widespread operation of open air conditioning systems in the target urban area which brings about excellent mixing of the outdoor and indoor air increases the validity of outdoor pollutants levels that are taken as exposure levels
Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015
Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe
Rational Development of A Polycistronic Plasmid with A CpG-Free Bacterial Backbone as A Potential Tool for Direct Reprogramming
Objective: Induced pluripotent stem cells are generated from somatic cells by direct reprogramming.
These reprogrammed pluripotent cells have different applications in biomedical
fields such as regenerative medicine. Although viral vectors are widely used for
efficient reprogramming, they have limited applications in the clinic due to the risk for
immunogenicity and insertional mutagenesis. Accordingly, we designed and developed a
small, non-integrating plasmid named pLENSO/Zeo as a 2A-mediated polycistronic expression
vector.
Materials and Methods: In this experimental study, we developed a single plasmid which
includes a single expression cassette containing open reading frames of human LIN28,
NANOG, SOX2 and OCT4 along with an EGFP reporter gene. Each reprogramming factor
is separated by an intervening sequence that encodes a 2A self-processing peptide.
The reprogramming cassette is located downstream of a CMV promoter. The vector is
easily propagated in the E. coli GT115 strain through a CpG-depleted vector backbone.
We evaluated the stability of the constructed vector bioinformatically, and its ability to stoichiometric
expression of the reprogramming factors using quantitative molecular methods
analysis after transient transfection into HEK293 cells.
Results: In the present study, we developed a nonviral episomal vector named pLENSO/
Zeo. Our results demonstrated the general structural stability of the plasmid DNA. This
relatively small vector showed concomitant, high-level expression of the four reprogramming
factors with similar titers, which are considered as the critical parameters for efficient
and consistent reprogramming.
Conclusion: According to our experimental results, this stable extrachromosomal plasmid
expresses reliable amounts of four reprogramming factors simultaneously. Consequently,
these promising results encouraged us to evaluate the capability of pLENSO/Zeo
as a simple and feasible tool for generation of induced pluripotent stem cells from primary
cells in the future
Attenuating Effect of Portulaca oleracea Extract on Chronic Constriction Injury Induced Neuropathic Pain in Rats: An Evidence of Anti-oxidative and Anti-inflammatory Effects
Background: Neuropathic pain responds poorly to drug treatments. The present study investigated the therapeutic effect of Portulaca oleracea, in chronic constriction injury (CCI)-induced neuropathic pain in rats. Objective & Methods: Neuropathic pain was performed by putting four loose ligatures around the sciatic nerve. CCI resulted in the development of heat hyperalgesia, mechanical allodynia and cold allodynia accompanied by an increase in the contents of TNF-α, IL1β, malondialdehyde, with a reduction in total thiol content. Results: Administration of Portulaca oleracea (100 and 200 mg/kg intraperitoneal) for 14 days in CCI rats significantly alleviated pain-related behaviors, oxidative damage and inflammatory cytokines in a dose-dependent manner. Conclusion: In conclusion, it is suggested that the antinociceptive effects of Portulaca oleracea might be due to antioxidant and anti-inflammatory properties