28 research outputs found
The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection
No full textAbstract
Background
The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society.
Methods
This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation.
Results
Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01)
Conclusion
The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation
Comparison of two transconjunctival and transcutaneous approaches in the incidence of scleral show during lower eyelid blepharoplasty
No full textCurrent therapy in oral and maxillofacial surgery /
No full textWritten by expert surgeons and educators, Current Therapy in Oral and Maxillofacial Surgery covers the latest treatment strategies, surgical techniques, and potential complications in OMS. Emphasizing an evidence-based approach, it covers all 12 subspecialties of OMS, addressing topics from surgical principles to oral surgery, anesthesia, cranio-maxillofacial trauma surgery, head and neck surgery, maxillofacial reconstructive surgery, orthognathic surgery, pediatric craniofacial surgery including cleft lip and palate, temporomandibular joint disorders, facial plastic surgery including rhinoplasty and facelifts, obstructive sleep apnea, and oral and maxillofacial infections. At the end of each chapter, Pearls and Pitfalls summarize the authors' insight, recommendations, and experience on that topic. Editor Dr. Shahrokh Bagheri is a noted professor, researcher, and speaker on OMS, and he leads an expert author team including Dr. R. Bryan Bell and Dr. Husain Ali Khan to help you master and apply the latest advances in OMS. More than 1,200 full-color photos and 200 color line drawings illustrate concepts and provide visual guidance in clinical areas. Comprehensive sections and chapters represent essential topics, the newest advances, and controversial topics. Clinical coverage brings together the latest knowledge in OMS in a concise, easy-to-apply way. Resident-specific coverage describes the wide array of subspecialties and treatments available in the armamentarium of the modern OMS. A focus on complications ensures that you are knowledgeable in this important part of any therapy or surgical discipline. Expert contributors include the "best of the best," featuring leading, well-established, and respected surgeons and educators writing on their areas of specialty and providing current treatment strategies.Written by expert surgeons and educators, Current Therapy in Oral and Maxillofacial Surgery covers the latest treatment strategies, surgical techniques, and potential complications in OMS. Emphasizing an evidence-based approach, it covers all 12 subspecialties of OMS, addressing topics from surgical principles to oral surgery, anesthesia, cranio-maxillofacial trauma surgery, head and neck surgery, maxillofacial reconstructive surgery, orthognathic surgery, pediatric craniofacial surgery including cleft lip and palate, temporomandibular joint disorders, facial plastic surgery including rhinoplasty and facelifts, obstructive sleep apnea, and oral and maxillofacial infections. At the end of each chapter, Pearls and Pitfalls summarize the authors' insight, recommendations, and experience on that topic. Editor Dr. Shahrokh Bagheri is a noted professor, researcher, and speaker on OMS, and he leads an expert author team including Dr. R. Bryan Bell and Dr. Husain Ali Khan to help you master and apply the latest advances in OMS. More than 1,200 full-color photos and 200 color line drawings illustrate concepts and provide visual guidance in clinical areas. Comprehensive sections and chapters represent essential topics, the newest advances, and controversial topics. Clinical coverage brings together the latest knowledge in OMS in a concise, easy-to-apply way. Resident-specific coverage describes the wide array of subspecialties and treatments available in the armamentarium of the modern OMS. A focus on complications ensures that you are knowledgeable in this important part of any therapy or surgical discipline. Expert contributors include the "best of the best," featuring leading, well-established, and respected surgeons and educators writing on their areas of specialty and providing current treatment strategies.Print version record.Includes bibliographical references and index.The history of oral and maxillofacial surgery / Lou S. Belinfante -- Wound healing: repair biology and wound and scar treatment / Anh D. Le, Jimmy James Brown -- Flap classification and principles of flap design for head and neck reconstruction / Andrew S. Salama -- Principles of repair and grafting of bone and cartilage / Tara L. Aghaloo, Alan L. Felsenfeld -- Burns of the head and neck / Nathan A. Kemalyan -- Endoscopic oral and maxillofacial surgery / Joseph P. McCain, King Kim -- Principles of microvascular surgery / Remy H. Blanchaert Jr. -- Antibiotic prophylaxis to prevent surgical site infections in oral and maxillofacial surgery / Julie Ann Smith -- Tissue engineering / Miller H. Smith, Kenji Izumi, Stephen E. Feinberg -- Molecular biology of head and neck cancer: therapeutic implications / David K. Lam, Brian L. Schmidt -- Principles of distraction osteogenesis / Cesar A. Guerrero, Helen Rivera, Elena V. Mujica, Mariana Henriquez, Marianela Gonzalez -- Principles of implantology and osseointegration / Guillermo E. Chacon, Carlos M. Ugalde.Management of asymptomatic wisdom teeth: an evidence-based approach / Thomas B. Dodson -- Value of oral and maxillofacial surgeons: dentistry's liaisons to medicine and hospital care / Connie L. Drisko -- Removal of third molars / M.A. Pogrel -- Management of the impacted canine / Steven W. Beadnell -- Implants for orthodontic anchorage: temporary anchorage device / Joyce T. Lee -- Dental implant prosthetic rehabilitation: autogenous bone grafting for alveolar defects / Stephen A. Bankston -- Dental implant prosthetic rehabilitation: allogeneic grafting/bone graft substitutes in implant dentistry / Mark R. Stevens, Hany A. Emam -- Dental implant prosthetic rehabilitation: vertical distraction osteogenesis / Glen Maron -- Dental implant prosthetic rehabilitation: sinus grafting / Antwan L. Treadway, Stephen A. Bankston -- Reconstruction of the atrophic mandible / Michael S. Jaskolka, George H. Blakey III -- Zygoma implants in the compromised maxilla: their use in both atrophic and maxillectomy patients / Eric J. Dierks, Kenji W. Higuchi -- Efficacy of rhBMP-2 in association with dental implants / Robert Gilbert Triplett, Mark E. Wong -- Computer-assisted implant surgery / Edward R. Schlissel -- Management of the anticoagulated patient / Rabie M. Shanti, Shahid R. Aziz -- The preoperative cardiac evaluation / Heather B. Westmoreland, A. Maziar Zafari -- Management of the irradiated patient / Martin I. Salgueiro, Mark R. Stevens -- Management of trigeminal nerve injuries / Shahrokh C. Bagheri, Roger Albert Meyer.Outpatient intravenous sedation for oral surgery / Harry Papadopoulos -- Nonsurgical management of facial pain / Steven J. Scrivani, David A. Keith, Jennifer P. Bassiur, James A Kraus, Noshir R. Mehta -- The pharmacology of Ketamine and its use in outpatient anesthesia / Christopher T. Kirkup, Jeffrey Bennett -- Nerve damage in dentistry / M.A. Pogrel.The surgical airway / Timothy Marx Osborn, Eric J. Dierks -- Traumatic epistaxis / Michael M. Demo, Martin B. Steed -- Nasal fractures / Tirbod Fattahi -- Mandibular fractures / Stephen P.R. MacLeod -- Mandibular subcondylar fractures / Larry L. Cunningham, Jr., Aaron Sterling Card -- Orbital fractures / R. Bryan Bell, Saif S. Al-Bustani -- Zygomaticomaxillary complex fractures / Christopher John Haggerty, Nagi Demian, Jose M. Marchena -- Le Fort fractures / Zachary S. Peacock, Brian Thomas Bast -- Naso-orbito-ethmoid fractures / Mark Engelstad -- Frontal sinus fractures / Yoh Sawatari, Johanny Caceres -- Pan-facial trauma / Alan S. Herford -- Management of avulsive gunshot wounds to the face / Amir H. Dorafshar, Eduardo D. Rodriguez -- Secondary reconstruction of post-traumatic maxillomandibular deformities / Rabie M. Shanti, Shahid R. Aziz.Neck mass: diagnosis and management / Deepak Kademani, Meredith August -- Keratocystic odontogenic tumor / M.A. Pogrel -- Contemporary treatment of ameloblastoma / Deepak Kademani, David Michael Junck -- Jaw cysts, benign odontogenic tumors of the jaws, and fibro-osseous diseases / Robert E. Marx -- The central giant cell granuloma / M.A. Pogrel -- Oral squamous cell carcinoma: epidemiology, clinical and radiographic evaluation, and staging / Brent B. Ward, Fayette C. Williams -- Oral squamous cell carcinoma / David L. Hirsch, Michael J. Spink -- Oral squamous cell carcinoma: management of the neck / Tuan Giang Bui, R. Bryan Bell -- Indications for adjuvant chemotherapy and radiation therapy / Robert Andrew Ord -- Salivary gland tumors: the parotid gland / Curtis Gregoire -- Minor salivary gland tumors / Antonia Kolokythas, Michael Miloro -- Management of head and neck sarcoma / Rafael A. Madero-Visbal, Thomas D. Shellenberger -- Osteoradionecrosis / Kevin Arce.Mandibular reconstruction / Jason K. Potter -- Palato-Maxillary reconstruction / Dimitrios Nikolarakos, Jason K. Potter -- Contemporary methods in tongue reconstruction / Phillip Pirgousis, Rui Fernandes -- Lip cancer: ablative and reconstructive surgery / Eric R. Carlson, Andres Guerra -- The temporalis system of flaps in head and neck reconstruction: temporoparietal fascia and temporalis muscle flaps / Jon D. Holmes -- Bisphosphonates and bisphosphonate-induced osteonecrosis of the jaws / Robert E. Marx -- Maxillofacial reconstruction using cancellous cellular marrow grafts / Robert E. Marx -- Ear reconstruction / Shawn A. McClure, Steven P. Best -- The pectoralis major myocutaneous flap / Dale A. Baur, Michael P. Horan, Juan C. Rodriquez -- Radial forearm free flap / Brian M. Woo, D. David Kim -- Fibula free flap and mandibular reconstruction / Phillip Pirgousis, Rui Fernandes -- Anterolateral thigh flap / Joshua Eli Lubek, Stephen L. Engroff -- Deep circumflex iliac artery free flap / Stephen L. Engroff, Joshua Eli Lubek -- Implant-assisted prosthetic reconstruction after tumor ablation / Devin Joseph Okay, Daniel Buchbinder.Computer-aided surgical simulation for orthognathic surgery / James J. Xia, Jaime Gateno, John F. Teichgraeber -- Mandibular deficiency: bilateral sagittal spilt osteotomy / Jessica J. Lee -- Maxillary deficiency: Le Fort I osteotomy / Vincent James Perciaccante -- Maxillary deficiency: transverse plane discrepancies / Rafael E. Alcalde, Dale S. Bloomquist, Don Joondeph -- Mandibular orthognathic surgery: vertical ramus osteotomy vs. sagittal split osteotomy / Shahid R. Aziz, Steven M. Roser -- Distraction osteogenesis / Marianela Gonzalez, Cesar A. Guerrero, Michael P. Ding -- Mandibular asymmetry: diagnosis and treatment considerations / Brian B. Farrell, Myron R. Tucker -- Mandibular asymmetry: condylar elongation/hypertrophy / Felice O'Ryan -- Mandibular asymmetry: temporomandibular joint degeneration / Larry M. Wolford.Cleft lip and palate: timing and approaches to reconstruction / Radhika Chigurupati -- Cleft lip and palate: nasoalveolar molding / Judah S. Garfinkle, Barry H. Grayson -- Cleft lip and palate: primary cleft lip repair / Bernard J. Costello, Ramon L. Ruiz -- Cleft lip and palate: primary cleft palate repair / Paul S. Tiwana, Matthew J. Madsen -- Cleft lip and palate: bone graft reconstruction of the cleft maxilla / Gregory J. Mackay -- Cleft lip and palate: orthognathic surgery / David S. Precious -- Cleft lip and palate: prosthetic rehabilitation in the growing cleft patient / Betsy K. Davis -- Nonsyndromic single suture craniosynostosis / Pat Ricalde -- Craniofacial dysostosis syndromes / Jeffrey C. Posnick, Ramon L. Ruiz, Paul S. Tiwana -- Pediatric head and neck tumors: benign lesions / Shelly Abramowicz, Bonnie L. Padwa -- Pediatric malignant tumors of the head and neck / Sean P. Edwards -- Surgical care of the hemifacial microsomia patient / Stanley Yung-Chuan Liu, Phoebe Good, Janice S. Lee -- Mandibular dysostosis / Timothy A. Turvey -- Pediatric cranio-maxillofacial trauma: mandibular fractures / Paul S. Tiwana, Aaron Vickers -- Pediatric mid-face fractures / Clement Qaqish, John F. Caccamese, Jr.Diagnosis and management of temporomandibular joint pain and masticatory dysfunction / Franklin M. Dolwick, Shelly Abramowicz, Shahrokh C. Bagheri -- Temporomandibular joint: hypermobility and ankylosis / Gary F. Bouloux -- Alloplastic temporomandibular joint reconstruction / Louis G. Mercuri -- Current therapy of the effects of juvenile idiopathic arthritis on the facial skeleton / Robert W.T. Myall, R. Bryan Bell.Initial assessment of the facial cosmetic surgery patients / Husain Ali Khan, Shahrokh C. Bagheri -- Current trends in rhinoplasty / Shahrokh C. Bagheri, Husain Ali Khan -- Revision rhinoplasty / Behnam Bohluli, Shahrokh C. Bagheri -- Forehead, eyebrow and upper eyelid lifting / Angelo Cuzalina, Tarek Victor Copty -- Micrografting and hair transplantation surgery / Barry H. Hendler, David C. Stanton -- Rhytidectomy (face-lifting) / Angelo Cuzalina, Tarek Victor Copty, Husain Ali Khan -- Blepharoplasty / Joseph D. Walrath, Brent R. Hayek, Ted Wojno -- Ablative facial resurfacing / Matthew R. Hlavacek -- Treatment of non-melanoma skin cancer / Jill M. Weber, Jonathan S. Bailey -- Evaluation and management of maxillofacial vascular lesions / Edward T. Lahey III, Leonard B. Kaban.Obstructive sleep apnea: evaluation and treatment planning / Reginald H.B. Goodday -- Obstructive sleep apnea: surgical treatment: Part I, UPPP, genioglossus advancement, hyoid suspension / Robert A. Strauss, Adam P. McCormick -- Obstructive sleep apnea: surgical treatment: part II, maxillomandibular advancement for adults / Jeffrey R. Prinsell -- Obstructive sleep apnea:surgical treatment: part III, mandibular advancement for children / Brinda Thimmappa, Stephen A. Schendel.Antimicrobial treatment of head and neck infections / Thomas R. Flynn -- Principles and surgical management of head and neck infections / Thomas R. Flynn -- Ludwig's angina / Sam E. Farish.Elsevie
Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
No full textSustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available
Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51–12·1) deaths (19·2% 16·9–21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% 14·6–16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% 10·3–13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
No full textSummary Background Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to 20·2 billion (17·0–25·0) and on tuberculosis it was 5·1 billion (4·9–5·4). Development assistance for health was 374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding The Bill & Melinda Gates Foundation
Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019
No full textBackground: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95 uncertainty interval UI 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60· ) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning
No full textRecent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.ope
Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019 [Elektronisk resurs] : a systematic analysis for the Global Burden of Disease Study 2019
No full textIn an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.AuthorOverflow(1598
