32 research outputs found
The artistic Surpassing of a Burning Desire Friendship and Love in Jörg Wickrams ›Gabriotto und Reinhart‹
No full textIsolated, yet at the same time, in an environment that is hostile to them, the four characters Jorg Wickram imagines in his novel > Gabriotto und Reinhart< are alone together, as the two doomed couples are all also bound to each other in friendship. The construction of paradoxes, calculated primarily for effect, appears to be one of the novels controlled narrative devices. Much like the narratological strategies of intensification, exaggeration and repetition, they are controlled artifices designed for impact, and well-thought-out gambits on the part of the author which he uses, above all, to continue and intensify the tradition of medieval storytelling, and less frequently to counterpose an alternative understanding. Time and again the author makes use of the potential of widespread literary concepts to demonstrate that the love described in the novel is unparalleled
Performance-Based Budgeting in the U.S.
No full textPerformance-Based Budgeting, im Folgenden kurz PBB genannt, ist eine leistungsorientierte Budgetreform, die in der Verwaltung angewendet wird. Die Reform beinhaltet eine leistungsorientierte Haushaltsaufstellung. Diese soll auf der Basis einer strategischen und operativen Planung erfolgen. Der weitere Budgetprozess beinhaltet die Sammlung und Auswertung von Datenmaterial im Hinblick darauf, ob durch das Verwaltungshandeln angestrebte Ziele erreicht wurden.
PBB wird bereits in fast allen Staaten der U.S.A. angewandt, jedoch, wie die Untersuchung von drei sogenannten Vorreiterstaaten (Florida, Texas und Virginia) gezeigt hat, in unterschiedlichen Ausprägungen. In Florida werden Leistungsinformationen nachträglich an den intrinsischen Haushalt angefügt, in Texas und Virginia liegt ein einheitlicher ergebnisorientierter Haushalts vor, der gleichwohl unterschiedliche Strukturen aufweist. Die Verfasserin kommt zu dem Schluss, dass der Haushalt von Texas den höchsten Reifegrad aufweist, da bei diesem Strategien bzw. Maßnahmen zur Zielerreichung mit Budget verbunden wurden. Weiterhin verfügt Texas über hochwertige, strukturierte Methoden, um das Datenmaterial auf Reliabilität und Validität zu überprüfen.
Durch die Einführung von PBB entstehen auf der einen Seite neue bürokratische Prozesse sowie hohe Investitionskosten, z. B. in eine neue bzw. an PBB angepasste EDV. Demgegenüber stehen Einsparungen durch die Beseitigung ineffizienter Prozesse und eine effektivere Ressourcenverwendung. Ob vom finanziellen Aspekt die Bilanz positiv oder negativ ausfällt, vermag die Verfasserin nicht zu beurteilen, zumal die Reform mit ganz unterschiedlichen Ausprägungen angewandt wurde. Jedoch werden eine einheitliche Darstellung und Überprüfung der angestrebten Ziele, Ergebnisse, Leistungsstandards und Maßnahmen zur Zielerreichung, wie sie in Texas im Budgetprozess erfolgen, von der Verfasserin positiv beurteilt. Hierdurch wird Verwaltungshandeln transparent, es wird letztendlich sichtbar, ob auch angestrebte politische Ziele realisiert werden konnten. Dieses alles führt zu einer rationaleren und somit auch gerechteren Zuteilung von immer knapperen Haushaltsmitteln.
Um die Situation in Deutschland zu beurteilen, wurden zwei Modellprojekte, das „Neue Kommunale Finanzmanagement“ in NRW und das Modellprojekt „Zur Neuen Verwaltungssteuerung“ für das Land Hessen betrachtet. Die vorliegenden produktorientierten Haushalte von Kommunen in Nordrhein-Westfalen und der hessischen Landesverwaltung wurden analysiert. Diese Untersuchungen führten zu den Schlussfolgerungen, dass in Deutschland der Fokus bei der Reformierung des Haushaltswesens noch auf der Einführung eines adäquaten Rechnungswesens liegt. Eine outputorientierte Leistungssteuerung wird zwar ebenfalls angestrebt, zzt. können jedoch lediglich Ansätze einer systematischen Leistungsrechnung festgestellt werden.Performance-Based Budgeting is a government reform. It has the aim to establish strategic planning and performance measurement in the government. Performance-Based plans shall include a comprehensive mission statement covering the major functions and operations of the agency; general goals and objectives, including outcome-related goals and objectives , for the major functions and operations of the agency; a description of how the goals and objectives are to be achieved, and performance indicators to be used in measuring or asssessing the relevant outputs, service levels, and outcomes of each program activity.
Performance-Based Budgeting has been applied in nearly all states of the United States. The author researched three states: Florida, Virginia and Texas. These three states had been chosen because they have a history of using performance-oriented budgeting methods. Furthermore they have been nationally recognized for their budget reforms.
Although the three states used Performance-Based Budgeting the results, e.g. performance plans, strategic plans were very different. Texas showed an excellent use of the reform which resulted in a performance-based budget for the government. Florida on the other hand wasn’t able to eliminate the line-item budget. Performance informations are just made for some programs.
The reform has advantages and disadvantages. It improves the public accountability by promoting a new focus on transparency, results, service quality, and customer satisfaction. Another advantage is an improved internal management because of key measures. Legislators can make better budget decisions based on objective performance information of the different programs. Disadvantages are the high cost of the reform. For example, high investitions in the accounting software were necessary in the analyzed states. Furthermore to initiate and implement the reform additionals bureaucracy is necessary.
The author also examined prominent budget reforms in germany. The so called “Kommunales Finanzmanagement” in Nordrhein-Westfalen and the “Neue Verwaltungssteuerung” of the county of Hessen. The author concluded that the main focus is the introduction of an accounting system the so called “Doppik” and not the introduction of performance-based accounting information. This may follow in a further phase of the reforms
Modulation of ion channels by natural products - identification of hERG channel inhibitors and GABAA receptor ligands from plant extracts
No full textIon channels are expressed in virtually all cell types in the human body and are involved in various physiological processes. Hence, it is not surprising that ion channels play an important role in modern drug discovery. Lead compounds are nowadays routinely tested against a panel of ion channels to evaluate selectivity and potential off-target activities.
The human ether-à-go-go-related gene (hERG) channel, a voltage-gated potassium channel, is the currently most critical antitarget with respect to cardiac safety. Inhibition of the hERG channel can prolong the QT interval on the electrocardiogram (ECG) and, as a consequence, lead to life-threatening arrhythmia. Considering the daily intake of plant-derived foods and herbal products, surprisingly few natural products have been tested for hERG blocking properties. In the course of an interdisciplinary hERG project, a selection of widely used herbal drugs and dietary plants was screened by means of a two-microelectrode voltage-clamp assay with Xenopus oocytes. Moderate hERG block was observed for the traditional Chinese herbal drug Coptidis rhizoma and black pepper fruits, and successfully tracked by HPLC-based activity profiling to dihydroberberine and piperine, respectively. The hERG blocking activity of cinnamon, guarana, and nutmeg, in contrast, was attributed to tannins. Our screening data suggest that major European medicinal plants and frequently consumed food plants are associated with a low risk for hERG inhibition. However, the case of Coptidis rhizoma pointed towards a need for a more thorough assessment of herbal drugs of the traditional Chinese medicine (TCM). Subsequent screening of a plant-derived alkaloid library led to the identification of several potent hERG blockers. Further investigations are certainly warranted to assess the cardiac safety profile of these alkaloids.
Dehydroevodiamine (DHE), a major bioactive constituent of the traditional Chinese herbal drug Evodiae fructus, has been previously shown to inhibit several cardiac ion currents in vitro. For further evaluation of its in vivo pharmacological and toxicological properties, gram amounts of DHE were needed. Since DHE is not commercially available, we developed an efficient method for its gram-scale isolation from a crude Evodia extract. Our approach is based on a combination of cation-exchange chromatography and preparative RP-HPLC. Moreover, the DHE content in commercially available Evodia products was assessed by HPLC-PDA analysis. A daily intake of up to mg amounts of DHE was calculated from recommended doses of these products. We also devised a procedure for the production of DHE-depleted Evodia products, should DHE indeed turn out to be toxicologically relevant.
The gamma-aminobutyric acid type A (GABAA) receptor, a ligand-gated chloride channel, mediates fast inhibitory neurotransmission in the central nervous system (CNS), and is thus a clinically important drug target. In the search for positive α1β2γ2S GABAA receptor modulators of plant origin, we investigated an extract of Curcuma kwangsiensis rhizomes. HPLC-based activity profiling was used in combination with a two-microelectrode voltage-clamp assay on Xenopus oocytes to identify the active constituents. Targeted isolation afforded a series of 11 structurally related labdane diterpenoids, including four new natural products. Structure elucidation was achieved by comprehensive analysis of HR-ESI-TOF-MS and NMR data. The absolute configuration of the compounds was assigned by electronic circular dichroism (ECD). The highest GABAA receptor modulating activity was observed for zerumin A.
From a more general perspective, this study demonstrates that HPLC-based activity profiling is an effective strategy to characterize bioactive compounds in crude natural extracts
a scientometric analysis and data acquisition of a global problem
No full textErtrinken ist ein beständiges globales Problem, das Schätzungen zufolge
jährlich etwa einer halben Million Menschen das Leben kostet, vorwiegend in
Entwicklungs- und Schwellenländern. Die Anzahl Beinahe-Ertrunkener übersteigt
die Zahl der Ertrinkungsopfer um ein Vielfaches. In vorliegender Arbeit wird
mittels szientometrischer Analysen das bisherige wissenschaftliche
Forschungsaufkommen zum Thema Ertrinken, d.h. die in den Datenbanken ISI-Web
und PubMed verzeichnete Literatur quantitativ und qualitativ untersucht. Für
den Zeitraum von 1900 bis einschließlich 2006 beträgt die Anzahl der zum
Suchbegriff „drowning“ veröffentlichten bzw. in ISI-Web indexierten Arbeiten
2381, wobei die Publikationsleistung in den vergangen Jahren beinahe stetig
zugenommen hat. Rund 93 Prozent dieser Publikationen erscheinen in englischer
Sprache; etwa 71 Prozent sind Originalarbeiten. Das mit Abstand höchste
Forschungssaufkommen zeigt die USA mit 800 themenbezogenen Veröffentlichungen.
Die meisten Ertrinkungstoten im Jahre 2002 werden von der WHO in China
(113.000) und Indien (69.000) gezählt; die höchsten Ertrinkungsraten hingegen
entfallen vorwiegend auf Staaten des afrikanischen Kontinents. Laut den
Zitationsanalysen entfallen die meisten Zitierungen (36) auf die Publikationen
des Jahres 1921. Bei Betrachtung der Zitationen nach Zitationsjahr weist das
Jahr 2006 mit einem Wert von 1770 die meisten Zitierungen auf. Die
Trendanalyse veranschaulicht eine Zunahme an Zitationen für die vergangen
Jahre. Englisch ist nicht nur die dominante Publikationssprache, sondern auch
die am häufigsten zitierte Sprache mit durchschnittlich 8,84 Zitierungen pro
Arbeit. Auch die zum Thema Ertrinken meistpublizierenden Zeitschriften sind
ausnahmslos auf Englisch. Unter ihnen befindet sich mit dem JAMA (Journal of
the American Medical Association) ein sehr renommiertes medizinisches Journal
mit einem Impactfaktor von 23,175 für das Jahr 2006. Die Untersuchung nach
Themenschwerpunkten ergibt, dass mit einem Anteil von 16,67 Prozent die
meisten Arbeiten der Kategorie Medicine, General & Internal zugeordnet werden.
Die Analyse nach Subheadings in der Datenbank PubMed zeigt auf, dass in den
zehn publikationsstärksten Ländern vorwiegend zur Epidemiologie, Ätiologie und
Diagnose von Ertrinkungsereignissen geforscht wird. Bei der Autorenanalyse tut
sich Modell, JH mit 34 Publikationen als produktivster Autor deutlich hervor.
Interesse und Resonanz seitens der Forschungsgemeinschaft am Thema Ertrinken
sind in den vergangen drei Jahrzehnten stetig gestiegen. Es ist anzunehmen,
dass aufgrund der Aktualität der Ertrinkungsunfälle (z.B. durch
Naturkatastrophen) und im Zuge des Klimawandels die wissenschaftliche
Hinwendung zum Thema Ertrinken noch größere Dimensionen erlangt.Drowning is a constant global problem which claims about half a million
victims worldwide each year, mainly in developing countries. The number of
near-drowning victims is considerably higher. The previous and current
literature of the subject “drowning” will be analysed quantitatively and
qualitatively by using scientometric tools. There were 2381 articles listed in
the ISI-Web, using the search term “drowning” and including the years 1900
until 2006. The publication effort has increased constantly in the past few
years. Almost 93 per cent of these articles were published in English,
approximately 71 per cent are original papers. With 800 articles about
drowning, the United States are the most publishing nation by far. According
to the WHO data of the year 2002, the highest numbers of drowning victims are
recorded in China (113000) and India (69000). However, the highest drowning
rates are allotted to African states. According to the citation analysis, most
citations (36) are allotted to the publications of the year 1921. Regarding
the citations of citation years, most citations (1770) are recorded for the
year 2006. The trend analysis demonstrates an increase of citations for the
past years. English is not only the dominant publication language but also the
most cited language with an average of 8.84 citations per article. Without
exception, also all journals publishing to the topic drowning are in English.
Among them is the JAMA (Journal of the American Medical Association), a very
famous medical journal with an impact factor of 23.175 for the year 2006. The
analysis of the subject area shows that most papers (16.67 per cent) are
related to the category Medicine, General & Internal. The subheading analysis
on the PubMed database demonstrates that among the ten most publishing
nations, the main subheadings are epidemiology, etiology and diagnosis of
drowning incidents. According to the author analysis, the most productive
author is Modell, JH with 34 articles about the subject drowning. Interest and
feedback on the part of the research community on the topic drowning have been
rising continuously in the past three decades. It can be assumed that,
according to the actuality of drowning incidents, e.g. because of natural
catastrophes, and the climate change, the scientific turning to the subject
drowning will achieve even greater dimensions
Patterns of perceived addiction in relation to e-cigarette use and associations with vaping and smoking cessation: a longitudinal analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey 2016 – 2020
No full textOur recent cross-sectional analysis of the patterns and correlates of perceived addiction to electronic cigarettes (e-cigarettes) and perceived addictiveness of e-cigarettes relative to tobacco cigarettes (relative addictiveness) showed that levels of perceived addiction were associated with established markers of addiction (e.g., time to first e-cigarette after waking (Lohner, 2023)), suggesting that self-reported perceived addiction might serve as indicator of addiction. Additionally, it indicated that positive and negative reinforcement, reflected by enjoyment and satisfaction of e-cigarettes relative to tobacco cigarettes, might play a role in e-cigarette addiction (Lohner et al., 2023). Here, we propose to investigate these associations longitudinally over a four-year period.
The main objective of this proposed study is to examine trends of perceived addiction to e-cigarettes over a four-year span, focusing on changes in markers of addiction and vaping and smoking characteristics. Furthermore, associations of perceived addiction and relative addictiveness with changes in e-cigarette usage patterns (quitting smoking, quitting e-cigarette use) will be examined.
Lohner V, McNeill A, Schneider S, Vollstädt-Klein S, Andreas M, Szafran D, Grundinger N, Demjén T, Fernandez E, Przewozniak K, Tountas Y, Trofor A, Zatonski W, Willemsen MC, Vardavas C, Fong GT, Mons U. Understanding perceived addiction to and addictiveness of electronic cigarettes among electronic cigarette users: a cross-sectional analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey. Addiction. 2023 Feb 11. doi: 10.1111/add.16162. Epub ahead of print. PMID: 36772958
Patterns of perceived addiction in relation to e-cigarette use and associations with vaping and smoking cessation: a longitudinal analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey 2016 – 2020
No full textOur recent cross-sectional analysis of the patterns and correlates of perceived addiction to electronic cigarettes (e-cigarettes) and perceived addictiveness of e-cigarettes relative to tobacco cigarettes (relative addictiveness) showed that levels of perceived addiction were associated with established markers of addiction (e.g., time to first e-cigarette after waking (Lohner, 2023)), suggesting that self-reported perceived addiction might serve as indicator of addiction. Additionally, it indicated that positive and negative reinforcement, reflected by enjoyment and satisfaction of e-cigarettes relative to tobacco cigarettes, might play a role in e-cigarette addiction (Lohner et al., 2023). Here, we propose to investigate these associations longitudinally over a four-year period.
The main objective of this proposed study is to examine trends of perceived addiction to e-cigarettes over a four-year span, focusing on changes in markers of addiction and vaping and smoking characteristics. Furthermore, associations of perceived addiction and relative addictiveness with changes in e-cigarette usage patterns (quitting smoking, quitting e-cigarette use) will be examined.
Lohner V, McNeill A, Schneider S, Vollstädt-Klein S, Andreas M, Szafran D, Grundinger N, Demjén T, Fernandez E, Przewozniak K, Tountas Y, Trofor A, Zatonski W, Willemsen MC, Vardavas C, Fong GT, Mons U. Understanding perceived addiction to and addictiveness of electronic cigarettes among electronic cigarette users: a cross-sectional analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey. Addiction. 2023 Feb 11. doi: 10.1111/add.16162. Epub ahead of print. PMID: 36772958
The Longer, the Better? An Empirical Study of the Extent and Mechanisms of Attenuating Biomarker Associations in Cardiovascular Patient Cohorts.
No full textIdentifying novel risk markers in cardiovascular patients remains a research priority. Longer follow-up generally is considered favorable in such studies, but associations of interest may become attenuated with increasing follow-up. This issue has not been adequately addressed in the context of patient cohorts. The current study analyzed the extent and mechanisms of attenuating associations in a cardiovascular patient cohort.The associations of numerous biomarkers with all-cause mortality were estimated by multiple Cox regression in the Langzeiterfolge der KARdiOLogischen Anschlussheilbehandlung (KAROLA) prospective cohort study of 1204 patients who had participated in an inpatient rehabilitation program after an acute coronary syndrome (ACS) or coronary bypass operation. Hazard ratios were estimated based on the entire follow-up period (13 years), and after truncation at previous follow-up times (3, 4.5, 6, 8, 10 years).For the majority of markers, a clear and sometimes very pronounced attenuation of the hazard ratios could be observed with increasing follow-up duration. Differential attrition generally was not a sufficient explanation for this phenomenon, whereas further analyses suggested a role for reverse causality for some of the markers. Power analyses showed that the relationship of follow-up duration and statistical power can be counterintuitive in the presence of realistic amounts of attenuation.The attenuation of estimates of association in patient cohorts is a much more substantial and complex issue than currently appreciated. This has important implications for the design and interpretation of prognostic, as well as etiologic, studies which may be particularly relevant in the case of patient cohorts defined by an initial acute event
Growth Differentiation Factor 15, Its 12-Month Relative Change, and Risk of Cardiovascular Events and Total Mortality in Patients with Stable Coronary Heart Disease: 10-Year Follow-up of the KAROLA Study.
No full textThis study considered whether baseline concentrations and 12-month changes of growth differentiation factor 15 (GDF-15) are associated with subsequent cardiovascular events (CVEs) and total mortality in patients with stable coronary heart disease.Baseline GDF-15 serum concentrations were measured in 1073 participants in a cardiac rehabilitation program (median follow-up 10 years). GDF-15 associations with subsequent CVE and total mortality were evaluated by Cox-proportional hazards models adjusting for well-established cardiovascular risk factors (Model 2), plus N-terminal probrain natriuretic peptide, high-sensitivity (hs) CRP, and hs cardiac troponin T (Model 3).In our study population [84.7% men, mean age 59 years, median baseline GDF-15 1232 ng/L (interquartile range, 916, 1674)] we observed 190 CVE and 162 deaths. Compared to participants with GDF-15 =1200 and 1800 ng/L [HR 1.73 (1.02-2.94)], even in Model 3. The 12-month relative median change was -16.7%. As compared to participants with 12-month relative changes between -20% and 20%, GDF-15 increments >20% were associated with: a) an HR of 1.84 (1.04-3.26) for CVE in Model 2, but found nonsignificant in Model 3; (b) an HR of 2.26 (1.32-3.86) for death even in Model 3.GDF-15 at baseline is independently associated with subsequent CVE and 10-year total mortality. Twelve-month relative changes remained associated with subsequent CVE when adjusting for well-established cardiovascular risk factors, and with total mortality even after further adjustment for established cardiac biomarkers
Increased Plasma Concentrations of Soluble ST2 Independently Predict Mortality but not Cardiovascular Events in Stable Coronary Heart Disease Patients: 13-Year Follow-up of the KAROLA Study.
No full textsST2 (soluble suppression of tumorigenicity 2), a member of the interleukin-1 family, has been suggested to play a role in cardiac remodeling and inflammatory signaling. We assessed the association between sST2 in patients with stable coronary heart disease (CHD) with multiple cardiovascular outcomes and total mortality, simultaneously controlling for a large number of potential confounders.Plasma concentrations of sST2 (ELISA, Critical Diagnostics) were measured at baseline in a cohort of 1081 patients. The Cox-proportional hazards model was used to determine the prognostic value of sST2 on a combined cardiovascular disease (CVD) endpoint, on cardiovascular death, and on total mortality after adjustment for covariates.The median sST2 level was 28.9 ng/mL (IQR 23.8, 35.1) (mean age at baseline 58.9 years, 84.6% male). sST2 concentration was positively correlated with inflammatory markers and emerging risk factors, e.g., cystatin C, N-terminal probrainnatriuretic peptide (NT-proBNP), high-sensitivity (hs)-Troponin T and I, mid-regional pro-atrial natriuretic peptide (MR-proANP), and growth differentiation factor 15 (GDF-15). Results after short- and long-term (4.5 and 12.3 years, respectively) follow-up (FU) displayed no statistically significant association with the combined endpoint of non-fatal and fatal CVD events when the top quartile (Q4) of sST2 concentration was compared to the bottom quartile (Q1). A relationship during long-term FU was seen with CVD mortality even after multivariable adjustments including clinical risk variables (HR 1.65; 95% CI 1.02-2.86), but not in a fully adjusted model whereas, in contrast, it was still highly significant after short-term FU (HR (5.97 (95%CI 1.32-27.06)). In addition, the sST2 concentration was still strongly associated with total mortality in the fully adjusted model including clinical variables and cystatin C based estimated glomerular filtration rate, NT-proBNP, hsCRP and hs-TnI comparing Q4 vs Q1 during long-term FU (HR of 1.48 (95% CI 1.03-2.13)) and short-term FU (HR 3.06 (95% CI 1.29-7.24)).Elevated levels of sST2 concentration in stable CHD patients may independently predict short- and long-term risk for fatal CVD events and total mortality but not non-fatal CVD events
Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019
No full textBACKGROUND:While most European Regions perform well in global comparisons, large discrepancies within stroke epidemiological parameters exist across Europe. The objective of this analysis was to evaluate the stroke burden across European regions and countries in 2019 and its difference to 2010.METHODS:The GBD 2019 analytical tools were used to evaluate regional and country-specific estimates of incidence, prevalence, deaths, and disability-adjusted life years of stroke for the European Region as defined by the World Health Organization, with its 53 member countries (EU-53) and for European Union as defined in 2019, with its 28 member countries (EU-28), between 2010 and 2019. Results were analyzed at a regional, subregional, and country level.RESULTS:In EU-53, the absolute number of incident and prevalent strokes increased by 2% (uncertainty interval [UI], 0%-4%), from 1 767 280 to 1 802 559 new cases, and by 4% (UI, 3%-5%) between 2010 and 2019, respectively. In EU-28, the absolute number of prevalent strokes and stroke-related deaths increased by 4% (UI, 2%-5%) and by 6% (UI, 1%-10%), respectively. All-stroke age-standardized mortality rates, however, decreased by 18% (UI, -22% to -14%), from 82 to 67 per 100 000 people in the EU-53, and by 15% (UI, -18% to -11%), from 49.3 to 42.0 per 100 000 people in EU-28. Despite most countries presenting reductions in age-adjusted incidence, prevalence, mortality, and disability-adjusted life year rates, these rates remained 1.4x, 1.2x, 1.6x, and 1.7x higher in EU-53 in comparison to the EU-28.CONCLUSIONS:EU-53 showed a 2% increase in incident strokes, while they remained stable in EU-28. Age-standardized rates were consistently lower for all-stroke burden parameters in EU-28 in comparison to EU-53, and huge discrepancies in incidence, prevalence, mortality, and disability-adjusted life-year rates were observed between individual countries
