Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005)

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries

Development of a multifunctional bicycle carriage : A studie for increased load capacity in everyday life

Denna rapport behandlar ett projekt för examen inom programmet Högskoleingenjör inom innovationsteknik och design. Projektet genomfördes tillsammans med företaget Atran Velo med målet att utveckla en cykel-/dragvagn som ska integreras med företagets AVS-system. Projektet genomfördes under våren 2021 vid Karlstads universitet och omfattar 22,5 hp. Projektets syfte är att ta fram en vagn som ökar lastförmågan hos en standardcykel. Detta möjliggör att människor kan bruka sin cykel vid flera tillfällen, vilket bidrar till flera positiva aspekter. Genom att transportera sig med cykel i stället för bilen bidrar det till minskade utsläpp. Detta har en positiv påverkan på miljön och klimatet. Det ökar även den fysiska aktiviteten hos människan, vilket bidrar till att individens välmående ökar. Projektet har utgått från produktutvecklingsprocessen med faserna: projektplanering, förstudie, produktspecifikation, konceptgenerering, konceptval, konstruktion, slutprocess och rapportskrivning. I faserna har olika beprövade metoder används.  Projektet resulterade i ett konceptförslag på en vagn och koppling som företaget ska arbeta vidare med efter detta projekt. Vagnen fungerar som både en cykel- och dragvagn som enkelt går att koppla på och av cykeln med en AVS-adapter. Till exempel för att cykla förbi affären och använda vagnen för mathandling. Vagnen har två lastytor som har integrerade AVS-bryggor vilket gör vagnen till en AVS-bärare, med detta menas att vagnen kan användas med företagets olika tillbehör. Vagnen går även att vika ihop för platsbesparing i hemmet för att öka kundvärdet. Vagnen är tillverkad av aluminium för att minimera vikten på produkten och motstå korrosion.This report deals with a project for a Bachelor of Science in innovation technology and design engineering degree at Karlstad University. The project was conducted on behalf of the company Atran velo. The goal of this project is to develop a bicycle/tractor that is integrated with the company´s AVS-system. The project was carried out during the spring 2021 and comprises 22,5 hp.  The purpose of this project is to develop a trolly that can increase the load capacity when using a standard bicycle. This allows people to use their bicycle on several occasions which contributes to many positive aspects. By taking the bicycle instead of the car it contributes to reduced emission, which has a positive effect on the environment. It can also increase the physical activity of people which contributes to the individual’s health.  The project has been based on the product development process with the phases project planning, pilot study, product specification, concept selection, design, final process, and report writing. In these phases various proven methods have been used.  The result of this project is a concept of a trolley with coupling. The trolley can be used both as a bicycle cart and carriage. It can easily be connected and disconnected from the bicycle, when for example doing grocery shopping. The trolley has two loading surfaces, and both are integrated with AVS - bridges which makes it work like an AVS-carrier. It can also be folded for space saving witch increase customer value. Most of the trolley is made of aluminum which minimize the weight and is corrosion resistance.

Lost and Found : Activating forgotten space and knowledge

The project proposes the production of devices to enhance the value or experience of a place as well as to allow research and education in history, collective memory and contemporary times of the city that we live in. Looking at the city through a specific type of architecture, concept or material, and hopefully giving an honest perspective of the space we inhabit. For this project the topic was contemporary ruins and their structural and visual values. Cataloging the timber barn, exploring it in an industrial hall and then exhibiting them on the concrete dolphins in the river, all buildings or structures created purely for convenience but have since lost all or some of this convenience, therefore becoming contemporary ruins. In the end creating structures with the purpose of learning, exhibiting them for others to learn as well; and in the end finding a place and purpose for the structure. Turning the building from a research project into a folly and then into a device for experience. Producing with the goal of learning, placing with the goal of enhancing, without designing specifically for the end product but rather for the process itself

Lost and Found : Activating forgotten space and knowledge

The project proposes the production of devices to enhance the value or experience of a place as well as to allow research and education in history, collective memory and contemporary times of the city that we live in. Looking at the city through a specific type of architecture, concept or material, and hopefully giving an honest perspective of the space we inhabit. For this project the topic was contemporary ruins and their structural and visual values. Cataloging the timber barn, exploring it in an industrial hall and then exhibiting them on the concrete dolphins in the river, all buildings or structures created purely for convenience but have since lost all or some of this convenience, therefore becoming contemporary ruins. In the end creating structures with the purpose of learning, exhibiting them for others to learn as well; and in the end finding a place and purpose for the structure. Turning the building from a research project into a folly and then into a device for experience. Producing with the goal of learning, placing with the goal of enhancing, without designing specifically for the end product but rather for the process itself

Patienters tillfredsställelse av smärtlindring vid akut smärta inom akutsjukvård : En litteraturstudie

Bakgrund: Akut smärta är en av det vanligaste orsakerna till besök på akutmottagningar nationellt och internationellt. Det är viktigt att patienter erhåller en adekvat smärtlindring då de annars kan riskera akuta och kroniska besvär, behöva utstå onödigt lidande både på kort och lång sikt samt även utveckla en misstro till vården. Syfte: Att utifrån litteraturen undersöka patienters tillfredsställelse av smärtlindring vid akut smärta inom akutsjukvården.Metod: Litteraturöversikt med induktiv ansats. 14 studier inkluderades i arbetet samtliga hämtades från Pubmed eller CINAHL. Resultatet skapades genom en tematisk analys av de inkluderade studiernas resultat. Resultat: Tre teman identifierades efter analys av inkluderade studier. Dessa var faktorer som påverkar tillfredställelsen, faktorer som effektiviserar behandling och påverkar tillfredställelsen samt upplevelser av behandling som påverkar tillfredställelsen. Vårdpersonalens bemötande, att patienter får smärtlindring i tid samt att patienter faktiskt erbjuds smärtlindring var faktorer som påverkar tillfredsställelsen av smärtlindringen. Smärtprotokoll samt rädslor/oro som patienter hade kunde också vara faktorer som påverkade tillfredsställelsen av handläggningen av deras akuta smärta inom akutsjukvården. Slutsats: För att patienter ska känna tillfredställelse av smärtlindring vid akut smärta inom akutsjukvården bör patienter erhålla smärtlindring, erhålla den i tid samt att en vårdrelation baserad på tillit etableras mellan vårdgivare och patient.Background: One of the most common reasons for patients visiting emergency care units are due to acute pain of some sort both nationally and internationally. It’s therefore of great importance that these patients are offered an adequate treatment for their pain, if not this could lead to acute and chronic discomfort, unnecessary suffering both in a short and a long time perspective and ultimately even to distrust in the emergency healthcare system. Aim: To investigate the literature on patients’ satisfaction with pain management provided by emergency care.Method: A literature review with an inductive approach. A total of 14 articles from the PubMed and CINAHL databases are included and are presented through a thematic analysis. Results: Three themes were identified after the analysis of the included articles. These consist of factors that affect satisfaction, factors that increase the effectiveness of management and affect satisfaction and experiences towards treatment that affect satisfaction. The compassion from caregivers, the fact that patients received analgesics and in good time are all factors that contributed to increased satisfaction among patients. Different pain protocols and fears/worries that patients may have were also factors that contributed to how satisfied the patients felt about the management of their acute pain in the emergency care setting. Conclusion: Key factors when it comes to satisfactory treatment of patients in acute pain are: receiving analgesia, receiving analgesia on time and the establishment of a relationship based on trust between patient and caregiver

Patienters tillfredsställelse av smärtlindring vid akut smärta inom akutsjukvård : En litteraturstudie

Bakgrund: Akut smärta är en av det vanligaste orsakerna till besök på akutmottagningar nationellt och internationellt. Det är viktigt att patienter erhåller en adekvat smärtlindring då de annars kan riskera akuta och kroniska besvär, behöva utstå onödigt lidande både på kort och lång sikt samt även utveckla en misstro till vården. Syfte: Att utifrån litteraturen undersöka patienters tillfredsställelse av smärtlindring vid akut smärta inom akutsjukvården.Metod: Litteraturöversikt med induktiv ansats. 14 studier inkluderades i arbetet samtliga hämtades från Pubmed eller CINAHL. Resultatet skapades genom en tematisk analys av de inkluderade studiernas resultat. Resultat: Tre teman identifierades efter analys av inkluderade studier. Dessa var faktorer som påverkar tillfredställelsen, faktorer som effektiviserar behandling och påverkar tillfredställelsen samt upplevelser av behandling som påverkar tillfredställelsen. Vårdpersonalens bemötande, att patienter får smärtlindring i tid samt att patienter faktiskt erbjuds smärtlindring var faktorer som påverkar tillfredsställelsen av smärtlindringen. Smärtprotokoll samt rädslor/oro som patienter hade kunde också vara faktorer som påverkade tillfredsställelsen av handläggningen av deras akuta smärta inom akutsjukvården. Slutsats: För att patienter ska känna tillfredställelse av smärtlindring vid akut smärta inom akutsjukvården bör patienter erhålla smärtlindring, erhålla den i tid samt att en vårdrelation baserad på tillit etableras mellan vårdgivare och patient.Background: One of the most common reasons for patients visiting emergency care units are due to acute pain of some sort both nationally and internationally. It’s therefore of great importance that these patients are offered an adequate treatment for their pain, if not this could lead to acute and chronic discomfort, unnecessary suffering both in a short and a long time perspective and ultimately even to distrust in the emergency healthcare system. Aim: To investigate the literature on patients’ satisfaction with pain management provided by emergency care.Method: A literature review with an inductive approach. A total of 14 articles from the PubMed and CINAHL databases are included and are presented through a thematic analysis. Results: Three themes were identified after the analysis of the included articles. These consist of factors that affect satisfaction, factors that increase the effectiveness of management and affect satisfaction and experiences towards treatment that affect satisfaction. The compassion from caregivers, the fact that patients received analgesics and in good time are all factors that contributed to increased satisfaction among patients. Different pain protocols and fears/worries that patients may have were also factors that contributed to how satisfied the patients felt about the management of their acute pain in the emergency care setting. Conclusion: Key factors when it comes to satisfactory treatment of patients in acute pain are: receiving analgesia, receiving analgesia on time and the establishment of a relationship based on trust between patient and caregiver

Multiparadigmet F# : Dess tekniska fördelar och använning hos företag

Uppsatsen behandlar programmeringsspråket F# med mål att undersöka hur användbart det är för företag idag jämfört med andra språk. Arbetet är uppdelat i två delar. En teoretisk del redogör for språkets upplägg som hybridspråk och undersöker fördelarna hos den funktionalitet som hämtats från det objektorienterade samt det funktionella paradigmet respektive. Den andra delen består av en enkätundersökning som utförts där vi frågat systemutvecklare i Sverige om användandet av F# i deras verksamhet, samt vilka tankar de har kring språkets upplägg och framtid inom arbetsmarknaden. Slutligen jämförs vår teoretiska slutsats med resultatet från vår undersökning för att kunna avgöra om F# är något som är värt för företag att investera i, eller om det inte bidrar tillräckligt för att vara värt besväret.Resultatet blev att trots att det ger ett antal nya möjligheter i teorin då man kombinerar objektorienterad och funktionell programmering, så innebär detta i praktiken bara att slå ihop två komponenter som redan kunde kopplas samman sedan innan. Inget revolutionerande presenteras i F# och därför finns det heller ingen anledning för företag att bygga om sina existerande system - även om många respondenter i undersökningen fann konceptet intressant.This essay processes the programming language F# in an attempt to discover its usefulness within companies today compared to other languages. The work is split into two parts. A theoretical part examines the structure of F# as a hybrid language and assesses the benefits of the functionalities that has been implemented from both the object oriented as well as the functional paradigm respectively. The second part presents the results of a performed survey where we have asked system developers in Sweden regarding the use of F# in their company, along with their thoughts regarding the structure and future of the language. Lastly, our theoretical analysis is compared with the results from our survey to determine whether F# is worth company’s investments, or contributes too little to be worth the hassle.2The results showed that despite combining object oriented and functional programming in theory opens up a number of new possibilities, it practically just means making a new language from two components which could already be connected. No revolutionary aspects are presented along with F# and therefore there is no reason for companies to rebuild their existing systems for this - even though many respondents of the survey found it an interesting concept

Multiparadigmet F# : Dess tekniska fördelar och använning hos företag

Uppsatsen behandlar programmeringsspråket F# med mål att undersöka hur användbart det är för företag idag jämfört med andra språk. Arbetet är uppdelat i två delar. En teoretisk del redogör for språkets upplägg som hybridspråk och undersöker fördelarna hos den funktionalitet som hämtats från det objektorienterade samt det funktionella paradigmet respektive. Den andra delen består av en enkätundersökning som utförts där vi frågat systemutvecklare i Sverige om användandet av F# i deras verksamhet, samt vilka tankar de har kring språkets upplägg och framtid inom arbetsmarknaden. Slutligen jämförs vår teoretiska slutsats med resultatet från vår undersökning för att kunna avgöra om F# är något som är värt för företag att investera i, eller om det inte bidrar tillräckligt för att vara värt besväret.Resultatet blev att trots att det ger ett antal nya möjligheter i teorin då man kombinerar objektorienterad och funktionell programmering, så innebär detta i praktiken bara att slå ihop två komponenter som redan kunde kopplas samman sedan innan. Inget revolutionerande presenteras i F# och därför finns det heller ingen anledning för företag att bygga om sina existerande system - även om många respondenter i undersökningen fann konceptet intressant.This essay processes the programming language F# in an attempt to discover its usefulness within companies today compared to other languages. The work is split into two parts. A theoretical part examines the structure of F# as a hybrid language and assesses the benefits of the functionalities that has been implemented from both the object oriented as well as the functional paradigm respectively. The second part presents the results of a performed survey where we have asked system developers in Sweden regarding the use of F# in their company, along with their thoughts regarding the structure and future of the language. Lastly, our theoretical analysis is compared with the results from our survey to determine whether F# is worth company’s investments, or contributes too little to be worth the hassle.2The results showed that despite combining object oriented and functional programming in theory opens up a number of new possibilities, it practically just means making a new language from two components which could already be connected. No revolutionary aspects are presented along with F# and therefore there is no reason for companies to rebuild their existing systems for this - even though many respondents of the survey found it an interesting concept