Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Assessment of the resident’s promotion exam: One step to validity of competency measurement in Arak University of Medical Sciences

Introduction: Designing a tool for measuring of residents’competency with attention to their main role in education and practice of university. This study aims to assess the residents’ promotion tests of clinical departments at Arak University of Medicals Sciences. Methods: This cross- sectional study that was undertook in 2010 at Arak University of Medical Sciences. Seven hundred and fifty multiple choice questions related to resident promotion tests in surgery, internal medicine, pediatrics, gynecology and anesthesiology was compared. Questionnaire of each department contained 150 questions.   These questions were evaluated in the following domains: structure, Blum taxonomy, discrimination and difficulty index of questions and compliance to the core curriculums. Data gathering tool were: Millmen standard check list for evaluating questions’ structure and check list for evaluating Blum taxonomy and core curriculum and OMR system for evaluating discrimination and difficulty index. The validity and reliability of tools was confirmed and data were analyzed using by ANOVA and X2 tests. Results: Results showed gynecology department had structural problem (4.5±4.2) compared with other departments. Internal medicine department had the highest Blum domain (40% application and 47% comprehension), surgery department had the highest learning aims (90.7%) and was assessed as the most suitable questions from difficulty index (67.3%) and discrimination index (73.5%). There was significant difference between structural problem, core curriculum and rate of standard questions in various clinical departments (P=0.001). Conclusion: This study confirmed the necessity of test assessment in universities, to form effective educational workshops, control of questions before exams and incentives for clinical departments to design standard questions. Development of electronic question analysis system is recommended

THE STUDY OF CLINICAL SYMPTOMS OF MYOCARDIAL INFARCTION IN MEN AND WOMEN HOSPITALIZED IN THE CCU OF IMAM-ALI HOSPITAL, ZAHEDAN

Coronary heart diseases are the main reason of mortality in most of the industrial countries. At present, the most important cause of mortality is the cardiovascular diseases on top of which one can find coronary artery disease. The present research aims at studying the clinical symptoms of myocardial infarction in men and women hospitalized in the CCU of Imam Ali Hospital in Zahedan. The present study is an analytical cross-sectional study in which 210 patients were studied; they were diagnosed with acute myocardial infraction that was confirmed by a cardiologist. The patients were hospitalized in Imam Ali Hospital in Zahedan in 2016. The information of the patients was collected through the researcher-made questionnaire. The questionnaire includes demographic information and symptoms of acute myocardial infraction. The data were analyzed using SPSS 18 and chi-square test. Moreover, in the present study p0.05). However, symptoms such as vomiting, dyspnea, fatigue, and anxiety were significantly more in women than men were. The findings of the present study indicate that atypical symptoms especially in women are likely to cause women's delay to visit the doctor and delayed decision of diagnosing and treating by the medical team. Thus, it is essential and recommended to provide programs to teach the whole society as well as the healthcare workers especially in the emergency units of the hospitals

THE RELATIONSHIP BETWEEN VITAMIN D AND GESTATIONAL DIABETES-A REVIEW ARTICLE

Introduction: Gestational diabetes manifests itself as not having glucose tolerance, and is seen in around 2-13 of all cases of pregnancy. One of the important factors in the development of gestational pregnancy is vitamin D deficiency. so, this study is designed to determine the relationship between low levels of vitamin D in pregnancy and gestational diabetes mellitus. Methods: In this review article, the databases Medline, Cochrane, Science Direct, and Google Scholar were thoroughly searched to identify the studies investigating the relationship between vitamin D and gestational diabetes. Results: vitamin D deficiency will definitely leave harmful effects on the pregnant women's health and on their infants, in a way that vitamin D deficiency condition during pregnancy is accompanied by the development of gestational diabetes, mother's blood pressure disorder, the embryo's skeletal growth disorder, brain growth and development disorders, and disorders in the functioning of the embryonic immune system. Discussion and conclusion: Given that pregnancy is diabetogenic and that the incidence of gestational diabetes is the society is high, paying more attention to providing adequate amounts of vitamin D can be an important factor in this area