15 research outputs found
The safety and efficacy of N-acetylcysteine as an augmentation in the treatment of obsessive-compulsive disorder in adults: a systematic review and meta-analysis of randomized clinical trials
No full textBackground: Obsessive-compulsive disorder (OCD) ranks as the fourth most prevalent psychiatric disorder, with selective serotonin reuptake inhibitors (SSRIs) as its mainstay pharmacological treatment. However, approximately 40 to 60% of patients do not adequately respond to initial treatment, highlighting the need for alternative options. N-acetylcysteine (NAC) is one of the several medications that have been used in augmentation with SSRIs to enhance their efficacy. Objectives: We aimed to investigate the safety and efficacy of NAC, a glutamate-modulating agent, as an augmentation in the treatment of moderate to severe OCD. Method: We conducted a thorough search across PubMed, Scopus, Web of science, and ProQuest to identify relevant trials published until December 2023. The primary outcome of interest was the mean difference between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores before and after administrating augmented NAC among patients with moderate to severe OCD. Furthermore, we compared the occurrence of adverse drug events between the experimental and control groups. Results: We included six randomized controlled trials with 195 patients. The results of our study indicated a positive outcome for the experimental group in terms of the total Y-BOCS score when using the medication for a period of five to eight weeks (p-Value = 0.05). However, no significant difference was observed for durations shorter than five weeks or longer than 12 weeks. Additionally, no significant difference was found between the two groups in terms of the obsession and compulsion Y-BOCS scores. Furthermore, no significant differences were observed in terms of adverse events. Conclusion: Augmentation of NAC with SSRIs may benefit patients with moderate to severe OCD. However, it is necessary to conduct additional multi-center trials over extended periods to develop a comprehensive strategy for action
Examining Convective Froude Number as a Fire Spread Rate and Plume Structure Predictor Using WRF Model
No full textFire responders and local authorities face significant challenges when dealing with extreme wildfires. These fires are unpredictable and exhibit varying spread rates and plume structures depending on whether the fire regime is plume-driven or wind-driven. To better predict fire spread in these uncertain scenarios, it is crucial to gain a deeper understanding of the drivers of the fire regime. Here, we examine the Froude Number to predict the plume structure and fire spread rate using idealized simulations run with the Weather Research and Forecasting (WRF) model. Changing levels of relative humidity in the atmosphere as well as different fuel types can provide further insight into how fire spreads in varying conditions. The intensity of wildfires has greatly increased over the past several years and that trend is predicted to continue in the near future. By improving predictions of fire spread and plume structure during wildfire events, our results directly help the work of firefighters, potentially leading to less infrastructure damage and more lives saved.This material is based upon work supported by the National Science Foundation under Grant No. AGS-1641177 (SOARS). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation
Three-month functional outcomes of acute ischemic stroke in patients with chronic renal function impairment.
No full textBackgroundChronic renal function impairment (RFI) increases the risk of acute ischemic stroke (AIS), greater stroke severity, and post-stroke disability and mortality.ObjectiveWe aimed to assess the three-month functional outcomes of AIS in patients with chronic RFI.MethodsIn this prospective study, stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were assessed using the modified Rankin Scale (mRS). Outcomes were analyzed based on estimated glomerular filtration rate (eGFR).ResultsAmong the 205 patients included (median age: 70 years, IQR: 61-82), 123 (60%) were male. Patients with lower eGFR had higher NIHSS scores (more severe strokes) and higher mRS scores at both baseline and three months (poorer functional outcomes). Based on a logistic regression model adjusted for confounding factors, higher eGFR was significantly associated with good three-month functional outcomes (adjusted OR = 2.634, 95% CI [1.207, 5.748], p = 0.015).ConclusionsChronic RFI is associated with more severe strokes and poorer baseline and three-month functional outcomes after AIS. Future research should explore targeted management strategies to improve post-stroke recovery in this population
Gut Microbiota and Obsessive–Compulsive Disorder: A Systematic Review of Mechanistic Links, Evidence from Human and Preclinical Studies, and Therapeutic Prospects
No full textObsessive–compulsive disorder (OCD) is a multifactorial condition, and interest in gut–brain interactions is increasing. We conducted a systematic two-step review, registered in PROSPERO (CRD420251083936). Step 1 mapped core OCD biology to gut-relevant pathways, including neuroimmune activation, epithelial barrier function, microbial metabolites, and stress circuitry, to clarify plausible mechanisms. Step 2 synthesized evidence from human and preclinical studies that measured or manipulated microbiota. Searches across PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane (September 2025) yielded 357 biological and 20 microbiota-focused studies. Risk of bias was assessed using the Joanna Briggs Institute checklist for human studies and SYRCLE’s tool for animal studies. Although taxonomic findings in human cohorts were heterogeneous, functional patterns converged: reduced short-chain fatty acid capacity, enrichment of pro-inflammatory pathways, and host markers of barrier disruption and inflammation correlating with OCD severity. Transferring patient microbiota to mice induced OCD-like behaviors with neuroinflammatory changes, partly rescued by metabolites or barrier-supporting strains. Mendelian randomization suggested possible causal contributions at higher taxonomic levels. Diet, especially fiber intake, and psychotropic exposure were major sources of heterogeneity. Evidence supports the microbiota as a modifiable co-factor in a subset of OCD, motivating diet-controlled, stratified clinical trials with composite host–microbe endpoints
Broadening the paradigm of laminin α2-related muscular dystrophy: A case of partial merosin deficiency with compound heterozygous variants
No full textLaminin α2-related muscular dystrophy is a rare autosomal recessive condition caused by mutations in the LAMA2 gene, with clinical presentations ranging from severe congenital forms to milder phenotypes resembling limb-girdle muscular dystrophy. We report a case of a 4-month-old girl presenting with delayed head control, axial hypotonia, and proximal muscle weakness, while cognitive and cardiac functions remained preserved. Laboratory evaluations revealed elevated serum creatine phosphokinase and lactate dehydrogenase levels. Muscle biopsy demonstrated dystrophic changes and partial merosin deficiency. Whole-exome sequencing identified two heterozygous variants in LAMA2: a known missense variant ( c.6548T>G; p.L2183R ) and another likely pathogenic missense variant ( c.6979G>T; p.G2327 ). However, targeted parental testing and quantitative PCR confirmed c.6548T>G as paternally inherited and revealed a novel heterozygous frameshift deletion ( c.291delC ) maternally inherited, consistent with compound heterozygosity in trans. The c.6979G>T variant was not confirmed as part of the disease-causing allele combination. In silico analyses supported the pathogenicity of the novel deletion. The patient received multidisciplinary care, including individualized physical and occupational therapy, and her family received genetic counseling. This case highlights the diagnostic value of early genetic testing, the importance of confirming inheritance patterns, and the contribution of novel LAMA2 mutations to the understanding of genotype–phenotype correlations in laminin α2-related muscular dystrophy
Risk Factors of Ankle Sprain in Soccer Players: A Systematic Review and Meta-Analysis
No full textBackground: Soccer is associated with substantial injury risk, with reported between 13 to 35 injuries per 1000 player-hours of competitive play. Notably, approximately 77% of soccer-related ankle injuries are attributed to ankle sprain injuries (ASIs). ASI can lead to chronic ankle instability, obesity, and post-traumatic osteoarthritis. This study focuses on identifying factors such as gender, age, body mass index (BMI), and a history of ASIs, which contribute to the development of ASI in soccer players. Methods: A systematic literature search was conducted in October 2023 across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and ProQuest, without applying any filters. Keywords included ankle, ankle joint, sprain, risk factors, etc. Data extraction was performed on the included studies, with findings standardized and analyzed using Stata Statistical Software: Release 17 to determine a weighted treatment effect. Results: Our systematic review included 26 studies. The meta-analysis revealed that a history of ankle sprain is the most significant risk factor for future ASIs. BMI emerged as a risk factor in three out of seven studies, while age and height were significant in one out of six studies each. Gender and weight were not found to significantly affect ASI occurrence. Other factors identified but not subjected to a meta-analysis due to methodological heterogeneity or insufficient studies included playing surface, joint laxity, muscle weakness, match congestion, strength asymmetries, ground reaction forces, balance maintenance, skill level, and playing position. Conclusions: This research contributes valuable insights into the prevention of ASIs in soccer, highlighting the importance of previous ankle sprains and playing surface quality. These findings assist sports professionals in developing optimal conditions and strategies for effective ankle sprain prevention
A Cross-Sectional Study of Patient Satisfaction Among Immigrants in the Pediatric Outpatient Clinic of Firoozabadi Hospital
No full textPatient satisfaction is important in healthcare as it affects the quality of care and can lower costs in hospitals. This study aimed to measure immigrant satisfaction with outpatient services at Firoozabadi Hospital's pediatric clinic. Data were collected from immigrant patients from January to July 2023. The Patient Satisfaction Questionnaire 18 and the personal information checklist were used in oral interviews with caregivers. The overall satisfaction score was 72.95 out of 90, with a standard deviation of 12.57. Financial issues received the lowest satisfaction scores, while interpersonal manner received the highest ratings. Out of the 241 respondents, 48.6% were completely satisfied, 32.7% were satisfied, 10.6% had no opinion, and 4.4% expressed dissatisfaction. Satisfaction levels were not correlated with income, education, possession of identification documents or health insurance, and length of stay in Iran. Overall, most participants were happy with the outpatient services, but many lacked health insurance. Providing easier access to health insurance for immigrants could help reduce dissatisfaction with expensive medical bills
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22¿223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30¿763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31¿642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.Research reported in this publication was supported by the Gates Foundation, UK Department of Health and Social Care, the Norwegian Institute of Public Health, and the New Zealand Ministry of Health. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license no. SLN2019-8-64 and SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law-2000.Peer ReviewedArticle signat per 1836 autors/es: Austin E Schumacher, Hmwe Hmwe Kyu, Amirali Aali, Cristiana Abbafati, Jaffar Abbas, Rouzbeh Abbasgholizadeh, Madineh Akram Abbasi, Mohammadreza Abbasian, Samar Abd ElHafeez, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab, Mohammad Abdollahi, Meriem Abdoun, Auwal Abdullahi, Ame Mehadi Abdurehman, Mesfin Abebe, Aidin Abedi, Armita Abedi, Tadesse M Abegaz, Roberto Ariel Abeldaño Zuñiga, E S Abhilash, Olugbenga Olusola Abiodun, Richard Gyan Aboagye, Hassan Abolhassani, Mohamed Abouzid, Lucas Guimarães Abreu, Woldu Aberhe Abrha, Michael R M Abrigo, Dariush Abtahi, Samir Abu Rumeileh, Niveen ME Abu-Rmeileh, Salahdein Aburuz, Ahmed Abu-Zaid, Juan Manuel Acuna, Tim Adair, Isaac Yeboah Addo, Oladimeji M Adebayo, Oyelola A Adegboye, Victor Adekanmbi, Bashir Aden, Abiola Victor Adepoju, Charles Oluwaseun Adetunji, Temitayo Esther Adeyeoluwa, Olorunsola Israel Adeyomoye, Rishan Adha, Amin Adibi, Wirawan Adikusuma, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Abel Afework, Aanuoluwapo Adeyimika Afolabi, Ali Afraz, Shadi Afyouni, Saira Afzal, Pradyumna Agasthi, Shahin Aghamiri, Antonella Agodi, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Aqeel Ahmad, Danish Ahmad, Firdos Ahmad, Muayyad M Ahmad, Tauseef Ahmad, Keivan Ahmadi, Amir Mahmoud Ahmadzade, Mohadese Ahmadzade, Ayman Ahmed, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Olufemi Ajumobi, Gizachew Taddesse Akalu, Essona Matatom Akara, Karolina Akinosoglou, Sreelatha Akkala, Samuel Akyirem, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Ammar Al Homsi, Mohammad Al Qadire, Moein Ala, Timothy Olukunle Aladelusi, Tareq Mohammed Ali AL-Ahdal, Samer O Alalalmeh, Ziyad Al-Aly, Khurshid Alam, Manjurul Alam, Zufishan Alam, Rasmieh Mustafa Al-amer, Fahad Mashhour Alanezi, Turki M Alanzi, Mohammed Albashtawy, Mohammad T AlBataineh, Robert W Aldridge, Sharifullah Alemi, Ayman Al-Eyadhy, Adel Ali Saeed Al-Gheethi, Khalid F Alhabib, Fadwa Alhalaiqa Naji Alhalaiqa, Mohammed Khaled Al-Hanawi, Abid Ali, Akhtar Ali, Beriwan Abdulqadir Ali, Hassam Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Shujait Ali, Zahid Ali, Shohreh Alian Samakkhah, Gianfranco Alicandro, Sheikh Mohammad Alif, Mohammad Aligol, Rasoul Alimi, Ahmednur Adem Aliyi, Adel Al-Jumaily, Syed Mohamed Aljunid, Wael Almahmeed, Sabah Al-Marwani, Sadeq Ali Ali Al-Maweri, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Omar Almidani, Mahmoud A Alomari, Nivaldo Alonso, Jaber S Alqahtani, Ahmed Yaseen Alqutaibi, Salman Khalifah Al-Sabah, Awais Altaf, Jaffar A Al-Tawfiq, Khalid A Altirkawi, Farrukh Jawad Alvi, Hassan Alwafi, Yaser Mohammed Al-Worafi, Hany Aly, Karem H Alzoubi, Azmeraw T Amare, Edward Kwabena Ameyaw, Abebe Feyissa Amhare, Tarek Tawfik Amin, Alireza Amindarolzarbi, Javad Aminian Dehkordi, Sohrab Amiri, Hubert Amu, Dickson A Amugsi, Jimoh Amzat, Robert Ancuceanu, Deanna Anderlini, Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei, Dhanalakshmi Angappan, Abhishek Anil, Afifa Anjum, Catherine M Antony, Ernoiz Antriyandarti, Iyadunni Adesola Anuoluwa, Sumadi Lukman Anwar, Anayochukwu Edward Anyasodor, Seth Christopher Yaw Appiah, Muhammad Aqeel, Jalal Arabloo, Razman Arabzadeh Bahri, Morteza Arab-Zozani, Mosab Arafat, Ana Margarida Araújo, Aleksandr Y Aravkin, Abdulfatai Aremu, Hany Ariffin, Timur Aripov, Benedetta Armocida, Mahwish Arooj, Anton A Artamonov, Kurnia Dwi Artanti, Judie Arulappan, Idowu Thomas Aruleba, Raphael Taiwo Aruleba, Ashokan Arumugam, Malke Asaad, Saeed Asgary, Mubarek Yesse Ashemo, Muhammad Ashraf, Marvellous O Asika, Seyyed Shamsadin Athari, Maha Moh’d Wahbi Atout, Alok Atreya, Sameh Attia, Avinash Aujayeb, Abolfazl Avan, Adedapo Wasiu Awotidebe, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Getnet Melaku Ayele, Jose L Ayuso-Mateos, Seyed Mohammad Ayyoubzadeh, Sina Azadnajafabad, Gulrez Shah Azhar, Shahkaar Aziz, Ahmed Y Azzam, Mina Babashahi, Abraham Samuel Babu, Muhammad Badar, Alaa Badawi, Ashish D Badiye, Soroush Baghdadi, Nasser Bagheri, Sara Bagherieh, Sulaiman Bah, Saeed Bahadorikhalili, Jianjun Bai, Ruhai Bai, Jennifer L Baker, Shankar M Bakkannavar, Abdulaziz T Bako, Senthilkumar Balakrishnan, Saliu A Balogun, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Palash Chandra Banik, Hansi Bansal, Shirin Barati, Martina Barchitta, Mainak Bardhan, Suzanne Lyn Barker-Collo, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Ronald D Barr, Lope H Barrero, Zarrin Basharat, Asma’u I J Bashir, Hameed Akande Bashiru, Pritish Baskaran, Buddha Basnyat, Quique Bassat, João Diogo Basso, Saurav Basu, Kavita Batra, Ravi Batra, Bernhard T Baune, Mohsen Bayati, Nebiyou Simegnew Bayileyegn, Thomas Beaney, Neeraj Bedi, Tahmina Begum, Emad Behboudi, Amir Hossein Behnoush, Maryam Beiranvand, Diana Fernanda Bejarano Ramirez, Uzma Iqbal Belgaumi, Michelle L Bell, Aminu K Bello, Muhammad Bashir Bello, Olorunjuwon Omolaja Bello, Luis Belo, Apostolos Beloukas, Salaheddine Bendak, Derrick A Bennett, Isabela M Bensenor, Habib Benzian, Zombor Berezvai, Adam E Berman, Amiel Nazer C Bermudez, Paulo J G Bettencourt, Habtamu B Beyene, Kebede A Beyene, Devidas S Bhagat, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Prarthna V Bhardwaj, Ashish Bhargava, Sonu Bhaskar, Vivek Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti, Rajbir Bhatti, Zulfiqar A Bhutta, Boris Bikbov, Nada Binmadi, Bagas Suryo Bintoro, Antonio Biondi, Catherine Bisignano, Francesca Bisulli, Atanu Biswas, Raaj Kishore Biswas, Saeid Bitaraf, Tone Bjørge, Archie Bleyer, Mary Sefa Boampong, Virginia Bodolica, Aadam Olalekan Bodunrin, Obasanjo Afolabi Bolarinwa, Milad Bonakdar Hashemi, Aime Bonny, Kaustubh Bora, Berrak Bora Basara, Safiya Bala Borodo, Rohan Borschmann, Alejandro Botero Carvajal, Souad Bouaoud, Sofiane Boudalia, Edward J Boyko, Nicola Luigi Bragazzi, Dejana Braithwaite, Hermann Brenner, Gabrielle Britton, Annie J Browne, Andre R Brunoni, Norma B Bulamu, Lemma N Bulto, Danilo Buonsenso, Katrin Burkart, Richard A Burns, Sharath Burugina Nagaraja, Reinhard Busse, Yasser Bustanji, Zahid A Butt, Florentino Luciano Caetano dos Santos, Tianji Cai, Daniela Calina, Luis Alberto Cámera, Luciana Aparecida Campos, Ismael R Campos-Nonato, Chao Cao, Carlos Alberto Cardenas, Rosario Cárdenas, Sinclair Carr, Giulia Carreras, Juan J Carrero, Andrea Carugno, Felix Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Ferrán Catalá-López, Alberico L Catapano, Maria Sofia Cattaruzza, Arthur Caye, Christopher R Cederroth, Francieli Cembranel, Muthia Cenderadewi, Kelly M Cercy, Ester Cerin, Muge Cevik, Pamela R Uscamaita Chacón-Uscamaita, Yaacoub Chahine, Chiranjib Chakraborty, Jeffrey Shi Kai Chan, Chin-Kuo Chang, Periklis Charalampous, Jaykaran Charan, Vijay Kumar Chattu, Victoria Chatzimavridou-Grigoriadou, Malizgani Paul Chavula, Huzaifa Ahmad Cheema, An-Tian Chen, Haowei Chen, Lingxiao Chen, Meng Xuan Chen, Simiao Chen, Nicolas Cherbuin, Derek S Chew, Gerald Chi, Jesus Lorenzo Chirinos-Caceres, Abdulaal Chitheer, So Mi Jemma Cho, William C S Cho, Bryan Chong, Hitesh Chopra, Rahul Choudhary, Rajiv Chowdhury, Dinh-Toi Chu, Isaac Sunday Chukwu, Eric Chung, Eunice Chung, Sheng-Chia Chung, Karly I Cini, Cain C T Clark, Kaleb Coberly, Alyssa Columbus, Haley Comfort, Joao Conde, Sara Conti, Paolo Angelo Cortesi, Vera Marisa Costa, Ewerton Cousin, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Patricia Cullen, Matthew Cunningham, Daniel da Silva e Silva, Sriharsha Dadana, Omid Dadras, Zhaoli Dai, Koustuv Dalal, Lachlan L Dalli, Giovanni Damiani, Emanuele D’Amico, Sara Daneshvar, Aso Mohammad Darwesh, Jai K Das, Saswati Das, Nihar Ranjan Dash, Mohsen Dashti, Claudio Alberto Dávila-Cervantes, Nicole Davis Weaver, Kairat Davletov, Diego De Leo, Aklilu Tamire Debele, Louisa Degenhardt, Reza Dehbandi, Lee Deitesfeld, Ivan Delgado-Enciso, Laura Delgado-Ortiz, Daniel Demant, Berecha Hundessa Demessa, Andreas K Demetriades, Xinlei Deng, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Don C Des Jarlais, Hardik Dineshbhai Desai, Rupak Desai, Keshab Deuba, Vinoth Gnana Chellaiyan Devanbu, Sourav Dey, Arkadeep Dhali, Kuldeep Dhama, Mandira Lamichhane Dhimal, Meghnath Dhimal, Sameer Dhingra, Diana Dias da Silva, Daniel Diaz, Adriana Dima, Delaney D Ding, M Ashworth Dirac, Abhinav Dixit, Shilpi Gupta Dixit, Thanh Chi Do, Thao Huynh Phuong Do, Camila Bruneli do Prado, Masoud Dodangeh, Klara Georgieva Dokova, Christiane Dolecek, E Ray Dorsey, Wendel Mombaque dos Santos, Rajkumar Doshi, Leila Doshmangir, Abdel Douiri, Robert Kokou Dowou, Tim Robert Driscoll, Haneil Larson Dsouza, John Dube, Samuel C Dumith, Susanna J Dunachie, Bruce B Duncan, Andre Rodrigues Duraes, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Sulagna Dutta, Paulina Agnieszka Dzianach, Arkadiusz Marian Dziedzic, Oluwakemi Ebenezer, Ejemai Eboreime, Alireza Ebrahimi, Chidiebere Peter Echieh, Abdelaziz Ed-Dra, Hisham Atan Edinur, David Edvardsson, Kristina Edvardsson, Defi Efendi, Ferry Efendi, Shayan Eghdami, Terje Andreas Eikemo, Ebrahim Eini, Michael Ekholuenetale, Emmanuel Ekpor, Temitope Cyrus Ekundayo, Rabie Adel El Arab, Doaa Abdel Wahab El Morsi, Maysaa El Sayed Zaki, Maha El Tantawi, Iffat Elbarazi, Noha Mousaad Elemam, Frank J Elgar, Islam Y Elgendy, Ghada Metwally Tawfik ElGohary, Hala Rashad Elhabashy, Muhammed Elhadi, Omar Abdelsadek Abdou Elmeligy, Mohammed Elshaer, Ibrahim Elsohaby, Amir Emami Zeydi, Mehdi Emamverdi, Theophilus I Emeto, Luchuo Engelbert Bain, Ryenchindorj Erkhembayar, Tesfahun C Eshetie, Sharareh Eskandarieh, Juan Espinosa-Montero, Kara Estep, Farshid Etaee, Ugochukwu Anthony Eze, Natalia Fabin, Adewale Oluwaseun Fadaka, Adeniyi Francis Fagbamigbe, Saman Fahimi, Luca Falzone, Carla Sofia e Sá Farinha, MoezAlIslam Ezzat Mahmoud Faris, Mohsen Farjoud Kouhanjani, Andre Faro, Hossein Farrokhpour, Ali Fatehizadeh, Hamed Fattahi, Nelsensius Klau Fauk, Pooria Fazeli, Valery L Feigin, Ginenus Fekadu, Seyed-Mohammad Fereshtehnejad, Abdullah Hamid Feroze, Daniela Ferrante, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Irina Filip, Florian Fischer, Joanne Flavel, Abraham D Flaxman, Luisa S Flor, Bobirca Teodor Florin, Morenike Oluwatoyin Folayan, Kristen Marie Foley, Artem Alekseevich Fomenkov, Lisa M Force, Carla Fornari, Behzad Foroutan, Matteo Foschi, Kate Louise Francis, Richard Charles Franklin, Alberto Freitas, Joseph Friedman, Sara D Friedman, Takeshi Fukumoto, John E Fuller, Peter Andras Gaal, Muktar A Gadanya, Santosh Gaihre, Abduzhappar Gaipov, Emmanuela Gakidou, Yaseen Galali, Nasrin Galehdar, Silvano Gallus, Quan Gan, Aravind P Gandhi, Balasankar Ganesan, Jalaj Garg, Shuo-Yan Gau, Prem Gautam, Rupesh K Gautam, Federica Gazzelloni, Miglas W Gebregergis, Mesfin Gebrehiwot, Tesfay Brhane Gebremariam, Urge Gerema, Motuma Erena Getachew, Tamirat Getachew, Peter W Gething, Mansour Ghafourifard, Sulmaz Ghahramani, Khalid Yaser Ghailan, Alireza Ghajar, Mohammad Javad Ghanbarnia, MohammadReza Ghasemi, Afsaneh Ghasemzadeh, Fariba Ghassemi, Ramy Mohamed Ghazy, Sailaja Ghimire, Asadollah Gholamian, Ali Gholamrezanezhad, Pooyan Ghorbani Vajargah, Ghozali Ghozali, Sherief Ghozy, Arun Digambarrao Ghuge, Alessandro Gialluisi, Ruth Margaret Gibson, Artyom Urievich Gil, Paramjit Singh Gill, Tiffany K Gill, Richard F Gillum, Themba G Ginindza, Alem Girmay, James C Glasbey, Elena V Gnedovskaya, Laszlo Göbölös, Amit Goel, Mohamad Goldust, Mahaveer Golechha, Pouya Goleij, Arefeh Golestanfar, Davide Golinelli, Philimon N Gona, Houman Goudarzi, Amir Hossein Goudarzian, Anmol Goyal, Scott Greenhalgh, Michal Grivna, Giovanni Guarducci, Mohammed Ibrahim Mohialdeen Gubari, Mesay Dechasa Gudeta, Avirup Guha, Stefano Guicciardi, Damitha Asanga Gunawardane, Sasidhar Gunturu, Cui Guo, Anish Kumar Gupta, Bhawna Gupta, Indarchand Ratanlal Gupta, Rajat Das Gupta, Sapna Gupta, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Kumar Gupta, Reyna Alma Gutiérrez, Farrokh Habibzadeh, Parham Habibzadeh, Vladimir Hachinski, Mohammad Haddadi, Rasool Haddadi, Nils Haep, Adel Hajj Ali, Esam S Halboub, Sobia Ahsan Halim, Brian J Hall, Sebastian Haller, Rabih Halwani, Randah R Hamadeh, Kanaan Hamagharib Abdullah, Samer Hamidi, Mohammad Hamiduzzaman, Ahmad Hammoud, Nasrin Hanifi, Graeme J Hankey, Md Abdul Hannan, Md Nuruzzaman Haque, Harapan Harapan, Josep Maria Haro, Ahmed I Hasaballah, Faizul Hasan, Ikramul Hasan, M Tasdik Hasan, Hamidreza Hasani, Mohammad Hasanian, Ali Hasanpour- Dehkordi, Abbas M Hassan, Amr Hassan, Hossein Hassanian-Moghaddam, Soheil Hassanipour, Johannes Haubold, Rasmus J Havmoeller, Simon I Hay, Youssef Hbid, Jeffrey J Hebert, Omar E Hegazi, Golnaz Heidari, Mohammad Heidari, Mahsa Heidari-Foroozan, Reza Heidari-Soureshjani, Bartosz Helfer, Claudiu Herteliu, Hamed Hesami, Dineshani Hettiarachchi, Demisu Zenbaba Heyi, Kamal Hezam, Yuta Hiraike, Howard J Hoffman, Ramesh Holla, Nobuyuki Horita, Md Belal Hossain, Md Mahbub Hossain, Sahadat Hossain, Mohammad-Salar Hosseini, Hassan Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mohamed Hsairi, Vivian Chia-rong Hsieh, Chengxi Hu, Junjie Huang, Md Nazmul Huda, Fernando N Hugo, Michael Hultström, Javid Hussain, Salman Hussain, Nawfal R Hussein, Le Duc Huy, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Oluwatope Olaniyi Idowu, Desta Ijo, Kevin S Ikuta, Mehran Ilaghi, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Arnaud Iradukunda, Farideh Iravanpour, Kenneth Chukwuemeka Iregbu, Md Rabiul Islam, Mohammad Mainul Islam, Sheikh Mohammed Shariful Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Chidozie C D Iwu, Chinwe Juliana Iwu-Jaja, Mahalaxmi Iyer, Linda Merin J, Jalil Jaafari, Louis Jacob, Kathryn H Jacobsen, Farhad Jadidi-Niaragh, Morteza Jafarinia, Khushleen Jaggi, Kasra Jahankhani, Nader Jahanmehr, Haitham Jahrami, Akhil Jain, Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Reza Jalilzadeh Yengejeh, Elham Jamshidi, Chinmay T Jani, Mark M Janko, Abubakar Ibrahim Jatau, Sathish Kumar Jayapal, Shubha Jayaram, Jayakumar Jeganathan, Alelign Tasew Jema, Digisie Mequanint Jemere, Wonjeong Jeong, Anil K Jha, Ravi Prakash Jha, John S Ji, Heng Jiang, Yingzhao Jin, Yinzi Jin, Olatunji Johnson, Nabi Jomehzadeh, Darwin Phan Jones, Tamas Joo, Abel Joseph, Nitin Joseph, Charity Ehimwenma Joshua, Jacek Jerzy Jozwiak, Mikk Jürisson, Billingsley Kaambwa, Ali Kabir, Hannaneh Kabir, Zubair Kabir, Vidya Kadashetti, Farima Kahe, Pradnya Vishal Kakodkar, Rizwan Kalani, Leila R Kalankesh, Feroze Kaliyadan, Sanjay Kalra, Ashwin Kamath, Arun Kamireddy, Thanigaivelan Kanagasabai, Himal Kandel, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Rami S Kantar, Neeti Kapoor, Mehrdad Karajizadeh, Behzad Karami Matin, Shama D Karanth, Ibraheem M Karaye, Asima Karim, Hanie Karimi, Salah Eddin Karimi, Arman Karimi Behnagh, Samad Karkhah, Ajit K Karna, Faizan Zaffar Kashoo, Hengameh Kasraei, Nigussie Assefa Kassaw, Nicholas J Kassebaum, Molly B Kassel, Adarsh Katamreddy, Srinivasa Vittal Katikireddi, Patrick DMC Katoto, Joonas H Kauppila, Navjot Kaur, Neda Kaydi, Jeanne Françoise Kayibanda, Gbenga A Kayode, Foad Kazemi, Sina Kazemian, Sara Kazeminia, Leila Keikavoosi-Arani, Cathleen Keller, John H Kempen, Jessica A Kerr, Emmanuelle Kesse-Guyot, Mohammad Keykhaei, Mohamad Mehdi Khadembashiri, Mohammad Amin Khadembashiri, Morteza Abdullatif Khafaie, Himanshu Khajuria, Mohammad Khalafi, Amirmohammad Khalaji, Nauman Khalid, Ibrahim A Khalil, Faham Khamesipour, Asaduzzaman Khan, Gulfaraz Khan, Ikramullah Khan, Imteyaz A Khan, Maseer Khan, Moien AB Khan, Taimoor Khan, Mahammed Ziauddin Khan suheb, Shaghayegh Khanmohammadi, Khaled Khatab, Fatemeh Khatami, Armin Khavandegar, Hamid Reza Khayat Kashani, Khalid A Kheirallah, Feriha Fatima Khidri, Elaheh Khodadoust, Moein Khormali, Mahmood Khosrowjerdi, Jagdish Khubchandani, Helda Khusun, Zemene Demelash Kifle, Grace Kim, Jihee Kim, Ruth W Kimokoti, Kasey E Kinzel, Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Juniper Boroka Kiss, Mika Kivimäki, Desmond Klu, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Soewarta Kosen, Karel Kostev, Ashwin Laxmikant Kotnis, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Hare Krishna, Vijay Krishnamoorthy, Yuvaraj Krishnamoorthy, Kris J Krohn, Barthelemy Kuate Defo, Connor M Kubeisy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Omar Kujan, Mukhtar Kulimbet, Vishnutheertha Kulkarni, Ashish Kumar, Harish Kumar, Nithin Kumar, Rahul Kumar, Shiv Kumar, Madhulata Kumari, Almagul Kurmanova, Om P Kurmi, Asep Kusnali, Dian Kusuma, Tezer Kutluk, Ambily Kuttikkattu, Evans F Kyei, Ilias Kyriopoulos, Carlo La Vecchia, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Abdelilah Lahmar, Daphne Teck Ching Lai, Tri Laksono, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Judit Lám, Demetris Lamnisos, Tuo Lan, Francesco Lanfranchi, Berthold Langguth, Van Charles Lansingh, Ariane Laplante-Lévesque, Bagher Larijani, Anders O Larsson, Savita Lasrado, Kamaluddin Latief, Mahrukh Latif, Kaveh Latifinaibin, Paolo Lauriola, Long Khanh Dao Le, Nhi Huu Hanh Le, Thao Thi Thu Le, Trang Diep Thanh Le, Munjae Lee, Paul H Lee, Sang-woong Lee, Seung Won Lee, Wei-Chen Lee, Yo Han Lee, Samson Mideksa Legesse, James Leigh, Jacopo Lenzi, Elvynna Leong, Temesgen L Lerango, Ming-Chieh Li, Wei Li, Xiaopan Li, Yichong Li, Zhihui Li, Massimo Libra, Virendra S Ligade, Andrew Tiyamike Makhiringa Likaka, Lee-Ling Lim, Ro-Ting Lin, Shuzhi Lin, Vasileios-Arsenios Lioutas, Stefan Listl, Jue Liu, Simin Liu, Xiaofeng Liu, Katherine M Livingstone, Erand Llanaj, Chun-Han Lo, Arianna Maever Loreche, László Lorenzovici, Mojgan Lotfi, Masoud Lotfizadeh, Rafael Lozano, Jailos Lubinda, Giancarlo Lucchetti, Alessandra Lugo, Raimundas Lunevicius, Jianing Ma, Stefan Ma, Zheng Feei Ma, Mahmoud Mabrok, Nikolaos Machairas, Monika Machoy, Christian Madsen, Javier A Magaña Gómez, Azzam A Maghazachi, Sandeep B Maharaj, Preeti Maharjan, Soleiman Mahjoub, Mansour Adam Mahmoud, Elham Mahmoudi, Morteza Mahmoudi, Omar Mohamed Makram, Jeadran N Malagón-Rojas, Elaheh Malakan Rad, Reza Malekzadeh, Armaan K Malhotra, Kashish Malho
Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023
No full textBackground: Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. Objectives: We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. Methods: The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. Results: CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. Conclusions: CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding: Bill & Melinda Gates Foundation
