The Global Burden Attributable to Low Bone Mineral Density

[spa] INTRODUCCIÓN: En la iniciativa The Global Burden of Disease Study 2010, la densidad mineral ósea (DMO) ha sido analizada como un factor de riesgo de fracturas, las cuales son analizadas como parte de la carga en salud atribuida a las caídas. Las medidas métricas principales para determinar la carga en salud de dicha iniciativa son los Disability-Adjusted Life Years (DALYs), los Years lived with disability (YLDs), los Years of Life Lost due to premature mortality (YLLs), y las Muertes. OBJETIVOS: Calcular la distribución mundial de los valores de DMO; calcular el número de DALYs, YLDs, YLLs y muertes debidos a la baja DMO. MÉTODOS: Se realizó una revisión sistémica de estudios poblacionales con valores de DMO medidos con Dual-X-Ray-Absorptiometry en cuello femoral en población a partir de 50 años. Se utilizó análisis de riesgo comparativo para determinar la fracción poblacional atribuible de la DMO para caídas. El percentil 90 por grupo de edad y género del estudio americano NHANESIII se adquirió como la distribución de mínimo riesgo posible del factor de exposición. Los riesgos relativos DMO-fractura se obtuvieron de una meta-análisis previa. Datos hospitalarios con doble codificación (causa y tipo de lesión) se utilizaron para calcular la fracción de la carga en salud de las caídas debido a las fracturas. RESULTADOS: Las muertes y los DALYs mundiales atribuibles a la baja DMO incrementaron de 103.000 y 3.125.000 en 1990 a 188.000 y 5.216.000 en 2010, respectivamente. Un tercio de todas las muertes relacionadas con caídas fueron atribuibles a la baja DMO. La DMO fue responsable de un 12.1% y un 14.8% de todos los DALYs por caídas en 1990 y 2010, respectivamente. El Asia Sur y Asia Este fueron las regiones del mundo que más contribuyeron al aumento de la carga mundial en salud atribuible a la baja DMO. CONCLUSIÓN: Los resultados muestran un aumento de la carga en salud mundial debido a la bajo DMO entre 1990 y 2010. Una séptima parte de los DALYs y un tercio de las muertes en el mundo debido a caídas fueron atribuibles a la baja DMO, y por lo tanto, prevenibles.[eng] INTRODUCTION: Osteoporosis and osteoporotic fractures represent an enormous health burden and economic cost for most societies in the world, and future projections forecast their steady increase over the next few decades. Strategies to detect and treat those individuals with high risk of fracture have proved to be cost-effective, but still an important lack of awareness exists among health professionals and institutions. Low bone mineral density (BMD) is one of the factors better correlated with fracture risk. The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors. The main metrics for the burden measurements were the Disability-Adjusted Life Years (DALYs), the Years lived with disability (YLDs), the Years of Life Lost due to premature mortality (YLLs) and Deaths. For the first time, BMD was analysed as a risk factor for fractures, which formed part of the health burden due to falls. Risk analysis followed the Comparative Risk Assessment (CRA) methodology to determine which proportion of the falls burden was attributable to low BMD. OBJECTIVES: To calculate the global distribution of BMD, its population attributable fraction (PAF) for falls, and the number of DALYs, YLDs, YLLs and deaths due to low BMD, with estimates for each region, age group, sex and time period (1990 and 2010). METHODS: Systematic review was performed seeking population-based studies with BMD measured by Dual-X-Ray-Absorptiometry at femoral neck in people 50 years and over. Age- and sex- specific levels of mean BMD+/-SD (g/cm2) were extracted from eligible studies. For the CRA methodology to calculate PAFs of BMD for fractures, the theoretical minimum risk factor exposure distribution was estimated as the age and sex-specific 90th percentile from NHANES III. Relative risks for fractures were obtained from a previous meta-analysis. Hospital data with double coding (cause and nature of injury) was used to calculate the fraction of the health burden of falls due to fractures. RESULTS: Global deaths and DALYs attributable to low BMD increased from 103,000 and 3,125,000 in 1990 to 188,000 and 5,216,000 in 2010 respectively. The contribution to the total DALYs was slightly superior for YLLs compared to YLDs. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). In population 70 years old and over these percentages increased from 0.64% in 1990 to 0.79% in 2010. Around one third of all falls-related deaths were attributable to low BMD, with slight increase between 1990 and 2010. Low BMD was responsible for 12.1% and 14.8% of all global DALYs due to falls in 1990 and 2010, respectively. Males showed more contribution to the global deaths and DALYs, with a higher increase over time, compared to females. Asia South and Asia East were the world regions contributing the most in the increase of the global burden attributable to low BMD over time. The greatest proportion of DALYs within the regional burden was found in Europe Western, Europe Central and Asia Pacific-High Income. Low BMD was the eight risk factor with the highest number of global YLDs in population 80 years and over. CONCLUSION: Results showed an increase of the burden attributable to low BMD worldwide from 1990 to 2010, greatly influenced by the ageing of the population. A significant fraction of all falls-related deaths and health burden in the world was attributable to low BMD and, therefore, preventable. Data systems should improve in the detection of injuries potentially related to low BMD and osteoporosis in general. This information can be used by health institutions and authorities to identify priorities and allocate resources

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

Memory improvement in the AβPP/PS1 mouse model of familial Alzheimer's disease induced by carbamylated-erythropoietin is accompanied by modulation of synaptic genes

Neuroprotection of erythropoietin (EPO) following long-term administration is hampered by the associated undesirable effects on hematopoiesis and body weight. For this reason, we tested carbamylated-EPO (CEPO), which has no effect on erythropoiesis, and compared it with EPO in the AβPP/PS1 mouse model of familial Alzheimer's disease. Groups of 5-month-old wild type (WT) and transgenic mice received chronic treatment consisting of CEPO (2,500 or 5,000 UI/kg) or EPO (2,500 UI/kg) 3 days/week for 4 weeks. Memory at the end of treatment was assessed with the object recognition test. Microarray analysis and quantitative-PCR were used for gene expression studies. No alterations in erythropoiesis were observed in CEPO-treated WT and AβPP/PS1 transgenic mice. EPO and CEPO improved memory in AβPP/PS1 animals. However, only EPO decreased amyloid-β (Aβ) plaque burden and soluble Aβ40. Microarray analysis of gene expression revealed a limited number of common genes modulated by EPO and CEPO. CEPO but not EPO significantly increased gene expression of dopamine receptors 1 and 2, and adenosine receptor 2a, and significantly down-regulated adrenergic receptor α1D and gastrin releasing peptide. CEPO treatment resulted in higher protein levels of dopamine receptors 1 and 2 in WT and AβPP/PS1 animals, whereas the adenosine receptor 2a was reduced in WT animals. The present results suggest that the improved behavior observed in AβPP/PS1 transgenic mice after CEPO treatment may be mediated, at least in part, by the observed modulation of the expression of molecules involved in neurotransmission

The burden of disease in Spain: results from the global burden of disease study 2010

BackgroundWe herein evaluate the Spanish population¿s trends in health burden by comparing results of two Global Burden of Diseases, Injuries, and Risk Factors Studies (the GBD studies) performed 20 years apart.MethodsData is part of the GBD study for 1990 and 2010. We present results for mortality, years of life lost (YLLs), years lived with disability, and disability-adjusted life years (DALYs) for the Spanish population. Uncertainty intervals for all measures have been estimated.ResultsNon-communicable diseases accounted for 3,703,400 (95% CI 3,648,270¿3,766,720) (91.3%) of 4,057,400 total deaths, in the Spanish population. Cardiovascular and circulatory diseases were the main cause of mortality among non-communicable diseases (34.7% of total deaths), followed by neoplasms (27.1% of total deaths). Neoplasms, cardiovascular and circulatory diseases, and chronic respiratory diseases were the top three leading causes for YLLs. The most important causes of DALYs in 2010 were neoplasms, cardiovascular and circulatory diseases, musculoskeletal disorders, and mental and behavioral disorders.ConclusionsMortality and disability in Spain have become even more linked to non-communicable diseases over the last years, following the worldwide trends. Cardiovascular and circulatory diseases, neoplasms, mental and behavioral disorders, and neurological disorders are the leading causes of mortality and disability. Specific focus is needed from health care providers and policy makers to develop health promotion and health education programs directed towards non-communicable disorders

The global burden attributable to low bone mineral density

Introduction: The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors by calculating disability-adjusted life years (DALYs). Osteoporosis was not considered as a disease, and bone mineral density (BMD) was analysed as a risk factor for fractures, which formed part of the health burden due to falls. Objectives: To calculate (1) the global distribution of BMD, (2) its population attributable fraction (PAF) for fractures and subsequently for falls, and (3) the number of DALYs due to BMD. Methods: A systematic review was performed seeking population-based studies in which BMD was measured by dual-energy X-ray absorptiometry at the femoral neck in people aged 50 years and over. Age- and sex-specific mean ± SD BMD values (g/cm2) were extracted from eligible studies. Comparative risk assessment methodology was used to calculate PAFs of BMD for fractures. The theoretical minimum risk exposure distribution was estimated as the age- and sex-specific 90th centile from the Third National Health and Nutrition Examination Survey (NHANES III). Relative risks of fractures were obtained from a previous meta-analysis. Hospital data were used to calculate the fraction of the health burden of falls that was due to fractures. Results: Global deaths and DALYs attributable to low BMD increased from 103 000 and 3 125 000 in 1990 to 188 000 and 5 216 000 in 2010, respectively. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). Around one-third of falls-related deaths were attributable to low BMD. Conclusions: Low BMD is responsible for a growing global health burden, only partially representative of the real burden of osteoporosis

Una aproximación a los procesos de radicalización y extremismo violento (PREDEIN)

El ciclo PREDEIN (Prevención, Detección e Intervención) en los procesos de radicalización y extremismo violento se celebró entre octubre de 2019 y 2020. Fue uno de los proyectos seleccionados en la cuarta convocatoria del Palau Macaya "La Caixa", dedicados a la reflexión y diálogo de propuestas relacionadas con la divulgación, la innovación social y el debate sobre los retos de nuestras sociedades. El proyecto PREDEIN, pretende ser un riguroso espacio de intercambio, trabajo y reflexión entre profesionales, académicos, gestores de políticas públicas y sociedad civil en los ámbitos de la prevención, detección e intervención de los procesos que conducen a la radicalización y extremismo violento