Application of environment capability theory in formulation of qualitative parameters in designing educational spaces

This research identifies and classifies environment capabilities by reviewing environmental psychology as well as analyzing and defining environments based on different theories. Identifying and applying these capabilities in designing ideal and high quality educational environments in terms of structure leads to a deliberate and thoughtful architecture. To briefly explain the concept of capability, it can be said that environment capabilities are the physical configuration belongings of a behavioral object or place that makes it usable for certain activities. Some demands are met by an environment or object, live or cultural, easier than others; some activities which are formed in a specific configuration of environment meet some people needs and do not others. The important thing is that the capabilities of a physical environment, whether good or bad, is what the environment suggests with its configuration characteristics and materials it is made of. It seems that the quality of an object can be defined as "a set of specific characteristics or traits which distinguish one object from others and enable us to judge about superiority, similarity or inferiority of something in comparison to something else, and from esthetical aspect judge and give a verdict about being ugly or beautiful, good or bad, as well as its goodness or badness and efficiency or inefficiency with regard to functionality. In this article, by studying environment elements and capabilities and reviewing some qualitative elements and parameters in designing educational spaces and urban environments, we attained two generalized models for environmental capabilities and qualitative parameters in designing educational spaces. Finally, in the first model, two series of indicators were categorized in form of a single model including principal environment capabilities and environment physical capabilities. In the second model, qualitative parameters of environment design are divided into superficial, real and mental components and according to the obtained results, the environment receives mental qualities from environment only if the capacity components are considered in designing correctly and with high quality

Application of environment capability theory in formulation of qualitative parameters in designing educational spaces

This research identifies and classifies environment capabilities by reviewing environmental psychology as well as analyzing and defining environments based on different theories. Identifying and applying these capabilities in designing ideal and high quality educational environments in terms of structure leads to a deliberate and thoughtful architecture. To briefly explain the concept of capability, it can be said that environment capabilities are the physical configuration belongings of a behavioral object or place that makes it usable for certain activities. Some demands are met by an environment or object, live or cultural, easier than others; some activities which are formed in a specific configuration of environment meet some people needs and do not others. The important thing is that the capabilities of a physical environment, whether good or bad, is what the environment suggests with its configuration characteristics and materials it is made of. It seems that the quality of an object can be defined as "a set of specific characteristics or traits which distinguish one object from others and enable us to judge about superiority, similarity or inferiority of something in comparison to something else, and from esthetical aspect judge and give a verdict about being ugly or beautiful, good or bad, as well as its goodness or badness and efficiency or inefficiency with regard to functionality. In this article, by studying environment elements and capabilities and reviewing some qualitative elements and parameters in designing educational spaces and urban environments, we attained two generalized models for environmental capabilities and qualitative parameters in designing educational spaces. Finally, in the first model, two series of indicators were categorized in form of a single model including principal environment capabilities and environment physical capabilities. In the second model, qualitative parameters of environment design are divided into superficial, real and mental components and according to the obtained results, the environment receives mental qualities from environment only if the capacity components are considered in designing correctly and with high quality

DNA damage and repair proteins in cellular response to sulfur mustard in Iranian veterans more than two decades after exposure

Delayed effects of sulfur mustard (SM) exposure on the levels of five important damage/repair proteins were investigated in 40 SM-exposed veterans of Iran-Iraq war and 35 unexposed controls. A major DNA damage biomarker protein – phosphorylated H2AX – along with four DNA repair proteins in cell response to the genome damage MRE11, NBS1, RAD51, and XPA were evaluated in blood lymphocytes from the veterans and controls using western blotting. Mean levels of XPA, MRE11, RAD51 and NBS1 were lower in SM-exposed patients and the decrease in NBS1 was significant. Even though the raised level of phosphor-H2AX in SM-poisoned group compared to the controls was not significant it was consistent with DNA damage findings confirming the severity of damage to the DNA after exposure to SM. There were correlations between the values of RAD51 and NBS1 proteins as well as XPA and MRE11 proteins. More than two decades after exposure to SM, there is still evidences of DNA damage as well as impaired repair mechanisms in cells of exposed individuals. Such disorders in cellular level may contribute to long term health problems of the SM veterans

Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees

How to Cite This Article: Poor Zamany Nejat Kermany M, Modirian E, Soroush M, Masoumi M, Hosseini M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) Among Young Landmine Amputees. Iran J Child Neurol. Summer 2016; 10(3):42-47. AbstractObjectiveTo determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.Materials & MethodsAll youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.ResultsThere were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.ConclusionPhantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation. References Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth 2001; 87:107-16.Tseng CC, Chen PY, Lee YC. Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med 2014;32(4):356-8.Davis RW. Phantom sensation, phantom pain, and stump pain. Arch Phys Med Rehabil 1993;74:79–91.Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983;17(3):243–256.Gupta R. FRCA, FFPMRCA, EDRA. Pain Management. Phantom Pain Syndromes. 2014, pp 71-74.Davidson JH, Khor KE, Jones LE. A cross-sectionalstudy of post-amputation pain in upper and lower limb amputees,experience of a tertiary referral amputee clinic. Disabil Rehabil 2010;32(22):1855-62.Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning inpersons with limb loss. J Pain. 2010; 11(1): 79–86.Anwar F. Phantom limb: Review of literature. KMUJ. 2013; 5(4): 207-12.Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005; 86(10):1910-19.Husum H, Resell K, Vorren G,Heng YV, Murad M, Gilbert M, et al. Chronic pain in land mine accident survivors in Cambodia and Kurdistan. SocSci Med 2002; 55(10):1813-6.Wartan SW, Hamann W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997; 78(6):652-9.Krane EJ, Heller LB. The prevalence of phantom sensation and pain in pediatric amputees. J Pain Symptom Manage 1995; 10(1): 21-9.Wilkins KL, McGrath PJ, Finley GA, Katz J. Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998; 78(1): 7–12.Mariane L. Simmel. Phantom experiences following amputation in childhood. J Neurol Neurosurg Psychiat 1962; 25(1): 69-78.Mohammadi Seilabipour N, Mohammadi Fallah S, Kazemi H, Shariat SV. Phantom limb correlates among amputee war veterans. Adv Cognitive Sci 2013; 15(2): 32-9.Modirian E, Shojaei H, Soroush MR, Masoumi M. Phantom pain in bilateral upper limb amputation. DisabilRehabil 2009; 31(22): 1878-81.Explosive remnants of war-Unicef. http://www.unicef. org/sowc2013/focus_war_remnants.htmlRayegani SM, Aryanmehr A, Soroosh MR, Baghbani M. Phantom Pain, Phantom Sensation, and Spine Pain in Bilateral Lower Limb Amputees: Results of a National Survey of Iraq-Iran War Victims’ Health Status. JPO 2010; 22(3): 162-165.Subedi B, GrossbergGT. PhantomLimbPain:Mechanisms and Treatment Approaches. Pain Res Treat 2011, Article ID 864605, 8 pages.Laura L. Burgoyne, Catherine A. Billups, José L. JirónJr, Roland N. Kaddoum, Becky B. Wright, George B. Bikhazi, et al. Phantom limb pain in young cancer-related amputees: Recent experience at St. Jude Children’s Research Hospital. Clin J Pain 2012; 28(3): 222–5.Sin EI, Thong SY, Poon KH. Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital. Singapore Med J. 2013; 54(2): 75-81.Melzack R, Israel R, Lacroix R and Schultz G. Phantom limbs in people with congenital limb deficiency or amputation in early childhood. Brain 1997; 120(9): 1603– 20.Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and Health-Related Quality of Life in War Veterans with Bilateral Lower Limb Amputations. Trauma Mon2012; 17(2):282-286.Ketz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil 2008, 89(6): 1127-32.Boyle M, Tebbi CK, Mindell ER, Mettlin CJ. Adolescent adjustment to amputation. Med Pediatr Oncol 1982; 10(3): 301-12.Patricia A. McGrath, Loretta M. Hillier. Phantom limb sensations in adolescents: A case study to illustrate the utility of sensation and pain logs in pediatric clinical practice. J Pain Symptom Manage 1992; 7(1): 46–53.Vida L. Tyc. Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clin Psychol Rev 1992; 12(3); 275–291. 

Lecturers' and Students' Perception of Using a Study Guide

Background & Objective: Today, using new educational strategies and methods is of great importance. Using a study guide is one of these new methods of teaching and learning. The aim of the present study was to evaluate the perception of lecturers and students of the School of Dentistry, Tehran University of Medical Sciences, Iran, toward the use of a study guide. Methods: In this quasi-experimental study, 25 students of the School of Dentistry of Tehran University of Medical Sciences who had chosen the community dentistry course were randomly selected. A study guide was given to students before their briefing session and 2 sessions in the school. A questionnaire was designed in order to collect data on the perception of students toward the study guide and was used after the completion of the course. The validity and reliability of the questionnaire were verified. The questionnaire was also filled out by a professor of the Department of Oral Health. Data was analyzed by SPSS software. Results: The survey of the students' and lecturers' perception of the study guide showed that 76.5% and 86%, respectively, chose agree and completely agree with the use of the study guide options. Conclusion: Using the study guide was rated as a suitable method; thus, it can be used to help students in the efficient use of training time. Keywords Study guide Dental students Community dentistr

Identifying Obstacles to Digital Transformation Using the Meta-Synthesis Method

vIntroductionBig data and digital technologies, such as artificial intelligence (AI), blockchain, the Internet of Things (IoT), and robotics, will transform businesses in many ways. This process of adapting to these changes is called digital transformation. Companies and policymakers in different countries are implementing various programs, strategies, and policies to achieve digital transformation. However, they face many challenges and obstacles that need to be identified and addressed. This research provides a comprehensive classification of the barriers to digital transformation using the meta-synthesis method including 38 selected articles.Literature ReviewThe literature on this topic has proposed various classifications of the barriers to digital transformation. This research focuses on the barriers from the perspective of digital transformation management and excludes the studies that examine the barriers from a technical perspective. The literature on this topic can be divided into three main approaches: "examining the barriers to digital transformation across industries and companies", "innovation approach" and "barriers to organizational change".Some of the barriers mentioned in the literature are:Lack of standards, lack of legal basis for data use, integration with existing system environment, dependence on other technologies, and fear of transparency/acceptance (Vogelsang et al, 2019)Law/standards, management, and workforce (Bailie & Chinn, 2018)Strategy, business model, business processes, organizational structures, and organizational culture (Vukˇ si´, 2018)The conflict between physical and digital systems, as well as the pervasive mindsets that are ingrained in the organization's culture (Nate & Erica, 2014).Lack of guidance from the government and hence resistance to change; Changing the operating models requires replacing a large number of equipment and systems and involves significant capital; The interaction of different technologies may cause problems in a complex system; The adoption of new technologies requires a certain time for evaluation, and it takes time to adjust the strategy according to the new environment; Lack of overall planning and standardization (Lu et al, 2019).MethodologyThis research is a descriptive-applied study that uses the meta-synthesis method. In this study, the seven-stage model of Sandusky and Barroso (2006) is applied. Based on the research objectives and questions, as well as the theoretical foundations related to the barriers to digital transformation, relevant articles were searched using the keywords in the national and international scientific databases. This search resulted in finding 173 articles related to the keywords. After identifying the articles, the models and concepts presented in them were coded. In this study, open, axial, and selective coding were performed. In the next step, the internal validity and reliability of the codings were checked.ConclusionAs mentioned in the literature, the technological change in the digital field can be analyzed as a technological system and from the perspective of socio-technical transitions (Reinhardt, 2022). Different approaches for analyzing technological transitions are of interest in the literature. This study has chosen a multi-level perspective for this analysis. This perspective views the transition as a historical pattern that can be depicted in three different layers. According to this perspective, technology transition can be conceptualized as three nested levels: landscape, socio-technical regime, and niche.Using this perspective, at the landscape level, the environment of a system is examined, and the two sub-categories of government and society are identified as barriers to digital transformation. Moreover, based on the systemic approach to the topic, the socio-technical regime, which is the system that governs the industry or the field studied in this study, is proposed. The basis of companies developing digital technologies should be analyzed and investigated according to the concept of barriers to digital transformation. In this thesis, this category is explained and the dimensions related to each category are discussed in detail.Considering the scope of the study, this framework does not examine the internal relationships between the variables (sub-categories) under the categories. It seems that suggesting the relationship between sub-categories in the proposed framework can be a recommendation for future studies. Also, examining the solutions to overcome the barriers identified in a case study can be suggested as another recommendation for future studies.Keywords: Digital Transformation, Barriers, Meta-Synthesis, Multi-Level Perspective (MLP).  IntroductionBig data and digital technologies, such as artificial intelligence (AI), blockchain, the Internet of Things (IoT), and robotics, will transform businesses in many ways. This process of adapting to these changes is called digital transformation. Companies and policymakers in different countries are implementing various programs, strategies, and policies to achieve digital transformation. However, they face many challenges and obstacles that need to be identified and addressed. This research provides a comprehensive classification of the barriers to digital transformation using the meta-synthesis method including 38 selected articles.Literature ReviewThe literature on this topic has proposed various classifications of the barriers to digital transformation. This research focuses on the barriers from the perspective of digital transformation management and excludes the studies that examine the barriers from a technical perspective. The literature on this topic can be divided into three main approaches: "examining the barriers to digital transformation across industries and companies", "innovation approach" and "barriers to organizational change".Some of the barriers mentioned in the literature are:Lack of standards, lack of legal basis for data use, integration with existing system environment, dependence on other technologies, and fear of transparency/acceptance (Vogelsang et al, 2019)Law/standards, management, and workforce (Bailie & Chinn, 2018)Strategy, business model, business processes, organizational structures, and organizational culture (Vukˇ si´, 2018)The conflict between physical and digital systems, as well as the pervasive mindsets that are ingrained in the organization's culture (Nate & Erica, 2014).Lack of guidance from the government and hence resistance to change; Changing the operating models requires replacing a large number of equipment and systems and involves significant capital; The interaction of different technologies may cause problems in a complex system; The adoption of new technologies requires a certain time for evaluation, and it takes time to adjust the strategy according to the new environment; Lack of overall planning and standardization (Lu et al, 2019).MethodologyThis research is a descriptive-applied study that uses the meta-synthesis method. In this study, the seven-stage model of Sandusky and Barroso (2006) is applied. Based on the research objectives and questions, as well as the theoretical foundations related to the barriers to digital transformation, relevant articles were searched using the keywords in the national and international scientific databases. This search resulted in finding 173 articles related to the keywords. After identifying the articles, the models and concepts presented in them were coded. In this study, open, axial, and selective coding were performed. In the next step, the internal validity and reliability of the codings were checked.ConclusionAs mentioned in the literature, the technological change in the digital field can be analyzed as a technological system and from the perspective of socio-technical transitions (Reinhardt, 2022). Different approaches for analyzing technological transitions are of interest in the literature. This study has chosen a multi-level perspective for this analysis. This perspective views the transition as a historical pattern that can be depicted in three different layers. According to this perspective, technology transition can be conceptualized as three nested levels: landscape, socio-technical regime, and niche.Using this perspective, at the landscape level, the environment of a system is examined, and the two sub-categories of government and society are identified as barriers to digital transformation. Moreover, based on the systemic approach to the topic, the socio-technical regime, which is the system that governs the industry or the field studied in this study, is proposed. The basis of companies developing digital technologies should be analyzed and investigated according to the concept of barriers to digital transformation. In this thesis, this category is explained and the dimensions related to each category are discussed in detail.Considering the scope of the study, this framework does not examine the internal relationships between the variables (sub-categories) under the categories. It seems that suggesting the relationship between sub-categories in the proposed framework can be a recommendation for future studies. Also, examining the solutions to overcome the barriers identified in a case study can be suggested as another recommendation for future studies

A phase III, randomized, two-armed, double-blind, parallel, active controlled, and non-inferiority clinical trial to compare efficacy and safety of biosimilar adalimumab (CinnoRA (R)) to the reference product (Humira (R)) in patients with active rheumatoid arthritis

Background: This study aimed to compare efficacy and safety of test-adalimumab (CinnoRA (R), CinnaGen, Iran) to the innovator product (Humira (R), AbbVie, USA) in adult patients with active rheumatoid arthritis (RA). Methods: In this randomized, double-blind, active-controlled, non-inferiority trial, a total of 136 patients with active RA were randomized to receive 40 mg subcutaneous injections of either CinnoRA (R) or Humira (R) every other week, while receiving methotrexate (15 mg/week), folic acid (1 mg/day), and prednisolone (7.5 mg/day) over a period of 24 weeks. Physical examinations, vital sign evaluations, and laboratory tests were conducted in patients at baseline and at 12-week and 24-week visits. The primary endpoint in this study was the proportion of patients achieving moderate and good disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR)-based European League Against Rheumatism (EULAR) response. The secondary endpoints were the proportion of patients achieving American College of Rheumatology (ACR) criteria for 20% (ACR20), 50% (ACR50), and 70% (ACR70) responses along with the disability index of health assessment questionnaire (HAQ), and safety. Results: Patients who were randomized to CinnoRA (R) or Humira (R) arms had comparable demographic information, laboratory results, and disease characteristics at baseline. The proportion of patients achieving good and moderate EULAR responses in the CinnoRA (R) group was non-inferior to the Humira (R) group at 12 and 24 weeks based on both intention-to-treat (ITT) and per-protocol (PP) populations (all p values >0.05). No significant difference was noted in the proportion of patients attaining ACR20, ACR50, and ACR70 responses in the CinnoRA (R) and Humira (R) groups (all p values >0.05). Further, the difference in HAQ scores and safety outcome measures between treatment arms was not statistically significant. Conclusion: CinnoRA (R) was shown to be non-inferior to Humira (R) in terms of efficacy at week 24 with a comparable safety profile to the reference product

Lead poisoning among opium users in Iran: an emerging health hazard

Background Lead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province. Methods Between January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained. Results The patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia. Conclusions The study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.publishedVersio

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe