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

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

Growth Parameters and Photosynthetic Pigments of Marigold under Stress Induced by Jasmonic Acid

In this research, the effects of different concentrations of jasmonic acid ( JA) on growth parameters of flower diameter, number of flowers, dry flower weight, plant height, 1000-seed weight and also, photosynthetic pigments in marigold (Calendula officinalis L.) were investigated. To achieve this aim, marigold planted in pots and jasmonic acid were sprayed on the shoots at concentrations of 0.75, 150 and 225 μM. Data were compared by Duncan test. The results showed that different concentrations of jasmonic acid significantly affected the dry flower weight, plant height and 1000-seed weight. The maximum plant height and 1000-seed weight were reached by 150 μM jasmonic acid, while 225 μM was recorded the dry flower weight

The effectiveness of motor based cognitive rehabilitation on improvement of working memory of children with ADHD

Attention deficit and hyperactivity disorder is one of the most prevalent neurodevelopmental psychiatric disorders with defects in executive functions as its general feature. The present study was conducted to explore the effects of motor-based cognitive rehabilitation on improvement of working memory in children with attention deficit and hyperactivity disorder. The present quasi-experimental study followed a randomized clinical trial design (pretest-posttest with control group). A total of 30 children, aged between 7-12,who had referred to different clinics in Tehran and were diagnosed by a psychiatrist with attention deficit and hyperactivity disorder, were selected using convenience sampling, and then were randomly divided into control and experimental groups. The working memory was  evaluated via recording  N-Back test. independent t-test and mixed ANOVA were run in SPSS (v. 20) to analyze the data. The results of the present study demonstrated that working memory of the experimental group improved after the intervention (P<0/01). In other words, the little difference observed in the pretest between the control and experimental groups in working memory was not significant; however, the scores obtained in the post-test were observed to be significantly higher in the experimental group as compared with those in the control group. The results of the statistical analyses shows that gesture-based cognitive rehabilitation therapy improved working memory in children with Attention Deficit and Hyperactivity Disorder

Effects of Harvesting Time and Fruit Tissue Type on Hesperidin Content in Lemon Fruits

Introduction: Citrus is in the first rank in the world with respect to production among fruits. They are grown commercially in more than 50 countries around the world. Several factors such as rootstock, nutrition and irrigation regimes, cultivation design and etc. may affect the promotion of quality and quantity of fruits. Lemon fruits are among the most valuable functional diets shown to lower oxidative-related disease risks, particularly cardiovascular disease. A well-documented characteristic of these fruits is the accumulation of high amounts of glycoside flavonones, named hesperidin in the fruits. Several recent studies have demonstrated that the cytoprotective action of citrus fruits is enhanced by the presence of antioxidants including vitamin C, phenolics, carotenoids and flavonoids. Hesperidin and its metabolites significantly have been found to lower the total cholesterol and triglyceride concentrations in plasma. Hesperidin acts as a chemopreventive agent against colon carcinogenesis induced by azoxymethane. Lemons are one of the citrus species having many medicinal effects owing to their secondary metabolites. Flavonoids are a part of aromatic polyphenols having different biological actions such as antioxidant activity, anti-cancer, anti-sensation and etc. Hesperidin is one of the abundant secondary metabolites belonging to flavonoids in citrus, which is effective in treating many diseases. Materials and Methods: In order to investigate the effect of lemon fruits (Citrus lemon cv. Cluster, C. lemon cv. Lisbon and C. lemon cv. Eureka) tissue type and harvesting time on the flavonoids hesperidin content, this experiment was carried out. Thus, this research was conducted in a factorial arrangement on the basis of completely randomized design with three factors: tissue type (Flavedo, Albedo and Flesh), harvesting time (45, 75, 105 and 135 days after full bloom) and three lemon cultivars (Cluster, Lisbon and Eureka) with three replications. Studied trees in Kotra Research Station were planted for research aims and were 20-year grafted on sour orange rootstocks. For selection of trees, the same height, crown, and other morphological attributes were considered. As the fruit quality may be differ in different parts of crown, fruits were harvested from different geographical orientations of crown. Samples were gathered after full bloom at the 30-day intervals. The measured parameters were included fruit weight, diameter, peel thickness, dry matter and hesperidin flavonoid in extraction of various fruit tissues. Extraction was conducted by methanol and hesperidin content recorded by High Performance Liquid Choromatography (HPLC). Chemicals and reagents used in this study were high quality grade and acquired from Sigma-Aldrich Results and Discussion: Results showed that the fruit harvesting time significantly affected on fruit diameter, peel thickness, dry matter and also hesperidin content of tissue extraction. Fruit diameter variation was related to the fruit weight. The highest fruit weight attained in cultivars Lisbon and Eureka (88.39 g and 84.72 g, respectively) at the fourth harvesting time (135 days after full bloom) and the minimum, in sour lemon cv. Cluster (4.16 g) at the first harvesting time (45 days after full bloom). The maximum of fruit diameter was recorded in cultivar Lisbon (54.81 mm) at the fourth harvesting time and the minimum diameter in cultivar Eureka (20.75 mm) at the first harvesting time. Fruit peel thickness at the first harvesting stage increased and then decreased. Cluster sour lemon cultivar possessed the highest peel thickness (7.16 mm) and the Eureka cultivar had the minimum (4.66 mm). Percentage of dry matter increased at the first harvesting stage and then decreased. The maximum percentage of dry matter was recorded in cluster sour lemon cultivar (22.83%) and minimum in Lisbon lemon cultivar (11.36%). The highest amount of hesperidin was observed in Lisbon cultivar (1606.93 ppm). These amounts decreased afterward until fruit harvesting time. The highest hesperidin content was produced in albedo tissue. Lisbon lemon in the hesperidin was better than the other two cultivars. It is concluded that the most suitable time of mature fruits harvesting is 45 days after full bloom. At this time the fruit diameter of lemon cv. Eureka, Lisbon and Cluster were 20.7, 22.8 and 25.8 mm; respectively. Hesperidin flavonoid was produced in albedo tissue in all cultivars. Therefor; fruit albedo tissue can be regarded as the best tissue for extracting hesperidin. Hesperidin was severely affected by harvesting time, tissue and cultivar. Hesperidin was achieved in the most amounts at the first harvesting stage in Lisbon lemon compared to all studied cultivars. As the fresh consumption of Eureka, Lisbon and specially Cluster lemon is few, thus preparing programs to extract flavonoid and use this cultivar in food industries is suggested

Phytochemical and Morphological Attributes of Borage (&lt;i&gt;Borago officinalis&lt;/i&gt;) Affected by Salicylic Acid as an Enhancer

The objective of this study was to determine the response of borage (Borago officinalis) phytochemical and morphological attributes in relation to application of different levels of salicylic acid. Borage planted in pots and salicylic acid was sprayed on the shoots at concentrations of 0, 0.5, 1.0 and 1.5 mM with 6 replications in a completely randomized block design. Morphological attributes such as shoot height, shoot dry matter, flower dry matter, flower weight and shoot wet weight were measured. In the other hand, phytochemical attributes such as ion leakage, chlorophyll a, b, carotenoid, and antioxidant activity were also investigated under induced stress by different concentrations of salicylic acid. Results showed that some morphological traits such as shoot dry matter (31.23%), flower dry matter (20.43%), flower weight (38.54 g), shoot wet weight (109.43 g), possessed the highest values under treatment of 1.5 mM salicylic acid. Also, some phytochemical traits in plants treated with 1.5 mM salicylic acid reached the highest values during the growth stage with the exception of ion leakage (0.54%). These measured traits with higher values consisted of chlorophyll a (4.16 mg.l-1), chlorophyll b (1.65 mg.l-1), total chlorophyll (5.81 mg.l-1), carotenoid (1.18 mg.l-1), antioxidant activity (53.73%)

Screening of tomato landraces for drought tolerance based on growth and chlorophyll fluorescence analyses

To investigate the effects of water withholding on 17 tomato (Solanum lycopersicum L.) landraces collected from different climatic zones of Iran and two commercial hybrids, the polyphasic OJIP fluorescence transient, relative water content (RWC), electrolyte leakage (EL) and vegetative growth parameters were analyzed. Duncan’s multiple range test (DMRT) for all the studied parameters and drought factor index (DFI) based on performance index on the absorption basis (PIabs) were used for screening the plants based on their tolerance to drought condition. Result showed that compared to the control plants, vegetative growth parameters, RWC, PIabs, relative maximal variable fluorescence (FM/F0), maximum quantum efficiency of PSII (FV/FM), quantum yield of electron transport (ΦE0) and electron transport flux per reaction center (RC) (ET0/RC) were decreased, whereas, EL, quantum yield of energy dissipation (ΦD0), specific energy fluxes per RC for energy absorption (ABS/RC) and dissipated energy flux (DI0/RC), which are closely related to the incidence of photoinhibition were increased in plants exposed to water withholding. DMRT and DFI screening results clearly categorized the landraces into three groups (tolerant, moderately sensitive and sensitive). Tolerant landraces showed less change for most of the measured parameters compared to sensitive and moderately sensitive landraces. We found that adapted landraces to dry climates had a higher tolerance to drought stress. Principal component analysis (PCA) revealed that FM/F0, FV/FM, ΦE0, ΦD0, PIabs, ABS/RC, ET0/RC and DI0/RC parameters are the most sensitive parameters for detection of impact of drought stress on tomato plants. In conclusion, the eight parameters have the potential to identify the drought injury in tomato seedlings.The authors thanked the Gorgan University of Agricultural Sciences and Natural Resource, Iran for providing research facilities and fund. The study would not have been possible without the generous and willing cooperation of staff and people of Abureihan Campus, University of Tehran, Iran.Peer reviewe