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Ng'eno E, Lind M, Audi A, Ouma A, Oduor C, Munywoki PK, Agogo GO, Odongo G, Kiplangat S, Wamola N, Osita MP, Mugoh R, Ochieng C, Omballa V, Mogeni OD, Mikoleit M, Fields BS, Montgomery JM, Gauld J, Breiman RF, Juma B, Hunsperger E, Widdowson MA, Bigogo G, Mintz ED, Verani JR. Dynamic Incidence of Typhoid Fever over a 10-Year Period (2010-2019) in Kibera, an Urban Informal Settlement in Nairobi, Kenya. Am J Trop Med Hyg 2023:tpmd220736. [PMID: 37253442 DOI: 10.4269/ajtmh.22-0736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
Typhoid fever burden can vary over time. Long-term data can inform prevention strategies; however, such data are lacking in many African settings. We reexamined typhoid fever incidence and antimicrobial resistance (AMR) over a 10-year period in Kibera, a densely populated urban informal settlement where a high burden has been previously described. We used data from the Population Based Infectious Diseases Surveillance platform to estimate crude and adjusted incidence rates and prevalence of AMR in nearly 26,000 individuals of all ages. Demographic and healthcare-seeking information was collected through household visits. Blood cultures were processed for patients with acute fever or lower respiratory infection. Between 2010 and 2019, 16,437 participants were eligible for blood culture and 11,848 (72.1%) had a culture performed. Among 11,417 noncontaminated cultures (96.4%), 237 grew Salmonella enterica serovar Typhi (2.1%). Overall crude and adjusted incidences were 95 and 188 cases per 100,000 person-years of observation (pyo), respectively. Annual crude incidence varied from 144 to 233 between 2010 and 2012 and from 9 to 55 between 2013 and 2018 and reached 130 per 100,000 pyo in 2019. Children 5-9 years old had the highest overall incidence (crude, 208; adjusted, 359 per 100,000 pyo). Among isolates tested, 156 of 217 were multidrug resistant (resistant to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole [71.9%]) and 6 of 223 were resistant to ciprofloxacin (2.7%). Typhoid fever incidence resurged in 2019 after a prolonged period of low rates, with the highest incidence among children. Typhoid fever control measures, including vaccines, could reduce morbidity in this setting.
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Affiliation(s)
- Eric Ng'eno
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Lind
- Institute for Disease Modelling, Seattle, Washington
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Allan Audi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clifford Oduor
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick K Munywoki
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George O Agogo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George Odongo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel Kiplangat
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Newton Wamola
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mike Powel Osita
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Mugoh
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Caroline Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Omballa
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Epidemiology, Public Health and Impact Unit, International Vaccine Institute, Seoul, South Korea
| | | | - Barry S Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jillian Gauld
- Institute for Disease Modelling, Seattle, Washington
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bonventure Juma
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric D Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Folmo EJ, Langjord T, Myhrvold NCS, Lind M. Metaphors in Mentalization-Based Treatment: Reintroducing the Language of Change in “Plain Old Therapy”. J Contemp Psychother 2021. [DOI: 10.1007/s10879-021-09512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractMetaphors, a central conduit of change in psychotherapy, have not been taken adequately into account in Mentalization-Based Treatment (MBT). Despite successfully utilized by other evidence-based treatments for borderline personality disorder (BPD), MBT considers metaphors confusing for patients with low mentalizing abilities. For metaphors and teaching stories to stimulate growth within the window of tolerance, interventions should be responsively tailored (e.g., explained). Metaphors might be a route to making spoken matter more apprehensible, and bridge emotions with cognitive content. They hold the potential for challenging without being too confronting, and to translate knowledge between different range of understanding. This theoretical article presents why the use of metaphors in MBT—in the hands of a responsive therapists—may prove a powerful tool to open social trust, despite being considered a “high risk” intervention. The timeless lens of the metaphor may help us connect with archetypical versions of our own narratives, hence understanding our subjectivity in a larger perspective. By reaching towards concepts beyond our normal reasoning, typically denoted perennial philosophy or wisdom, they may substitute and/or supplement mentors in a memorable way.
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Rathsman B, Haas J, Persson M, Ludvigsson J, Svensson AM, Lind M, Andersson Franko M, Nyström T. LDL cholesterol level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes mellitus: A nationwide cohort study. J Intern Med 2021; 289:873-886. [PMID: 33283333 PMCID: PMC8247303 DOI: 10.1111/joim.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Microvascular complications are common in people with diabetes, where poor glycaemic control is the major contributor. The aim of this study was to explore the association between elevated LDL cholesterol levels and the risk of retinopathy or nephropathy in young individuals with type 1 diabetes. METHODS This was a nationwide observational population-based cohort study, including all children and adults with a duration of type 1 diabetes of ≤ 10 years, identified in the Swedish National Diabetes Register between 1998 and 2017. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) of retinopathy or nephropathy in four LDL cholesterol categories: <2.6 (Reference), 2.6-3.4, 3.4-4.1 and > 4.1 mmol L-1 . RESULTS In total, 11 024/12 350 (retinopathy/nephropathy, both cohorts, respectively) children and adults (median age 21 years, female 42%) were followed up to 28 years from diagnosis until end of study. Median duration of diabetes when entering the study was 6 and 7 years in the retinopathy and nephropathy cohort, respectively. Median LDL cholesterol was 2.4 mmol L-1 , and median HbA1c level was 61 mmol mol-1 (7.7 %). After multivariable adjustment, the HRs (95% CI) for retinopathy in individuals with LDL cholesterol levels of 2.6-3.4, 3.4-4.1 or > 4.1 mmol L-1 were as follows: 1.13 (1.03-1.23), 1.16 (1.02-1.32) and 1.18 (0.99-1.41), compared with the reference. The corresponding numbers for nephropathy were as follows: 1.15 (0.96-1.32), 1.30 (1.03-1.65) and 1.41 (1.06-1.89). CONCLUSIONS Young individuals with type 1 diabetes exposed to high LDL cholesterol levels have an increased risk of retinopathy and nephropathy independent of glycaemia and other identified risk factors for vascular complications.
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Affiliation(s)
- B Rathsman
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - J Haas
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - M Persson
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet, Stockholm, Sweden
| | - J Ludvigsson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Crown Princess Victoria Children's Hospital, Linköping, Sweden
| | - A-M Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - M Andersson Franko
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - T Nyström
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Lind M, Pergam SA, Liu C, Phipps A, Mooney S, Althouse B, Carone M. 281. Detecting bacterial sepsis among allogeneic HCT recipients with population-specific bedside tools. Open Forum Infect Dis 2020. [PMCID: PMC7777916 DOI: 10.1093/ofid/ofaa439.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Diagnosing sepsis among allogeneic hematopoietic cell transplant (aHCT) recipients remains challenging. Existing criteria, for use in hospitalized patients, have limited predictive accuracy among aHCT recipients and their use may lead to missed events or antibiotic overuse. We developed bedside bacterial sepsis prediction tools (criteria and decision tree [DT]) for aHCT recipients and compared them against Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) criteria. Methods Adult aHCT recipients transplanted between September 2010–2019 with ≥ 1 potential infection (PI) within 100 days post-transplantation were randomly assigned to model/validation (7/3) cohorts. Tools included demographic and clinical factors and were built against a bacterial sepsis endpoint (gram-negative, Staphylococcus aureus, or Streptococcus species bacteremia). The tools were developed using best subset selection with rare event logistic regression (criteria) and classification tree (DT) algorithms. Criteria scores were estimated using a beta/10 integer weighting approach and tool predictive performances were compared against existing criteria. Results Between September 2010–2019, 1571 recipients with ≥ 1 PI contributed 7755 PIs and 238 sepsis events. The DT model included 7 terminal nodes based on 3 predictors: temperature, respiratory rate (RR), and sex. The criteria model contained 10 categories with 4 predictors: RR, temperature, pulse, and diastolic blood pressure (Figure 1). Our criteria and DT had AUCs of 71.1% (95% Confidence Interval (CI): 64.3, 77.9%) and 70.0% (CI: 63.7, 76.2%). SIRS had the highest AUC of existing criteria – 64.7% (CI: 57.1, 71.9%). Our criteria had the highest net benefit (for probabilities < 10%) and, at a 7+ cut-point, had a sensitivity of 73.8% (CI: 61.5–84.0%) and specificity of 55.0% (CI: 52.9, 57.1%) (Figure 2). ![]()
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Conclusion We developed aHCT recipient-specific bedside bacterial sepsis prediction tools with higher AUCs than existing criteria. Tools targeted to high-risk populations may lead to fewer missed sepsis events and, in turn, reduce sepsis related mortality among this high-risk population. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)
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Affiliation(s)
- Margaret Lind
- University of Washington, Department of Epidemiology & Fred Hutchinson Cancer Research Center, Chicago, Illinois
| | - Steven A Pergam
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA
| | - Catherine Liu
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA
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Risager S, Gronbech Nielsen T, Bartels E, Langberg H, Lind M, Jorgensen J, Vestergard Iversen J. Cross Cultural Adaptation of The Visa P Questionnaire for Danish Speaking Patients with Patella Tendinopathy. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.04.2020.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Risager
- Odense University Hospital, Odense, Denmark
| | - T. Gronbech Nielsen
- Division of Sports traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - E.M. Bartels
- Department of Neurology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - H. Langberg
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. Lind
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Mirza S, Haque F, Hodgson S, Lind M, Maraveyas A, Brown V. 60P Real-world experience of immunotherapy in elderly cancer patients in a UK cancer centre. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Deese J, Philip N, Lind M, Ahmed K, Batting J, Beksinska M, Edward VA, Louw CE, Onono M, Palanee-Phillips T, Smit JA, Baeten JM, Donnell D, Mastro TD, Mugo NR, Nanda K, Rees H, Morrison C. Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant. Sex Transm Infect 2020; 97:249-255. [PMID: 33208512 PMCID: PMC8165154 DOI: 10.1136/sextrans-2020-054590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives Reproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods. Methods We conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16–35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression. Results At baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87). Conclusions The findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.
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Affiliation(s)
- Jennifer Deese
- Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA (formerly with FHI 360)
| | - Neena Philip
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Margaret Lind
- Department of Global Health, International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | | | - Joanne Batting
- Effective Care Research Unit, University of the Witwatersrand, East London, South Africa
| | - Mags Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Vinodh A Edward
- The Aurum Institute, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl E Louw
- Madibeng Centre for Research, Brits, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jared M Baeten
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kavita Nanda
- Product Development and Introduction, FHI 360, Durham, North Carolina, USA
| | - Helen Rees
- Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Morrison
- Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
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Lind M, Gettinger S, Borghaei H, Brahmer J, Chow L, Burgio M, De Castro Carpeno J, Pluzanski A, Arrieta O, Frontera OA, Chiari R, Butts C, Wojcik-Tomaszewska J, Coudert B, Garassino M, Ready N, Felip E, Garcia MA, Waterhouse D, Domine M, Barlesi F, Antonia S, Wohlleber M, Gerber D, Czyzewicz G, Spigel D, Crino L, Eberhardt W, Li A, Marimuthu S, Vokes E. Five-year outcomes from the randomized, phase 3 trials CheckMate 017/057: nivolumab vs docetaxel in previously treated NSCLC. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ahmadi SS, Filipsson K, Dimenäs H, Isaksson SS, Imberg H, Sjöberg S, Ahrén B, Dahlqvist S, Gustafsson T, Tuomilehto J, Hirsch IB, Lind M. Effect of liraglutide on anthropometric measurements, sagittal abdominal diameter and adiponectin levels in people with type 2 diabetes treated with multiple daily insulin injections: evaluations from a randomized trial (MDI-liraglutide study 5). Obes Sci Pract 2019; 5:130-140. [PMID: 31019730 PMCID: PMC6469338 DOI: 10.1002/osp4.324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/30/2022] Open
Abstract
AIM Use of the glucagon-like peptide 1 receptor agonist liraglutide has been shown to reduce weight. Different types of anthropometric measurements can be used to measure adiposity. This study evaluated the effect of liraglutide on sagittal abdominal diameter, waist circumference, waist-to-hip ratio and adiponectin levels in people with type 2 diabetes (T2D) treated with multiple daily insulin injections (MDI). MATERIALS AND METHODS In the multicentre, double-blind, placebo-controlled MDI-liraglutide trial, 124 individuals with T2D treated with MDI were randomized to either liraglutide or placebo. Basal values of weight, waist circumference, waist-to-hip ratio, sagittal abdominal diameter and adiponectin were compared with measurements at 12 and 24 weeks after randomization. RESULTS Baseline-adjusted mean weight loss was 3.8 ± 2.9 kg greater in liraglutide than placebo-treated individuals (p < 0.0001). Waist circumference was reduced by 2.9 ± 4.3 cm and 0.2 ± 3.6 cm in the liraglutide and placebo groups, respectively, after 24 weeks (baseline-adjusted mean difference: 2.6 ± 4.0 cm, p = 0.0005). Corresponding reductions in sagittal abdominal diameter were 1.1 ± 1.7 cm and 0.0 ± 1.8 cm (baseline-adjusted mean difference: 1.1 ± 1.7 cm, p = 0.0008). Hip circumference was reduced in patients randomized to liraglutide (baseline-adjusted mean difference between treatment groups: 2.8 ± 3.8 cm, p = 0.0001), but there was no significant difference between the groups in either waist-to-hip ratio (baseline-adjusted mean difference: 0.0 ± 0.04 cm, p = 0.51) or adiponectin levels (baseline-adjusted mean difference: 0.8 ± 3.3 mg L-1, p = 0.17). Lower HbA1c and mean glucose levels measured by masked continuous glucose monitoring at baseline were associated with greater effects of liraglutide on reductions in waist circumference and sagittal abdominal diameter. CONCLUSIONS In patients with T2D, adding liraglutide to MDI may reduce abdominal and hip obesity to a similar extent, suggesting an effect on both visceral and subcutaneous fat. Liraglutide had greater effects on reducing abdominal obesity in patients with less pronounced long-term hyperglycaemia but did not affect adiponectin levels.
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Affiliation(s)
- S. S. Ahmadi
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
| | - K. Filipsson
- Department of Clinical Sciences LundLund UniversityLundSweden
| | - H. Dimenäs
- Department of MedicineSouth Älvsborg HospitalBoråsSweden
| | - S. S. Isaksson
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU Hospital GroupUddevallaSweden
| | - H. Imberg
- Department of Mathematical SciencesChalmers University of Technology and the University of GothenburgGothenburgSweden
- Statistiska konsultgruppenGothenburgSweden
| | - S. Sjöberg
- Department of Medicine, Karolinska InstituteKarolinska University Hospital HuddingeStockholmSweden
| | - B. Ahrén
- Department of Clinical Sciences LundLund UniversityLundSweden
- Lund UniversityLundSweden
| | - S. Dahlqvist
- Department of MedicineNU Hospital GroupUddevallaSweden
| | - T. Gustafsson
- Department of Clinical ChemistryKarolinska University HospitalStockholmSweden
| | - J. Tuomilehto
- Centre for Vascular PreventionDanube UniversityKremsAustria
- Department of Chronic Disease PreventionNational Institute for Health and WelfareHelsinkiFinland
- Diabetes Research GroupKing Abdulaziz UniversityJeddahSaudi Arabia
| | - I. B. Hirsch
- Division of metabolism, Endocrinology, and NutritionUniversity of WashingtonSeattleWashingtonUSA
| | - M. Lind
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU Hospital GroupUddevallaSweden
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Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, Abdelalim A, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abreu DMX, Abu-Raddad LJ, Adane AA, Adedoyin RA, Adetokunboh O, Adhikari TB, Afarideh M, Afshin A, Agarwal G, Agius D, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Aichour MTE, Akibu M, Akinyemi RO, Akinyemiju TF, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam T, Alasfoor D, Albittar MI, Alene KA, Al-Eyadhy A, Ali SD, Alijanzadeh M, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen C, Alomari MA, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amenu K, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Antonio CAT, Araújo VEM, Aremu O, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Asgedom SW, Asghar RJ, Ashebir MM, Asseffa NA, Atey TM, Atre SR, Atteraya MS, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayalew AA, Ayele HT, Ayer R, Ayuk TB, Azzopardi P, Azzopardi-Muscat N, Babalola TK, Badali H, Badawi A, Banach M, Banerjee A, Banstola A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barrero LH, Bassat Q, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Berhe DF, Bernabé E, Bernstein RS, Beuran M, Bhalla A, Bhatt P, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Birungi C, Biryukov S, Bizuneh H, Bolliger IW, Bolt K, Bou-Orm IR, Bozorgmehr K, Brady OJ, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha TS, Butt ZA, Cahuana-Hurtado L, Campos-Nonato IR, Campuzano JC, Car J, Car M, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Catalá-López F, Cercy K, Chalek J, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chiang PPC, Chisumpa VH, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Ciobanu LG, Cirillo M, Colombara D, Conti S, Cooper C, Cornaby L, Cortesi PA, Cortinovis M, Costa Pereira A, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Daryani M, Das J, Das SK, das Neves J, Davis Weaver N, Davletov K, de Courten B, De Leo D, De Neve JW, Dellavalle RP, Demoz G, Deribe K, Des Jarlais DC, Dey S, Dharmaratne SD, Dhimal M, Djalalinia S, Doku DT, Dolan K, Dorsey ER, dos Santos KPB, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duncan BB, Echko M, Edessa D, Edvardsson D, Ehrlich JR, Eldrenkamp E, El-Khatib ZZ, Endres M, Endries AY, Eshrati B, Eskandarieh S, Esteghamati A, Fakhar M, Farag T, Faramarzi M, Faraon EJA, Faro A, Farzadfar F, Fatusi A, Fazeli MS, Feigin VL, Feigl AB, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Fijabi DO, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Flor LS, Foigt N, Foreman KJ, Frostad JJ, Fürst T, Futran ND, Gakidou E, Gallus S, Gambashidze K, Gamkrelidze A, Ganji M, Gebre AK, Gebrehiwot TT, Gebremedhin AT, Gelaw YA, Geleijnse JM, Geremew D, Gething PW, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Gill PS, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Goli S, Gomez-Dantes H, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Goulart AC, Grada A, Griswold M, Grosso G, Gugnani HC, Guo Y, Gupta R, Gupta R, Gupta T, Gupta T, Gupta V, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hamidi S, Hankey GJ, Harb HL, Harewood HC, Harikrishnan S, Haro JM, Hassen HY, Havmoeller R, Hawley C, Hay SI, He J, Hearps SJC, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henry NJ, Herrera Ballesteros VH, Herteliu C, Hibstu DT, Hiluf MK, Hoek HW, Homaie Rad E, Horita N, Hosgood HD, Hosseini M, Hosseini SR, Hostiuc M, Hostiuc S, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Iburg KM, Idris F, Igumbor EU, Ikeda C, Ileanu BV, Ilesanmi OS, Innos K, Irvani SSN, Irvine CMS, Islami F, Jacobs TA, Jacobsen KH, Jahanmehr N, Jain R, Jain SK, Jakovljevic MB, Jalu MT, Jamal AA, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Jóúwiak J, John O, Johnson SC, Jonas JB, Joshua V, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kar C, Karanikolos M, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Kereselidze M, Ketema EB, Khader YS, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan G, Khan MN, Khan MA, Khanal MN, Khang YH, Khater MM, Khoja ATA, Khosravi A, Khubchandani J, Kibret GD, Kiirithio DN, Kim D, Kim YJ, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissoon N, Kochhar S, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar P, Kutz M, Kuzin I, Kyu HH, Lad DP, Lafranconi A, Lal DK, Lalloo R, Lam H, Lan Q, Lang JJ, Lansingh VC, Lansky S, Larsson A, Latifi A, Lazarus JV, Leasher JL, Lee PH, Legesse Y, Leigh J, Leshargie CT, Leta S, Leung J, Leung R, Levi M, Li Y, Liang J, Liben ML, Lim LL, Lim SS, Lind M, Linn S, Listl S, Liu P, Liu S, Lodha R, Lopez AD, Lorch SA, Lorkowski S, Lotufo PA, Lucas TCD, Lunevicius R, Lurton G, Lyons RA, Maalouf F, Macarayan ERK, Mackay MT, Maddison ER, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manhertz T, Manguerra H, Mansournia MA, Mantovani LG, Manyazewal T, Mapoma CC, Margono C, Martinez-Raga J, Martins SCO, Martins-Melo FR, Martopullo I, März W, Massenburg BB, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehata S, Mehrotra R, Mehta KM, Mehta V, Meier T, Mejia-Rodriguez F, Meles KG, Melku M, Memiah P, Memish ZA, Mendoza W, Mengiste DA, Mengistu DT, Menota BG, Mensah GA, Meretoja A, Meretoja TJ, Mezgebe HB, Miazgowski T, Micha R, Milam R, Millear A, Miller TR, Mini GK, Minnig S, Mirica A, Mirrakhimov EM, Misganaw A, Mitchell PB, Mlashu FW, Moazen B, Mohammad KA, Mohammadibakhsh R, Mohammed E, Mohammed MA, Mohammed S, Mokdad AH, Mola GL, Molokhia M, Momeniha F, Monasta L, Montañez Hernandez JC, Moosazadeh M, Moradi-Lakeh M, Moraga P, Morawska L, Moreno Velasquez I, Mori R, Morrison SD, Moses M, Mousavi SM, Mueller UO, Murhekar M, Murthy GVS, Murthy S, Musa J, Musa KI, Mustafa G, Muthupandian S, Nagata C, Nagel G, Naghavi M, Naheed A, Naik GA, Naik N, Najafi F, Naldi L, Nangia V, Nansseu JRN, Narayan KMV, Nascimento BR, Negoi I, Negoi RI, Newton CR, Ngunjiri JW, Nguyen G, Nguyen L, Nguyen TH, Nichols E, Ningrum DNA, Nolte E, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyandwi A, Obermeyer CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Oliveira PPVD, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortega-Altamirano DV, Ortiz A, Ozdemir R, PA M, Pain AW, Palone MRT, Pana A, Panda-Jonas S, Pandian JD, Park EK, Parsian H, Patel T, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paudel D, Pedroso MDM, Pedroza SP, Pereira DM, Perico N, Peterson H, Petzold M, Peykari N, Phillips MR, Piel FB, Pigott DM, Pillay JD, Piradov MA, Polinder S, Pond CD, Postma MJ, Pourmalek F, Prakash S, Prakash V, Prasad N, Prasad NM, Purcell C, Qorbani M, Quintana HK, Radfar A, Rafay A, Rafiei A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahman SU, Rai RK, Raju SB, Ram U, Rana SM, Rankin Z, Rasella D, Rawaf DL, Rawaf S, Ray SE, Razo-García CA, Reddy P, Reiner RC, Reis C, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rios Blancas MJ, Rivera JA, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Rothenbacher D, Roy A, Roy N, Ruhago GM, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salama J, Salamati P, Saldanha RDF, Salimzadeh H, Salomon JA, Samy AM, Sanabria JR, Sancheti PK, Sanchez-Niño MD, Santomauro D, Santos IS, Santric Milicevic MM, Sarker AR, Sarrafzadegan N, Sartorius B, Satpathy M, Savic M, Sawhney M, Saxena S, Saylan MI, Schaeffner E, Schmidhuber J, Schmidt MI, Schneider IJC, Schumacher AE, Schutte AE, Schwebel DC, Schwendicke F, Sekerija M, Sepanlou SG, Servan-Mori EE, Shafieesabet A, Shaikh MA, Shakh-Nazarova M, Shams-Beyranvand M, Sharafi H, Sharif-Alhoseini M, Shariful Islam SM, Sharma M, Sharma R, She J, Sheikh A, Shfare MT, Shi P, Shields C, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shiue I, Shrime MG, Shukla SR, Siabani S, Sigfusdottir ID, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh L, Singh NP, Singh V, Sinha DN, Sinke AH, Sisay M, Skirbekk V, Sliwa K, Smith A, Soares Filho AM, Sobaih BHA, Somai M, Soneji S, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Stokes MA, Sturua L, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse AH, Taffere GR, Tandon N, Tariku AT, Taveira N, Tehrani-Banihashemi A, Temam Shifa G, Temsah MH, Terkawi AS, Tesema AG, Tesfaye DJ, Tessema B, Thakur JS, Thomas N, Thompson MJ, Tillmann T, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Torre A, Tortajada M, Tran BX, Tran KB, Tripathi A, Tripathy SP, Troeger C, Truelsen T, Tsoi D, Tudor Car L, Tuem KB, Tyrovolas S, Uchendu US, Ukwaja KN, Ullah I, Updike R, Uthman OA, Uzochukwu BSC, Valdez PR, van Boven JFM, Varughese S, Vasankari T, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagnew F, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weaver MR, Weiderpass E, Weintraub RG, Weiss J, Weldegwergs KG, Werdecker A, West TE, Westerman R, White RG, Whiteford HA, Widecka J, Winkler AS, Wiysonge CS, Wolfe CDA, Wondimkun YA, Workicho A, Wyper GMA, Xavier D, Xu G, Yan LL, Yano Y, Yaseri M, Yimer NB, Yin P, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yu C, Zadnik V, Zaidi Z, Zaki MES, Zaman SB, Zamani M, Zenebe ZM, Zhou M, Zhu J, Zimsen SRM, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL, Lozano R. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391:2236-2271. [PMID: 29893224 PMCID: PMC5986687 DOI: 10.1016/s0140-6736(18)30994-2] [Citation(s) in RCA: 504] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING Bill & Melinda Gates Foundation.
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Møller M, Attermann J, Myklebust G, Lind M, Sørensen H, Hebert JJ, Nielsen RO, Bertelsen SL, Wedderkopp N. The inter- and intrarater reliability and agreement for field-based assessment of scapular control, shoulder range of motion, and shoulder isometric strength in elite adolescent athletes. Phys Ther Sport 2018; 32:212-220. [PMID: 29807278 DOI: 10.1016/j.ptsp.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 03/02/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To investigate the intra- and interrater reliability and agreement for field-based assessment of scapular control, shoulder range of motion (ROM), and shoulder isometric strength in elite youth athletes. DESIGN Test-retest reliability and agreement study. SETTING Eight blinded raters (two for each assessment) assessed players on field during two testing sessions separated by one week. PARTICIPANTS 162 elite youth handball players with or without a history of previous shoulder pain within the preceding six months. MAIN OUTCOME MEASURES Kappa (κ) and prevalence-adjusted bias-adjusted kappa (PABAK) coefficients for scapular control reliability, and 95% limits of agreement (LOA) for ROM and strength agreement. RESULTS Scapular control demonstrated substantial to almost perfect reliability (κ 0.67 to 0.84, PABAK from 0.68 to 0.88). Mean strength values ranged from 0.9 N/kg to 1.6 N/kg, and LOAs ranged from -0.7 N/kg to 0.8 N/kg. Rotational strength revealed additionally systematic bias between and within rater. No or acceptable systematic bias were evident for ROM and abduction strength measures. Mean values and LOAs for ROM ranged between 39.9° to 52.3°, and from -12.6° to 9.9°, respectively. CONCLUSIONS Scapular control and ROM can be assessed on the field with acceptable reliability. The threshold for reliable measurements of isometric strength using handheld-dynamometers is high.
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Affiliation(s)
- M Møller
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark.
| | - J Attermann
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - G Myklebust
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Lind
- Div. of Sportstraumatology, Aarhus University Hospital, Aarhus, Denmark
| | - H Sørensen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - J J Hebert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia; Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - R O Nielsen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | | | - N Wedderkopp
- Sport Medicine Clinic, Orthopaedic Dep. Hospital of Lillebaelt, Institute of Regional Health Service Research and Centre for Research in Childhood Health, IOB, University of Southern Denmark, Odense, Denmark
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Møller M, Wedderkopp N, Myklebust G, Lind M, Sørensen H, Hebert JJ, Attermann J. The SMS, Phone, and medical Examination sports injury surveillance system is a feasible and valid approach to measuring handball exposure, injury occurrence, and consequences in elite youth sport. Scand J Med Sci Sports 2018; 28:1424-1434. [PMID: 29286552 DOI: 10.1111/sms.13049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 12/23/2022]
Abstract
Current methods of sports injury surveillance are limited by lack of medical validation of self-reported injuries and/or incomplete information about injury consequences beyond time loss from sport. The aims of this study were to (a) evaluate the feasibility of the SMS, Phone, and medical Examination injury surveillance (SPEx) system (b) to evaluate the proportion of injuries and injury consequences reported by SPEx when compared to outcomes from a modified version of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. We followed 679 elite adolescent handball players over 31 weeks using the SPEx system. During the last 7 weeks, we also implemented a modified OSTRC questionnaire in a subgroup of 271 players via telephone interviews. The weekly response proportions to the primary SPEx questions ranged from 85% to 96% (mean 92%). SMS responses were received from 79% of the participants within 1 day. 95% of reported injuries were classified through the telephone interview within a week, and 67% were diagnosed by medical personnel. Comparisons between reported injuries from SPEx and OSTRC demonstrated fair (κ = 39.5% [25.1%-54.0%]) to substantial prevalence-adjusted bias-adjusted kappa (PABAK = 66.8% [95% CI 58.0%-75.6%]) agreement. The average injury severity score difference between SPEx and the OSTRC approach was -0.2 (95% CI -3.69-3.29) of possible 100 with 95% limits of agreement from(-14.81-14.41). These results support the feasibility and validity of the SPEx injury surveillance system in elite youth sport. Future studies should evaluate the external validity of SPEx system in different cohorts of athletes.
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Affiliation(s)
- M Møller
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - N Wedderkopp
- Department Of Orthopedics, Hospital of South-western Denmark, Esbjerg and Centre for Research in Childhood Health, IOB, University of Southern Denmark, Odense, Denmark
| | - G Myklebust
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Lind
- Division of Sportstraumatology, Aarhus University Hospital, Aarhus C, Denmark
| | - H Sørensen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - J J Hebert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - J Attermann
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark
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Oguh L, Ranatunge D, Lind M, Upadhyay S, El-Mahdawi N. A retrospective study of maintenance pemetrexed in advanced non-squamous non-small cell lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abrahamsen Ravn L, Leer Blindbaek S, Schlosser A, Koss M, Dacheva I, Lind M, Holmskov U, Sørensen G, Grauslund J. Intraocular expression of microfibrillar-associated protein 4 (MFAP4) in patients with neovascular age-related macular degeneration (nAMD). Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0f079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Abrahamsen Ravn
- Institute of Clinical Research; Research Unit of Ophthalmology- Odense University Hospital; Odense C Denmark
| | - S. Leer Blindbaek
- Institute of Clinical Research; Research Unit of Ophthalmology- Odense University Hospital; Odense C Denmark
| | - A. Schlosser
- Department of Molecular Medicine; Department of Cancer and Inflammation Research; Odense C Denmark
| | - M. Koss
- Department of Ophthalmology; Universität Heidelberg; Heidelberg Germany
| | - I. Dacheva
- Department of Ophthalmology; Universität Heidelberg; Heidelberg Germany
| | - M. Lind
- Institute of Clinical Research; Research Unit of Ophthalmology- Odense University Hospital; Odense C Denmark
| | - U. Holmskov
- Department of Molecular Medicine; Department of Cancer and Inflammation Research; Odense C Denmark
| | - G.L. Sørensen
- Department of Molecular Medicine; Department of Cancer and Inflammation Research; Odense C Denmark
| | - J. Grauslund
- Institute of Clinical Research; Research Unit of Ophthalmology- Odense University Hospital; Odense C Denmark
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Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abdurahman AA, Abera SF, Abraham B, Abreha GF, Adane K, Adelekan AL, Adetifa IMO, Afshin A, Agarwal A, Agarwal SK, Agarwal S, Agrawal A, Kiadaliri AA, Ahmadi A, Ahmed KY, Ahmed MB, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam N, Alam SS, Alemu ZA, Alene KA, Alexander L, Ali R, Ali SD, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amo-Adjei J, Amoako YA, Anderson BO, Androudi S, Ansari H, Ansha MG, Antonio CAT, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Astatkie A, Atey TM, Atique S, Atnafu NT, Atre SR, Avila-Burgos L, Avokpaho EFGA, Quintanilla BPA, Awasthi A, Ayele NN, Azzopardi P, Saleem HOB, Bärnighausen T, Bacha U, Badawi A, Banerjee A, Barac A, Barboza MA, Barker-Collo SL, Barrero LH, Basu S, Baune BT, Baye K, Bayou YT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Bernal OA, Beyene AS, Beyene TJ, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bose D, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Butt ZA, Cárdenas R, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Carrero JJ, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cecilio P, Cercy K, Charlson FJ, Chen AZ, Chew A, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coggeshall MS, Cooper LT, Cortinovis M, Crump JA, Dalal K, Danawi H, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, De Leo D, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dicker D, Ding EL, Dokova K, Dorsey ER, Doyle KE, Dubey M, Ehrenkranz R, Ellingsen CL, Elyazar I, Enayati A, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fürst T, Faghmous IDA, Fanuel FBB, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Fischer F, Fitzmaurice C, Fleming TD, Foigt N, Foreman KJ, Forouzanfar MH, Franklin RC, Frostad J, G/hiwot TT, Gakidou E, Gambashidze K, Gamkrelidze A, Gao W, Garcia-Basteiro AL, Gebre T, Gebremedhin AT, Gebremichael MW, Gebru AA, Gelaye AA, Geleijnse JM, Genova-Maleras R, Gibney KB, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold A, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Graetz N, Greaves F, Griswold M, Guban PI, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Habtewold TD, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Hakuzimana A, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, Hendrie D, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Htet AS, Hu G, Huang H, Huang JJ, Huntley BM, Huynh C, Iburg KM, Ileanu BV, Innos K, Irenso AA, Jahanmehr N, Jakovljevic MB, James P, James SL, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jha V, John D, Johnson C, Johnson SC, Jonas JB, Juel K, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kazanjan K, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Kerbo AA, Kereselidze M, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khan G, Khang YH, Khoja ATA, Khonelidze I, Khubchandani J, Kibret GD, Kim D, Kim P, Kim YJ, Kimokoti RW, Kinfu Y, Kissoon N, Kivipelto M, Kokubo Y, Kolk A, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar GA, Kumsa FA, Kutz M, Kyu HH, Lager ACJ, Lal A, Lal DK, Lalloo R, Lallukka T, Lan Q, Langan SM, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leinsalu M, Leshargie CT, Leung J, Leung R, Levi M, Liang X, Lim SS, Lind M, Linn S, Lipshultz SE, Liu P, Liu Y, Lo LT, Logroscino G, Lopez AD, Lorch SA, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Macarayan ERK, Mackay MT, El Razek HMA, El Razek MMA, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marcenes W, Marks GB, Marquez N, Martinez-Raga J, Marzan MB, Massano J, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McNellan C, Meaney PA, Mehari A, Mehndiratta MM, Meier T, Mekonnen AB, Meles KG, Memish ZA, Mengesha MM, Mengiste DT, Mengistie MA, Menota BG, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mezgebe HB, Micha R, Millear A, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Mock CN, Mohammad KA, Mohammed S, Mohanty SK, Mokdad AH, Mola GLD, Molokhia M, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Moses M, Mueller UO, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naheed A, Naldi L, Nangia V, Nascimento BR, Negoi I, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Ngunjiri JW, Nguyen G, Ningrum DNA, Nolte S, Nomura M, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Osman M, Owolabi MO, PA M, Pain AW, Pakhale S, Castillo EP, Pana A, Papachristou C, Parsaeian M, Patel T, Patton GC, Paudel D, Paul VK, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Polinder S, Pond CD, Prakash V, Purwar M, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rai RK, Ram U, Rana SM, Rankin Z, Rao PV, Rao PC, Rawaf S, Rego MAS, Reitsma M, Remuzzi G, Renzaho AMNN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Roba HS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy NK, Sachdev PS, Sackey BB, Saeedi MY, Safiri S, Sagar R, Sahraian MA, Saleh MM, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sandar L, Santos IS, Santos JV, Milicevic MMS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Seid AM, Seifu CN, Sepanlou SG, Serdar B, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Shamsipour M, Islam SMS, Sharma J, Sharma R, She J, Sheikhbahaei S, Shen J, Shi P, Shigematsu M, Shin MJ, Shiri R, Shoman H, Shrime MG, Sibamo ELS, Sigfusdottir ID, Silva DAS, Silveira DGA, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Sinke AH, Sinshaw AE, Skirbekk V, Sliwa K, Smith A, Sobngwi E, Soneji S, Soriano JB, Sousa TCM, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Steiner C, Steinke S, Stokes MA, Stranges S, Strong M, Stroumpoulis K, Sturua L, Sufiyan MB, Suliankatchi RA, Sun J, Sur P, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taffere GR, Talongwa RT, Tarajia M, Tavakkoli M, Taveira N, Teeple S, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Shifa GT, Terkawi AS, Tesema AG, Thakur JS, Thomson AJ, Tillmann T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Tortajada M, Troeger C, Truelsen T, Tura AK, Uchendu US, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Boven JFM, Van Dingenen R, Varughese S, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagner JA, Wakayo T, Waller SG, Walson JL, Wang H, Wang YP, Watkins DA, Weiderpass E, Weintraub RG, Wen CP, Werdecker A, Wesana J, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Won S, Workicho A, Workie SB, Wubshet M, Xavier D, Xu G, Yadav AK, Yaghoubi M, Yakob B, Yan LL, Yano Y, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zenebe ZM, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390:231-266. [PMID: 28528753 PMCID: PMC5528124 DOI: 10.1016/s0140-6736(17)30818-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING Bill & Melinda Gates Foundation.
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Martín-Merino E, Fortuny J, Rivero-Ferrer E, Lind M, Garcia-Rodriguez LA. Risk factors for diabetic macular oedema in type 2 diabetes: A case-control study in a United Kingdom primary care setting. Prim Care Diabetes 2017; 11:288-296. [PMID: 28395937 DOI: 10.1016/j.pcd.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/05/2017] [Accepted: 03/12/2017] [Indexed: 01/19/2023]
Abstract
AIM To identify risk factors associated with the development of DMO among patients diagnosed with type 2 diabetes managed in a primary care setting in the UK. METHODS A case-control study nested in a cohort of incident Type 2 diabetes identified in The Health Improvement Network database from 2000-2007. Cases were people with DMO (N=211) and controls were a DMO-free sample (N=2194). No age restrictions were applied. Adjusted odds ratios and 95%CIs were estimated (OR; 95%CI). RESULTS DMO increased with high alcohol use (2.88; 1.49-5.55), cataracts (4.10; 2.73-6.15), HbA1c ≥7% (1.58; 1.08-2.32), systolic blood pressure ≥160mm Hg (2.03; 1.17-3.53), total cholesterol ≥5mmol/L (1.66; 1.15-2.39), LDL ≥3mmol/L (1.73; 1.14-2.61), and microalbuminuria (1.78; 1.16-2.73). Diuretic drugs were associated with a reduced risk of DMO (0.68; 0.47-0.99), as did smoking (0.47; 0.28-0.77), overweight (0.53; 0.30-0.96) or obesity (0.52; 0.30-0.91) at diabetes diagnosis, and high triglyceride levels (0.51; 0.35-0.74). Patients treated with anti-diabetic drugs showed higher risk of DMO than non-treated patients, particularly those with sulphonylureas (3.40; 2.42-4.78), insulin (3.21; 1.92-5.36) or glitazones (1.88; 1.17-3.04). CONCLUSION In patients with type 2 diabetes managed in primary care, multiple factors associated with DMO were identified, such as cataracts, microalbuminuria and high levels of HbA1c, systolic BP, total cholesterol, and LDL. Diuretic drugs were associated with a reduced risk of DMO. Treated diabetes, particularly with sulphonylureas, insulin or glitazones showed highest risk of DMO. The inverse association between smoking, obesity, and triglycerides and DMO deserves further research.
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Affiliation(s)
- E Martín-Merino
- Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain.
| | - J Fortuny
- DS&E-Global Clinical Epidemiology, Novartis Farmaceutica S.A., Barcelona, Spain
| | - E Rivero-Ferrer
- DS&E-Global Clinical Epidemiology, Novartis Farmaceutica S.A., Barcelona, Spain
| | - M Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
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Hedén Ståhl C, Lind M, Svensson A, Kosiborod M, Gudbjörnsdottir S, Pivodic A, Clements M, Rosengren A. Long-term excess risk of stroke in people with Type 2 diabetes in Sweden according to blood pressure level: a population-based case-control study. Diabet Med 2017; 34:522-530. [PMID: 27885698 PMCID: PMC5363349 DOI: 10.1111/dme.13292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/14/2023]
Abstract
AIMS To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden. METHODS This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals (CIs) were estimated at six different blood pressure levels. RESULTS During a median follow-up of 4 years, 19 548 (4.8%) people with Type 2 diabetes and 61 690 (3.2%) without diabetes were diagnosed with stroke, corresponding to an adjusted hazard ratio of 1.43 (95% CI 1.41-1.46) for people with Type 2 diabetes as a group. Compared with people without diabetes, the risk of stroke for people with Type 2 diabetes with different blood pressure levels was significantly higher, starting at blood pressure levels > 130/80 mmHg. Hazard ratios for stroke were 1.20 (95% CI 1.16-1.24), 1.47 (95% CI 1.43-1.50), and 1.97 (95% CI 1.90-2.03) for blood pressure categories of 130-139/80-89 mmHg, 140-159/90-99 mmHg and ≥ 160/≥ 100 mmHg, respectively, after adjustment for age, sex, diabetes duration, being born in Sweden, maximum education level and baseline comorbidities. CONCLUSIONS People with Type 2 diabetes and blood pressure < 130/80 mmHg had a risk of stroke similar to that of the general population.
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Affiliation(s)
- C. Hedén Ståhl
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | - M. Lind
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU‐Hospital OrganizationUddevallaSweden
| | - A.‐M. Svensson
- Centre of Registers in the Västra Götaland RegionGothenburgSweden
| | - M. Kosiborod
- Saint Luke's Mid America Heart InstituteUniversity of Missouri–Kansas City School of MedicineMOUSA
| | | | - A. Pivodic
- Statistiska KonsultgruppenGothenburgSweden
| | - M. Clements
- University of Missouri–Kansas City School of Medicine and Children's Mercy HospitalKansas CityMOUSA
- University of Kansas School of MedicineKansas CityMOUSA
| | - A. Rosengren
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
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Møller M, Wedderkopp N, Myklebust G, Lind M, Sørensen H, Hebert JJ, Emery CA, Attermann J. Validity of the SMS, Phone, and medical staff Examination sports injury surveillance system for time-loss and medical attention injuries in sports. Scand J Med Sci Sports 2017; 28:252-259. [PMID: 28267868 DOI: 10.1111/sms.12869] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
The accurate measurement of sport exposure time and injury occurrence is key to effective injury prevention and management. Current measures are limited by their inability to identify all types of sport-related injury, narrow scope of injury information, or lack the perspective of the injured athlete. The aims of the study were to evaluate the proportion of injuries and the agreement between sport exposures reported by the SMS messaging and follow-up telephone part of the SMS, Phone, and medical staff Examination (SPEx) sports injury surveillance system when compared to measures obtained by trained on-field observers and medical staff (comparison method). We followed 24 elite adolescent handball players over 12 consecutive weeks. Eighty-six injury registrations were obtained by the SPEx and comparison methods. Of them, 35 injury registrations (41%) were captured by SPEx only, 10 injury registrations (12%) by the comparison method only, and 41 injury registrations (48%) by both methods. Weekly exposure time differences (95% limits of agreement) between SPEx and the comparison method ranged from -4.2 to 6.3 hours (training) and -1.5 to 1.0 hours (match) with systematic differences being 1.1 hours (95% CI 0.7 to 1.4) and -0.2 (95% CI -0.3 to -0.2), respectively. These results support the ability of the SPEx system to measure training and match exposures and injury occurrence among young athletes. High weekly response proportions (mean 83%) indicate that SMS messaging can be used for player measures of injury consequences beyond time-loss from sport. However, this needs to be further evaluated in large-scale studies.
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Affiliation(s)
- M Møller
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - N Wedderkopp
- Sport Medicine Clinic, Orthopaedic Department Hospital of Lillebaelt, Institute of Regional Health Service Research and Centre for Research in Childhood Health, IOB, University of Southern Denmark, Odense, Denmark
| | - G Myklebust
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Lind
- Division of Sportstraumatology, Aarhus University Hospital, Aarhus, Denmark
| | - H Sørensen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - J J Hebert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia.,Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - C A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, Calgary, Canada.,Sport Injury Prevention Research Centre, University of Calgary, Edmonton, Canada
| | - J Attermann
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Ståhl CH, Lind M, Svensson AM, Gudbjörnsdottir S, Mårtensson A, Rosengren A. Glycaemic control and excess risk of ischaemic and haemorrhagic stroke in patients with type 1 diabetes: a cohort study of 33 453 patients. J Intern Med 2017; 281:261-272. [PMID: 27925333 DOI: 10.1111/joim.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To estimate the excess risk of stroke in relation to glycaemic control in patients with type 1 diabetes. METHODS In this prospective, matched cohort study, we identified patients with type 1 diabetes, aged ≥18 years, who were registered in the Swedish National Diabetes Register from 1998-2011 and five control subjects for each case from the general population, matched for age, sex and county of residence. The risks of all strokes, ischaemic stroke and haemorrhagic stroke were estimated using Cox hazard regression. RESULTS Of 33 453 type 1 diabetes patients [mean age, 35.5 (SD 14.4) years; mean follow-up, 7.9 (SD 4.3) years; and mean diabetes duration, 20.2 years (SD 14.6)], 762 (2.3%) were diagnosed with stroke compared with 1122 (0.7%) of 159 924 control subjects [mean follow-up, 8.2 (SD 4.3) years]. The overall multiple-adjusted hazard ratios (HRs) for type 1 diabetes patients versus control subjects were 3.29 (95% CI: 2.96-3.66) and 2.49 (95% CI: 1.96-3.16) for ischaemic and haemorrhagic stroke, respectively. The risk of ischaemic and haemorrhagic stroke incrementally increased with increasing HbA1c; the risk of ischaemic stroke was significantly increased with HbA1c within target [≤6.9% (≤52 mmol mol-1 )] [multiple-adjusted HR 1.89 (95% CI: 1.44-2.47)]. For HbA1c ≥9.7% (≥83 mmol mol-1 ), there was a markedly increased risk of both ischaemic and haemorrhagic stroke, with multiple-adjusted HRs of 7.94 (95% CI: 6.29-10.03) and 8.17 (95% CI 5.00-13.35), respectively. CONCLUSIONS Individuals with type 1 diabetes have an increased risk of ischaemic and haemorrhagic stroke, increasing markedly with poor glycaemic control.
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Affiliation(s)
- C Hedén Ståhl
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
| | - A-M Svensson
- Center of Registers in Region Västra Götaland, Gothenburg, Sweden
| | | | | | - A Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Stener-Victorin E, Maliqueo M, Soligo M, Protto V, Manni L, Jerlhag E, Kokosar M, Sazonova A, Behre CJ, Lind M, Ohlsson C, Højlund K, Benrick A. Changes in HbA 1c and circulating and adipose tissue androgen levels in overweight-obese women with polycystic ovary syndrome in response to electroacupuncture. Obes Sci Pract 2016; 2:426-435. [PMID: 28090348 PMCID: PMC5192539 DOI: 10.1002/osp4.78] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/18/2022] Open
Abstract
Aim Insulin sensitivity is ~40% lower in women with polycystic ovary syndrome (PCOS) than in controls. We tested the hypothesis that 5 weeks of electroacupuncture treatment improves glucose regulation and androgen levels in overweight/obese women with PCOS. Material and Methods Seventeen women with PCOS, aged 18 to 38 years, with a body mass index (BMI) ≥25 kg/m2 and diagnosed with PCOS were included in this experimental and feasibility study and subjected to five weeks of electroacupuncture treatments three times/week. The primary outcome was changes in whole‐body glucose homeostasis measured by euglycemic hyperinsulinemic clamp before and after the intervention. Secondary outcome were changes in HbA1c, circulating catecholamines, adipocyte size and adipose tissue expression of sex steroids and nerve growth factor (NGF). Results No significant change in glucose homeostasis was observed, but HbA1c decreased by 9.5% (p = 0.004), circulating testosterone decreased by 22% (p = 0.0007) and dihydrotestosterone decreased by 12% (p = 0.007). The two vagal activity markers of plasma serotonin levels and the dopamine metabolite homovanillic acid decreased by 21% (p = 0.027) and 20% (p = 0.011), respectively. Adipose tissue concentrations of testosterone decreased by 18% (p = 0.049), and androstenedione decreased by 13% (p = 0.035), and mature NGF/proNGF ratio, a marker of sympathetic activity, increased (p = 0.04). These changes occurred without changes in anthropometrics. Conclusion Five weeks of electroacupuncture treatment improves HbA1c and circulating and adipose tissue androgens in women with PCOS. This effect is mediated, at least in part, via modulation of vagal activity and adipose tissue sympathetic activity. Based on these findings, we have recently initiated a randomized controlled study (NTC02647827).
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Affiliation(s)
- E Stener-Victorin
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - M Maliqueo
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden; Endocrinology and Metabolism Laboratory, West Division, School of Medicine University of Chile Santiago Chile
| | - M Soligo
- Institute of Translational Pharmacology - CNR, via del Fosso del Cavaliere 100 Rome Italy
| | - V Protto
- Institute of Translational Pharmacology - CNR, via del Fosso del Cavaliere 100 Rome Italy
| | - L Manni
- Institute of Translational Pharmacology - CNR, via del Fosso del Cavaliere 100 Rome Italy
| | - E Jerlhag
- Institute of Neuroscience and Physiology, Department of Pharmacology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - M Kokosar
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - A Sazonova
- Department of Obstetrics and Gynecology, Sahlgrenska Academy University of Gothenburg Sweden
| | - C J Behre
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg Gothenburg Sweden
| | - C Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - K Højlund
- Department of Endocrinology Odense University Hospital Odense Denmark
| | - A Benrick
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden; School of Health and Education University of Skövde Sweden
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Lim SS, Allen K, Bhutta ZA, Dandona L, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Hay SI, Holmberg M, Kinfu Y, Kutz MJ, Larson HJ, Liang X, Lopez AD, Lozano R, McNellan CR, Mokdad AH, Mooney MD, Naghavi M, Olsen HE, Pigott DM, Salomon JA, Vos T, Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Achoki T, Adebiyi AO, Adedeji IA, Afanvi KA, Afshin A, Agarwal A, Agrawal A, Kiadaliri AA, Ahmadieh H, Ahmed KY, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam U, Alasfoor D, AlBuhairan FS, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alkhateeb MAB, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barber R, Barker-Collo SL, Bärnighausen T, Barrero LH, Barrientos-Gutierrez T, Basu S, Bayou TA, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bello AK, Bennett DA, Bensenor IM, Benzian H, Berhane A, Bernabé E, Bernal OA, Betsu BD, Beyene AS, Bhala N, Bhatt S, Biadgilign S, Bienhoff KA, Bikbov B, Binagwaho A, Bisanzio D, Bjertness E, Blore J, Bourne RRA, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Broday DM, Brugha TS, Buchbinder R, Butt ZA, Cahill LE, Campos-Nonato IR, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cecílio P, Chang HY, Chang JC, Charlson FJ, Che X, Chen AZ, Chiang PPC, Chibalabala M, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Ciobanu LG, Cirillo M, Coates MM, Coggeshall M, Cohen AJ, Cooke GS, Cooper C, Cooper LT, Cowie BC, Crump JA, Damtew SA, Dandona R, Dargan PI, Neves JD, Davis AC, Davletov K, de Castro EF, De Leo D, Degenhardt L, Del Gobbo LC, Deribe K, Derrett S, Des Jarlais DC, Deshpande A, deVeber GA, Dey S, Dharmaratne SD, Dhillon PK, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Felicio MM, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Ferrari AJ, Fischer F, Fitchett JRA, Fitzmaurice C, Foigt N, Foreman K, Fowkes FGR, Franca EB, Franklin RC, Fraser M, Friedman J, Frostad J, Fürst T, Gabbe B, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Gessner BD, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin W, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Graetz N, Greenwell KF, Griswold M, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Gyawali B, Haagsma JA, Haakenstad A, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Hankey GJ, Harb HL, Haro JM, Hassanvand MS, Havmoeller R, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Htet AS, Hu G, Huang H, Iburg KM, Idrisov BT, Inoue M, Islami F, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Jansen HAFM, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Karunapema P, Kasaeian A, Kassebaum NJ, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khoja TAM, Khosravi A, Khubchandani J, Kieling C, Kim CI, Kim D, Kim S, Kim YJ, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kolte D, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko M, Krueger H, Defo BK, Kuchenbecker RS, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kwan GF, Kyu HH, Lal A, Lal DK, Lalloo R, Lam H, Lan Q, Langan SM, Larsson A, Laryea DO, Latif AA, Leasher JL, Leigh J, Leinsalu M, Leung J, Leung R, Levi M, Li Y, Li Y, Lind M, Linn S, Lipshultz SE, Liu PY, Liu S, Liu Y, Lloyd BK, Lo LT, Logroscino G, Lotufo PA, Lucas RM, Lunevicius R, El Razek MMA, Magis-Rodriguez C, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Mapoma CC, Margolis DJ, Martin RV, Martinez-Raga J, Masiye F, Mason-Jones AJ, Massano J, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Mensink GBM, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Micha R, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Mitchell PB, Mock CN, Mohammadi A, Mohammed S, Monasta L, de la Cruz Monis J, Hernandez JCM, Montico M, Moradi-Lakeh M, Morawska L, Mori R, Mueller UO, Murdoch ME, Murimira B, Murray J, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naidoo KS, Naldi L, Nangia V, Neal B, Nejjari C, Newton CR, Newton JN, Ngalesoni FN, Nguhiu P, Nguyen G, Le Nguyen Q, Nisar MI, Pete PMN, Nolte S, Nomura M, Norheim OF, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Ota E, Owolabi MO, PA M, Park EK, Park HY, Parry CD, Parsaeian M, Patel T, Patel V, Caicedo AJP, Patil ST, Patten SB, Patton GC, Paudel D, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pinho C, Pishgar F, Polinder S, Poulton RG, Pourmalek F, Qorbani M, Rabiee RHS, Radfar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Raju M, Ram U, Rana SM, Ranabhat CL, Ranganathan K, Rao PC, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Ribeiro AL, Blancas MJR, Roba HS, Roberts B, Rodriguez A, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Roy N, Sackey BB, Sagar R, Saleh MM, Sanabria JR, Santos JV, Santomauro DF, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Sawyer SM, Schmidhuber J, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford K, Shaheen A, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shey M, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silpakit N, Silva DAS, Silverberg JI, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Skirbekk V, Sligar A, Soneji S, Søreide K, Sorensen RJD, Soriano JB, Soshnikov S, Sposato LA, Sreeramareddy CT, Stahl HC, Stanaway JD, Stathopoulou V, Steckling N, Steel N, Stein DJ, Steiner C, Stöckl H, Stranges S, Strong M, Sun J, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Talongwa RT, Tarawneh MR, Tavakkoli M, Taye B, Taylor HR, Tedla BA, Tefera W, Tegegne TK, Tekle DY, Shifa GT, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, Varakin YY, Vasankari T, Vasconcelos AMN, Veerman JL, Venketasubramanian N, Verma RK, Violante FS, Vlassov VV, Volkow P, Vollset SE, Wagner GR, Wallin MT, Wang L, Wanga V, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Wolfe CDA, Wolfe I, Won S, Woolf AD, Workie SB, Wubshet M, Xu G, Yadav AK, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zegeye EA, Zhao Y, Zhou M, Zodpey S, Zonies D, Murray CJL. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet 2016; 388:1813-1850. [PMID: 27665228 PMCID: PMC5055583 DOI: 10.1016/s0140-6736(16)31467-2] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). METHODS We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. FINDINGS In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. INTERPRETATION GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. FUNDING Bill & Melinda Gates Foundation.
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Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR, Kutz M, Kyu HH, Larson HJ, Leung J, Liang X, Lim SS, Lind M, Lozano R, Marquez N, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Roth GA, Salomon JA, Sandar L, Silpakit N, Sligar A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Thomas BA, Troeger C, VanderZanden A, Vollset SE, Wanga V, Whiteford HA, Wolock T, Zoeckler L, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abreu DMX, Abu-Raddad LJ, Abyu GY, Achoki T, Adelekan AL, Ademi Z, Adou AK, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Lami FHA, Alabed S, Al-Aly Z, Alam K, Alam NKM, Alasfoor D, Aldhahri SF, Aldridge RW, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Alhabib S, Ali R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amegah AK, Ameh EA, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Aregay AF, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu A, Basu S, Bayou YT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Belay HA, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhalla A, Biadgilign S, Bikbov B, Abdulhak AAB, Biroscak BJ, Biryukov S, Bjertness E, Blore JD, Blosser CD, Bohensky MA, Borschmann R, Bose D, Bourne RRA, Brainin M, Brayne CEG, Brazinova A, Breitborde NJK, Brenner H, Brewer JD, Brown A, Brown J, Brugha TS, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cercy K, Cerda J, Chen W, Chew A, Chiang PPC, Chibalabala M, Chibueze CE, Chimed-Ochir O, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colistro V, Colomar M, Colquhoun SM, Cooper C, Cooper LT, Cortinovis M, Cowie BC, Crump JA, Damsere-Derry J, Danawi H, Dandona R, Daoud F, Darby SC, Dargan PI, das Neves J, Davey G, Davis AC, Davitoiu DV, de Castro EF, de Jager P, Leo DD, Degenhardt L, Dellavalle RP, Deribe K, Deribew A, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Ding EL, dos Santos KPB, Dossou E, Driscoll TR, Duan L, Dubey M, Duncan BB, Ellenbogen RG, Ellingsen CL, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Faghmous IDA, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Flaxman A, Foigt N, Fowkes FGR, Franca EB, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gall SL, Gambashidze K, Gamkrelidze A, Ganguly P, Gankpé FG, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Geleijnse JM, Gessner BD, Ghoshal AG, Gibney KB, Gillum RF, Gilmour S, Giref AZ, Giroud M, Gishu MD, Giussani G, Glaser E, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gosselin RA, Gotay CC, Goto A, Gouda HN, Greaves F, Gugnani HC, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Havmoeller R, Heckbert SR, Heredia-Pi IB, Heydarpour P, Hilderink HBM, Hoek HW, Hogg RS, Horino M, Horita N, Hosgood HD, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Htike MMT, Hu G, Huang C, Huang H, Huiart L, Husseini A, Huybrechts I, Huynh G, Iburg KM, Innos K, Inoue M, Iyer VJ, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jonas JB, Joshi TK, Kabir Z, Kamal R, Kan H, Kant S, Karch A, Karema CK, Karimkhani C, Karletsos D, Karthikeyan G, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Khader YS, Khalil IA, Khan AR, Khan EA, Khang YH, Khera S, Khoja TAM, Kieling C, Kim D, Kim YJ, Kissela BM, Kissoon N, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Krog NH, Defo BK, Bicer BK, Kudom AA, Kuipers EJ, Kulkarni VS, Kumar GA, Kwan GF, Lal A, Lal DK, Lalloo R, Lallukka T, Lam H, Lam JO, Langan SM, Lansingh VC, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leigh J, Levi M, Li Y, Lindsay MP, Lipshultz SE, Liu PY, Liu S, Liu Y, Lo LT, Logroscino G, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Ma S, Machado VMP, Mackay MT, MacLachlan JH, Razek HMAE, Magdy M, Razek AE, Majdan M, Majeed A, Malekzadeh R, Manamo WAA, Mandisarisa J, Mangalam S, Mapoma CC, Marcenes W, Margolis DJ, Martin GR, Martinez-Raga J, Marzan MB, Masiye F, Mason-Jones AJ, Massano J, Matzopoulos R, Mayosi BM, McGarvey ST, McGrath JJ, McKee M, McMahon BJ, Meaney PA, Mehari A, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Micha R, Millear A, Miller TR, Mirarefin M, Misganaw A, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Mohan V, Mola GLD, Monasta L, Hernandez JCM, Montero P, Montico M, Montine TJ, Moradi-Lakeh M, Morawska L, Morgan K, Mori R, Mozaffarian D, Mueller UO, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naidoo KS, Naik N, Naldi L, Nangia V, Nash D, Nejjari C, Neupane S, Newton CR, Newton JN, Ng M, Ngalesoni FN, de Dieu Ngirabega J, Nguyen QL, Nisar MI, Pete PMN, Nomura M, Norheim OF, Norman PE, Norrving B, Nyakarahuka L, Ogbo FA, Ohkubo T, Ojelabi FA, Olivares PR, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osman M, Ota E, Ozdemir R, PA M, Pain A, Pandian JD, Pant PR, Papachristou C, Park EK, Park JH, Parry CD, Parsaeian M, Caicedo AJP, Patten SB, Patton GC, Paul VK, Pearce N, Pedro JM, Stokic LP, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Plass D, Platts-Mills JA, Polinder S, Pope CA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Qorbani M, Quame-Amaglo J, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajavi Z, Rajsic S, Raju M, Rakovac I, Rana SM, Ranabhat CL, Rangaswamy T, Rao P, Rao SR, Refaat AH, Rehm J, Reitsma MB, Remuzzi G, Resnikoff S, Ribeiro AL, Ricci S, Blancas MJR, Roberts B, Roca A, Rojas-Rueda D, Ronfani L, Roshandel G, Rothenbacher D, Roy A, Roy NK, Ruhago GM, Sagar R, Saha S, Sahathevan R, Saleh MM, Sanabria JR, Sanchez-Niño MD, Sanchez-Riera L, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schaub MP, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Sharma R, She J, Sheikhbahaei S, Shen J, Shen Z, Shepard DS, Sheth KN, Shetty BP, Shi P, Shibuya K, Shin MJ, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Singh V, Soneji S, Søreide K, Soriano JB, Sposato LA, Sreeramareddy CT, Stathopoulou V, Stein DJ, Stein MB, Stranges S, Stroumpoulis K, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Takahashi K, Takala JS, Talongwa RT, Tandon N, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tedla BA, Tefera WM, Have MT, Terkawi AS, Tesfay FH, Tessema GA, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tirschwell DL, Tonelli M, Topor-Madry R, Topouzis F, Towbin JA, Traebert J, Tran BX, Truelsen T, Trujillo U, Tura AK, Tuzcu EM, Uchendu US, Ukwaja KN, Undurraga EA, Uthman OA, Dingenen RV, van Donkelaar A, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Vidavalur R, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Wagner JA, Wagner GR, Wallin MT, Wang L, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, White RA, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Wong JQ, Woolf AD, Xavier D, Xiao Q, Xu G, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yebyo HG, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Younis MZ, Yu S, Zaidi Z, Zaki MES, Zannad F, Zavala DE, Zeeb H, Zeleke BM, Zhang H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1459-1544. [PMID: 27733281 PMCID: PMC5388903 DOI: 10.1016/s0140-6736(16)31012-1] [Citation(s) in RCA: 4031] [Impact Index Per Article: 503.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. INTERPRETATION At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. FUNDING Bill & Melinda Gates Foundation.
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Moody H, Lind M, Maher S. MicroRNA-31 regulates chemosensitivity in malignant pleural mesothelioma via altered intracellular drug localisation. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang Y, Li X, Zhou M, Luo S, Liang J, Liddell CA, Coates MM, Gao Y, Wang L, He C, Kang C, Liu S, Dai L, Schumacher AE, Fraser MS, Wolock TM, Pain A, Levitz CE, Singh L, Coggeshall M, Lind M, Li Y, Li Q, Deng K, Mu Y, Deng C, Yi L, Liu Z, Ma X, Li H, Mu D, Zhu J, Murray CJL, Wang H. Under-5 mortality in 2851 Chinese counties, 1996-2012: a subnational assessment of achieving MDG 4 goals in China. Lancet 2016; 387:273-83. [PMID: 26510780 PMCID: PMC5703217 DOI: 10.1016/s0140-6736(15)00554-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. METHODS We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. FINDINGS In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4.4%. INTERPRETATION The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8.8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. FUNDING National "Twelfth Five-Year" Plan for Science and Technology Support, National Health and Family Planning Commission of The People's Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Yanping Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohong Li
- National Center for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shusheng Luo
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Center, Beijing, China; Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chelsea A Liddell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew M Coates
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Yanqiu Gao
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Center, Beijing, China; Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunhua He
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuyun Kang
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Center, Beijing, China; Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Dai
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Austin E Schumacher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maya S Fraser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Timothy M Wolock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amanda Pain
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Carly E Levitz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lavanya Singh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Megan Coggeshall
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Margaret Lind
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Yichong Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changfei Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Yi
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xia Ma
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongtian Li
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Dezhi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; National Center for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Lind L, Salihovic S, van Bavel B, Lind M. Circulating levels of perfluorinated compounds and left ventricular geometry. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lind M, Salihovic S, Larsson A, van Bavel B, Lind L. Circulating levels of perfluoroalkyl substances and biomarkers of liver function in a large population based sample of elderly men and women from Sweden. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mor A, Grijota M, Nørgaard M, Munthe J, Lind M, Déruaz A, Pedersen AB. Trends in arthroscopy-documented cartilage injuries of the knee and repair procedures among 15-60-year-old patients. Scand J Med Sci Sports 2014; 25:e400-7. [PMID: 25262959 DOI: 10.1111/sms.12330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 12/28/2022]
Abstract
We validated a registry-based method of identifying patients with knee cartilage injury and estimated temporal changes in the incidence of arthroscopy-documented cartilage injuries of the knee and the proportion leading to repair procedures in Denmark. After excluding patients with diagnosed osteoarthritis, we identified 21,392 patients aged 15-60 years with a first recorded procedure code indicating knee cartilage injury in the Danish National Registry of Patients (DNRP) from 1996 to 2011. Using the surgical descriptions of arthroscopy findings in medical records as gold standard, the positive and negative predictive value of procedure codes for knee cartilage injury was 88% and 99%, respectively. The arthroscopy-documented overall incidence of cartilage injury of the knee was 40/100,000 person-years (py) [95% confidence interval (CI): 39.5-40.6] during the period 1996-2011. The arthroscopy-documented age-standardized annual incidence of knee cartilage injury increased from 22 (95% CI: 20.5-23.7) in 1996 to 61 (95% CI: 58.7-64.0) in 2011, per 100,000 py. An increase occurred in all age groups and both sexes. Only 1/6 (17%) patients with knee cartilage injury had a repair procedure. The validity of procedure codes for knee cartilage injury in the DNRP is high. The arthroscopy-documented incidence of knee cartilage injuries increased substantially during the 15-year period.
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Affiliation(s)
- A Mor
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Grijota
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Munthe
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Lind
- Department of Orthopaedic Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - A Déruaz
- Merck Serono SA, Global Drug Safety, Geneva, Switzerland
| | - A B Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Glogner S, Rosengren A, Olsson M, Gudbjörnsdottir S, Svensson AM, Lind M. The association between BMI and hospitalization for heart failure in 83,021 persons with Type 2 diabetes: a population-based study from the Swedish National Diabetes Registry. Diabet Med 2014; 31:586-94. [PMID: 24147878 DOI: 10.1111/dme.12340] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 09/12/2013] [Accepted: 10/17/2013] [Indexed: 01/25/2023]
Abstract
AIM'S The aim was to To study the relationship between BMI and hospitalization for heart failure in people with Type 2 diabetes. METHODS We identified 83 021 individuals with Type 2 diabetes from the Swedish National Diabetes Registry during 1998-2003, who were followed until hospitalization for heart failure, death or end of follow-up on 31 December 2009. Cox regression analyses were performed, adjusting for age, sex, HbA(1c), blood pressure, diabetes duration, smoking, microalbuminuria, cardiac co-morbidities, glucose-lowering and anti-hypertensive medications. RESULTS During a median follow-up of 7.2 years, 10 969 patients (13.2%) were hospitalized with heart failure. By categories of BMI, with BMI 20 to < 25 kg/m(2) as the reference, hazard ratios for patients during follow-up were 1.07 (95% CI 0.91-1.26) for a mean BMI of < 20 kg/m(2), 1.04 (95% CI 0.98-1.11) for BMI 25 to < 27.5 kg/m(2), 1.22 (95% CI 1.15-1.30) for BMI 27.5 to < 30 kg/m(2), 1.54 (95% CI 1.45-1.63) for BMI 30 to < 35 kg/m(2), 2.16 (95% CI 2.00-2.33) for BMI 35 to < 40 kg/m(2) and 3.22 (95% CI 2.88-3.60) for BMI 40 kg/m(2) or higher. There was a significant interaction between BMI and sex (P = 0.0006), with numerically higher hazard ratios for hospitalization for heart failure within each BMI category for men than for women. CONCLUSIONS Obesity is strongly related to hospitalization for heart failure in people with Type 2 diabetes, and the relationship is somewhat stronger for men than for women. Preventing weight gain and promoting weight loss may be crucial in reducing the incidence of future hospitalizations for heart failure in this population.
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Affiliation(s)
- S Glogner
- Department of Medicine, NU-Hospital Organization, Trollhättan, Sweden
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Ramskov D, Sørensen H, Parner E, Nielsen R, Lind M, Rasmussen S. THE RUN CLEVER STUDY PROTOCOL: THE DESIGN OF A RANDOMIZED CONTROLLED TRIAL. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Møller M, Myklebust G, Attermann J, Wedderkopp N, Sørensen H, Lind M. SHOULDER PAIN PROBLEMS IN YOUTH HANDBALL. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Van der Nest MA, Olson A, Lind M, Vélëz H, Dalman K, Brandström Durling M, Karlsson M, Stenlid J. Distribution and evolution of het gene homologs in the basidiomycota. Fungal Genet Biol 2013; 64:45-57. [PMID: 24380733 DOI: 10.1016/j.fgb.2013.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/04/2013] [Accepted: 12/20/2013] [Indexed: 12/24/2022]
Abstract
In filamentous fungi a system known as somatic incompatibility (SI) governs self/non-self recognition. SI is controlled by a regulatory signaling network involving proteins encoded at the het (heterokaryon incompatible) loci. Despite the wide occurrence of SI, the molecular identity and structure of only a small number of het genes and their products have been characterized in the model fungi Neurospora crassa and Podospora anserina. Our aim was to identify and study the distribution and evolution of putative het gene homologs in the Basidiomycota. For this purpose we used the information available for the model fungi to identify homologs of het genes in other fungi, especially the Basidiomycota. Putative het-c, het-c2 and un-24 homologs, as well as sequences containing the NACHT, HET or WD40 domains present in the het-e, het-r, het-6 and het-d genes were identified in certain members of the Ascomycota and Basidiomycota. The widespread phylogenetic distribution of certain het genes may reflect the fact that the encoded proteins are involved in fundamental cellular processes other than SI. Although homologs of het-S were previously known only from the Sordariomycetes (Ascomycota), we also identified a putative homolog of this gene in Gymnopus luxurians (Basidiomycota, class Agaricomycetes). Furthermore, with the exception of un-24, all of the putative het genes identified occurred mostly in a multi-copy fashion, some with lineage and species-specific expansions. Overall our results indicated that gene duplication followed by gene loss and/or gene family expansion, as well as multiple events of domain fusion and shuffling played an important role in the evolution of het gene homologs of Basidiomycota and other filamentous fungi.
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Affiliation(s)
- M A Van der Nest
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden.
| | - A Olson
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - M Lind
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - H Vélëz
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - K Dalman
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - M Brandström Durling
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - M Karlsson
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
| | - J Stenlid
- Department of Forest Mycology and Plant Pathology, Swedish University of Agricultural Sciences, Uppsala SE-750 07, Sweden
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Lind M, Garcia-Rodriguez LA, Booth GL, Cea-Soriano L, Shah BR, Ekeroth G, Lipscombe LL. Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study. Diabetologia 2013; 56:2601-8. [PMID: 24114114 DOI: 10.1007/s00125-013-3063-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine the contemporary rate ratio of mortality and changes over time in individuals with vs without diabetes. METHODS Annual age- and sex-adjusted mortality rates were compared for adults (>20 years) with and without diabetes in Ontario, Canada, and the UK from January 1996 to December 2009 using The Health Improvement Network (THIN) and Ontario databases. The total number of individuals evaluated increased from 8,757,772 in 1996 to 12,696,305 in 2009. RESULTS The excess risk of mortality for individuals with diabetes in both cohorts was significantly lower during later vs earlier years of the follow-up period (1996-2009). In Ontario the diabetes mortality rate ratio decreased from 1.90 (95% CI 1.86, 1.94) in 1996 to 1.51 (1.48, 1.54) in 2009, and in THIN from 2.14 (1.97, 2.32) to 1.65 (1.57, 1.72), respectively. In Ontario and THIN, the mortality rate ratios among diabetic patients in 2009 were 1.67 (1.61, 1.72) and 1.81 (1.68, 1.94) for those aged 65-74 years and 1.11 (1.10, 1.13) and 1.19 (1.14, 1.24) for those aged over 74 years, respectively. Corresponding rate ratios in Ontario and THIN were 2.45 (2.36, 2.54) and 2.64 (2.39, 2.89) for individuals aged 45-64 years, and 4.89 (4.35, 5.45) and 5.18 (3.73, 6.69) for those aged 20-44 years. CONCLUSIONS/INTERPRETATION The excess risk of mortality in individuals with vs without diabetes has decreased over time in both Canada and the UK. This may be in part due to earlier detection and higher prevalence of early diabetes, as well as to improvements in diabetes care.
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Affiliation(s)
- M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
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Bailes G, Lind M, Ely A, Powell M, Moore-Kucera J, Miles C, Inglis D, Brodhagen M. Isolation of native soil microorganisms with potential for breaking down biodegradable plastic mulch films used in agriculture. J Vis Exp 2013:e50373. [PMID: 23712218 DOI: 10.3791/50373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Fungi native to agricultural soils that colonized commercially available biodegradable mulch (BDM) films were isolated and assessed for potential to degrade plastics. Typically, when formulations of plastics are known and a source of the feedstock is available, powdered plastic can be suspended in agar-based media and degradation determined by visualization of clearing zones. However, this approach poorly mimics in situ degradation of BDMs. First, BDMs are not dispersed as small particles throughout the soil matrix. Secondly, BDMs are not sold commercially as pure polymers, but rather as films containing additives (e.g. fillers, plasticizers and dyes) that may affect microbial growth. The procedures described herein were used for isolates acquired from soil-buried mulch films. Fungal isolates acquired from excavated BDMs were tested individually for growth on pieces of new, disinfested BDMs laid atop defined medium containing no carbon source except agar. Isolates that grew on BDMs were further tested in liquid medium where BDMs were the sole added carbon source. After approximately ten weeks, fungal colonization and BDM degradation were assessed by scanning electron microscopy. Isolates were identified via analysis of ribosomal RNA gene sequences. This report describes methods for fungal isolation, but bacteria also were isolated using these methods by substituting media appropriate for bacteria. Our methodology should prove useful for studies investigating breakdown of intact plastic films or products for which plastic feedstocks are either unknown or not available. However our approach does not provide a quantitative method for comparing rates of BDM degradation.
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Affiliation(s)
- Graham Bailes
- Biology Department, Western Washington University, USA
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Bohman B, Eriksson M, Lind M, Ghaderi A, Forsberg L, Rasmussen F. Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services. Acta Paediatr 2013; 102:520-4. [PMID: 23356388 DOI: 10.1111/apa.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 01/08/2023]
Abstract
AIM To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children. METHODS Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories. RESULTS The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%). CONCLUSION Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.
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Affiliation(s)
- B Bohman
- Department of Public Health Sciences; Karolinska Institutet; Stockholm; Sweden
| | | | - M Lind
- Child Health Services; Örebro County Council; Örebro; Sweden
| | | | - L Forsberg
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm; Sweden
| | - F Rasmussen
- Department of Public Health Sciences; Karolinska Institutet; Stockholm; Sweden
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Lind M, Olsson M, Rosengren A, Svensson AM, Bounias I, Gudbjörnsdottir S. The relationship between glycaemic control and heart failure in 83,021 patients with type 2 diabetes. Diabetologia 2012; 55:2946-53. [PMID: 22895807 DOI: 10.1007/s00125-012-2681-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/29/2012] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the relationship between glycaemic control and hospitalisation for heart failure in patients with type 2 diabetes. METHODS Patients included in the Swedish National Diabetes Register (NDR) during 1998-2003 were followed until hospitalisation for heart failure, death or 31 December 2009. Unadjusted and adjusted incidence rates for heart failure were estimated by Poisson regression and relative risk was estimated by Cox regression. RESULTS In 83,021 patients with type 2 diabetes, 10,969 (13.2%) were hospitalised with a primary or secondary diagnosis of heart failure during a mean follow-up of 7.2 years. The incidence increased by male sex (p < 0.001), older age (p < 0.001) and longer diabetes duration (p < 0.001). In Cox regression adjusting for risk factors of heart failure the HR per each percentage unit higher HbA(1c) (10 mmol/mol) for heart-failure hospitalisation was 1.12 (95% CI 1.10, 1.14). By category of HbA(1c) the HR for heart failure hospitalisation was: HbA(1c) 6.0 to <7.0% (42 to <53 mmol/mol), 0.91 (95% CI 0.84, 0.98); HbA(1c) 7.0 to <8.0% (53 to <64 mmol/mol), 0.99 (95% CI 0.91, 1.07); HbA(1c) 8.0 to <9.0% (64 to < 75 mmol/mol), 1.10 (95% CI 1.01, 1.20); HbA(1c) 9.0 to <10.0% (75 to <86 mmol/mol), 1.27 (95% CI 1.15, 1.41); HbA(1c) ≥ 10.0 % (≥ 86 mmol/mol), 1.71 (1.51, 1.93) (reference HbA(1c) <6% [42 mmol/mol]). The HR for patients with HbA(1c) 7.0 to <8.0% (53 to < 64 mmol/mol) compared with patients with HbA(1c) 6.0 to <7.0% (42 to <53 mmol/mol) was 1.09 (95% CI 1.03, 1.14). CONCLUSIONS/INTERPRETATION Poor glycaemic control (HbA(1c) >7% [53 mmol/mol]) is associated with an increased risk of hospitalisation for heart failure in patients with type 2 diabetes.
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Affiliation(s)
- M Lind
- Department of Medicine, Uddevalla Hospital, 451 80 Uddevalla, Sweden.
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Abstract
AIM To examine the availability of insulin pump therapy in patients with Type 1 diabetes. METHODS Patients using insulin pumps among a cohort of 7224 patients with Type 1 diabetes were studied. RESULTS In logistic regression, used to evaluate variables not changing over time among the total cohort, use of insulin pumps varied by outpatient clinic (P<0.001) and sex (P<0.001). Cox regression analysis in 5854 patients with detailed patient data prior to use of an insulin pump showed higher HbA(1c) (P<0.0001), lower creatinine (P=0.002), high and low insulin doses (P<0.0001), younger age (P<0.0001) and female sex (P<0.0001) to be associated with use of an insulin pump. Women were 1.5-fold more likely to start using an insulin pump (hazard ratio 1.52, 95% confidence interval 1.29-1.79) and patients in the 20- to 30-years age range were more than twice as likely to begin use of an insulin pump than patients aged 40-50 years (hazard ratio 8.63, 95% confidence interval 5.91-12.59 and hazard ratio 3.98, 95% confidence interval 2.80-5.64, respectively). A 10-μmol/l higher level of creatinine was associated with a hazard ratio of 0.56 (95% confidence interval 0.39-0.81) of starting use of an insulin pump. CONCLUSIONS At 10 hospital outpatient clinics in Sweden, use of insulin pumps therapy varied by clinic. A higher proportion of women began using insulin pumps. Younger patients and patients with fewer complications were also more likely to start using an insulin pump. Further research is needed to confirm these findings in other geographical regions and to understand whether the availability of insulin pumps today is optimized.
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Affiliation(s)
- B-M Carlsson
- Diabetes Section of Medicine, SÄS-Hospital Organization, Skene, Uddevalla, Sweden
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Masters C, Robert B, Ryan T, Lind M, Li QX, Watt A, Cherny R, Barnham K. 49 Aβ oligomers as diagnostic and therapeutic targets for Alzheimer's disease. Neurobiol Aging 2012. [DOI: 10.1016/j.neurobiolaging.2012.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lind M, Boman K, Johansson L, Nilsson TK, Järvholm LS, Jansson JH. Von Willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment. J Intern Med 2012; 271:239-46. [PMID: 21707795 DOI: 10.1111/j.1365-2796.2011.02418.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Oral anticoagulation (OAC), predominantly with warfarin, is an effective treatment to prevent thromboembolic events. Serious bleeding is a frequent and feared treatment complication. In this longitudinal cohort study of OAC-treated patients, we aimed to evaluate the relationship between von Willebrand factor (VWF) levels and risk of bleeding complications, cardiovascular mortality and all-cause mortality. METHODS AND RESULTS A total of 719 patients receiving warfarin treatment were observed for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified into clinically relevant bleeding (CRB) and major bleeding. Ischaemic stroke, peripheral arterial embolism, myocardial infarction, and death were also recorded. We identified 113 cases of CRB and 73 of major bleeding. In total, 161 deaths occurred during follow-up with cardiovascular disease identified as the cause of death in 110 patients. Patients in the highest tertile of VWF had a significantly increased risk of bleeding complications: hazard ratio (HR) 2.53 (95% CI 1.41-4.56) for major bleeding and HR 2.19 (95% CI 1.38-3.48) for CRB. VWF, expressed either in tertiles or as a continuous variable, showed a significant association with cardiovascular mortality (HR 1.68, 95% CI 1.40-2.01) and all-cause mortality (HR 1.77, 95% CI 1.52-2.05). In multivariate Cox regression analysis, the findings remained significant after adjusting for age, high-sensitivity C-reactive protein and creatinine. CONCLUSIONS Patients with high levels of VWF had an increased risk of bleeding complications, cardiovascular mortality and all-cause mortality during OAC treatment. Our findings imply that the use of VWF as a risk marker for thromboembolic events is complicated by the association of VWF with bleeding complications.
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Affiliation(s)
- M Lind
- Department of Public Health and Clinical Medicine, Umeå University, Umeå.
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Bohn MB, Vestergaard R, Dalstra M, Jakobsen BW, Søballe K, Lind M. Mechanical stability of the femoral fixation for single- and double-bundle ACL reconstruction in an in vitro experimental model. Scand J Med Sci Sports 2011; 23:263-70. [PMID: 22093025 DOI: 10.1111/j.1600-0838.2011.01402.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 11/30/2022]
Abstract
Anterior cruciate ligament ACL reconstruction using the double-bundle (DB) technique is gaining popularity. A possible weak link in the DB technique could be that two tendon grafts of smaller diameters are used. The purpose of this study was to test different femoral fixation methods and graft diameters representing single-bundle (SB) and DB ACL reconstructions and compare their biomechanical properties. We hypothesized that SB 6-mm graft constructs had inferior biomechanical properties than SB 9-mm grafts or DB 2 × 6-mm grafts. Furthermore, we hypothesized that interference (IF) screw fixation would demonstrate less elongation and a higher stiffness than Endobutton (Smith & Nephew®, Inc., Andover, Massachusetts, USA) fixation (EBF). We performed an in vitro study using porcine knees and extensor tendons. The mechanical test consisted of a cyclic test followed by a load-to-failure test. We found that 6-mm graft constructs had an ultimate failure load that was up to 40% less than both the 9-mm and 2 × 6-mm graft constructs, despite the fixation method (P-values ≥ 0.004). Comparing fixation methods, EBF was superior to IF concerning maximum load to failure (P < 0.001); IF resulted in a higher stiffness of the femur/graft complex than the EBF (P < 0.001) but no significant difference in elongation between fixation methods. Since the two graft strands are subjected to different loads in different knee flexion angles, the reduced strength of the individual graft strands in DB ACL reconstruction could be a concern.
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Affiliation(s)
- M B Bohn
- Sports Trauma Division, Department of Orthopeadic Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Nielsen R, Ramskov D, Sorensen H, Lind M, Rasmussen S, Buist I. Protocol for the dano-run study: a 1-year observational follow up study on running related injuries in 1000 novice runners. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rustin G, Reed N, Jayson GC, Ledermann JA, Adams M, Perren T, Poole C, Lind M, Persic M, Essapen S, Gore M, Calvert H, Stredder C, Wagner A, Giurescu M, Kaye S. A phase II trial evaluating two schedules of sagopilone (ZK-EPO), a novel epothilone, in patients with platinum-resistant ovarian cancer. Ann Oncol 2011; 22:2411-2416. [PMID: 21372124 DOI: 10.1093/annonc/mdq780] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sagopilone, the first fully synthetic epothilone, has shown promising preclinical activity in tumour models. This open-label randomised phase II study investigated two infusion schedules of sagopilone in women with ovarian cancer. PATIENTS AND METHODS Women with ovarian cancer recurring within 6 months of end of last platinum-containing treatment received sagopilone 16 mg/m(2) as a 3- or 0.5-h i.v. infusion every 21 days for up to 6 weeks. RESULTS Sixty-three patients received sagopilone as a 3-h (n=38) or 0.5-h (n=25) infusion. There were nine confirmed tumour responses [by modified RECIST (n=8) and by Gynecologic Cancer Intergroup CA-125 criteria (n=1)] in 57 patients assessable for efficacy overall [three (13%) with 0.5-h and six (18%) with 3-h infusions]. The 0.5-h arm was closed when it failed to meet its target efficacy. Main drug-related adverse events were peripheral sensory neuropathy (73%; 16% grade 3), nausea (37%; 2% grade 3), fatigue (35%; 3% grade 3) and arthralgia (30%; 5% grade 3). Overall incidence of peripheral sensory neuropathy was similar in both treatment arms, with no grade 4 neuropathy events. No acute allergic infusion reactions were observed. CONCLUSION Sagopilone is effective, with balanced tolerability, in patients with recurrent platinum-resistant ovarian cancer.
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Affiliation(s)
- G Rustin
- Medical Oncology, Mount Vernon Cancer Centre, Northwood.
| | - N Reed
- Department of Clinical Oncology, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow
| | - G C Jayson
- School of Cancer and Enabling Sciences, University of Manchester and Christie Hospital, Manchester
| | - J A Ledermann
- Department of Oncology, UCL Hospitals and UCL Cancer Institute, London
| | - M Adams
- Clinical Oncology, Velindre NHS Trust, Cardiff
| | - T Perren
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds
| | - C Poole
- Arden Cancer Research Centre, University Hospitals Coventry and Warwickshire, Coventry
| | - M Lind
- Department of Oncology, Princess Royal Hospital, Hull
| | - M Persic
- Clinical Oncology, Derbyshire Royal Infirmary, Derby
| | - S Essapen
- Clinical Oncology, The Royal Surrey County Hospital, Guildford
| | - M Gore
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London
| | | | | | - A Wagner
- Global Medical Development Oncology, Bayer Schering Pharma AG, Berlin, Germany
| | - M Giurescu
- Global Medical Development Oncology, Bayer Schering Pharma AG, Berlin, Germany
| | - S Kaye
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London
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Sørensen OG, Larsen K, Jakobsen BW, Kold S, Hansen TB, Lind M, Søballe K. The combination of radiostereometric analysis and the telos stress device results in poor precision for knee laxity measurements after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19:355-62. [PMID: 20680246 DOI: 10.1007/s00167-010-1205-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/14/2010] [Indexed: 02/01/2023]
Abstract
PURPOSE Several devices for measuring knee laxity following anterior cruciate ligament ACL reconstruction exist, but the precision of the methods has never been optimal. Therefore, a new standardized protocol (NSP) was made, aiming at ensuring a reliable positioning of the Telos Stress Device (TSD) which theoretically could result in precise knee laxity measurements when using radiostereometric analysis (RSA) in combination with TSD. METHOD The TSD was applied to the knee of 30 healthy persons, using both the NSP and the official company instructions. The position of the stress arms of the TSD was marked following each measurement. The reliability of each protocol was calculated as the difference in length between the first and second markings. The NSP for the TSD was then used in a clinical study. Thirty-five patients underwent ACL reconstruction. Double measurements of knee laxity by RSA were performed at a 3-month follow-up. RESULTS Using the NSP for TSD positioning, the prediction interval at the marking sites ranged from ±0.4 to ±1.1 mm. Following the company instructions, the prediction interval ranged from ±0.8 to ±3.9 mm depending on marking site. Thus, the precision of positioning the stress arms of the TSD was improved at all marking sites using the NSP compared with the original company protocol. The double measurements of the knee laxity in the clinical study resulted in a mean difference of 0.0 mm and a prediction interval of ±5.2 mm. CONCLUSION Even though the NSP improved the positioning of the TSD on patients' extremities, the combination of NSP-TSD and RSA was not able to provide acceptable knee laxity measurements in a clinical setting compared with published precision data for other devices on the market. Therefore, the Telos Stress Device is not recommendable for use in knee laxity measurements following ACL reconstruction.
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Affiliation(s)
- O G Sørensen
- Orthopaedic Research Unit, Hospital Unit West, Laegaardvej 12, 7500, Holstebro, Denmark.
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Lind M, Odén A, Fahlén M, Eliasson B. The shape of the metabolic memory of HbA1c: re-analysing the DCCT with respect to time-dependent effects. Diabetologia 2010; 53:1093-8. [PMID: 20237754 DOI: 10.1007/s00125-010-1706-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/20/2010] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS We determined the shape of the metabolic memory of HbA1c and its contribution to retinopathy, as well as the importance of reducing HbA1c to prevent progression of retinopathy. METHODS The relative risk contribution of HbA1c values at different points in time to current progression of retinopathy was determined in the DCCT patients. RESULTS HbA1c 2 to 3 years earlier had the greatest relative risk contribution to current progression of retinopathy. HbA1c up to 5 years earlier made a greater contribution than current values, while values from 8 years earlier still had an important impact. When HbA1c had been at 8% for a long period and was subsequently lowered to 7%, the salutary effects did not begin to appear until 2 to 3 years after lowering. The hazard function for a constant level of HbA1c increased with time. The numbers needed to treat when reducing HbA1c from 8.3% to 8% from diagnosis was estimated to be 1,688 for the first 3 years and 13 for the period 9 to 12 years. Survival functions when reducing HbA1c from 8% to 7% show that pre-study glycaemic control dominates the effect on progression of retinopathy during the first years of a trial. CONCLUSIONS/INTERPRETATION The most harmful effect of hyperglycaemia on progression of retinopathy in type 1 diabetes initially increases, but declines after roughly 5 years. The salutary effect of reducing HbA1c accelerates with time and becomes greater in clinical practice than has been previously understood. Clinical trials should preferably be designed for long periods or include patients with low previous glycaemic exposure to distinguish trial effects from those of the metabolic memory.
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Affiliation(s)
- M Lind
- Department of Medicine, NU Hospital Organization, SE-451 80 Uddevalla, Sweden.
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Aleksyniene R, Thomsen JS, Eckardt H, Bundgaard KG, Lind M, Hvid I. Three-dimensional microstructural properties of regenerated mineralizing tissue after PTH (1-34) treatment in a rabbit tibial lengthening model. J Musculoskelet Neuronal Interact 2009; 9:268-277. [PMID: 19949285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Since the approval of parathyroid hormone (PTH) as treatment for osteoporosis, PTH has increasingly been investigated for bone repair and regeneration. The aim of the study was to investigate the effects of intermittent PTH treatment on the microstructure of regenerated mineralizing tissue after distraction osteogenesis in rabbits. After tibial mid-diaphyseal osteotomy the callus was distracted 1 mm/day for 10 days. 72 rabbits were divided in to 3 groups, which daily received a PTH (1-34) 25 microg/kg injection for 30 days; a saline injection for 10 days and a PTH injection for 20 days; or a saline injection for 30 days. The microstructure of the regenerate was assessed by micro computed tomography (microCT). In all 51 obtained specimens were evaluated morphometrically using three different volumes of interests. The results showed that treatment with PTH during distraction osteogenesis resulted in a significantly higher trabecular number, a more isotropic trabecular orientation, a higher connectivity density, and a higher mineralizing tissue mass. We also found that distraction calluses treated with PTH were more mature than the non-treated. CONCLUSION treatment with PTH resulted in an enhanced microstructure of the newly regenerated mineralizing tissue indicating that PTH has a potential role as a stimulating agent during distraction osteogenesis.
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Affiliation(s)
- R Aleksyniene
- Orthopaedic Division of Northern Denmark, Aalborg University Hospital, University of Aarhus, Aalborg, Denmark.
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Ceberg C, Johnsson S, Lind M, Knöös T. A NOVEL BEAM-QUALITY SPECIFIER FOR NON-STANDARD FIELDS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Scandurra I, Hägglund M, Koch S, Lind M. Usability laboratory test of a novel mobile homecare application with experienced home help service staff. Open Med Inform J 2008; 2:117-28. [PMID: 19415140 PMCID: PMC2669647 DOI: 10.2174/1874431100802010117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 06/19/2008] [Accepted: 07/07/2008] [Indexed: 11/22/2022] Open
Abstract
Using participatory design, we developed and deployed a mobile Virtual Health Record (VHR) on a personal digital assistant (PDA) together with experienced homecare staff. To assess transferability to a second setting and usability when used by novice users with limited system education the application was tested in a usability lab. Eight participants from another homecare district performed tasks related to daily homecare work using the VHR. Test protocols were analyzed with regard to effectiveness, potential usability problems and user satisfaction. Usability problems having impact on system performance and contextual factors affecting system transferability were uncovered. Questionnaires revealed that the participants frequently used computers, but never PDAs. Surprisingly there were only minor differences in input efficiency between novice and experienced users. The participants were overall satisfied with the application. However, transfer to another district can not be performed, unless by means of careful field observations of contextual differences.
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Affiliation(s)
- I Scandurra
- Centre for eHealth, Uppsala University, Uppsala, Sweden
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Jensen TB, Overgaard S, Lind M, Rahbek O, Bünger C, Søballe K. Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs. ACTA ACUST UNITED AC 2007; 89:121-6. [PMID: 17259430 DOI: 10.1302/0301-620x.89b1.17077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Impacted bone allograft is often used in revision joint replacement. Hydroxyapatite granules have been suggested as a substitute or to enhance morcellised bone allograft. We hypothesised that adding osteogenic protein-1 to a composite of bone allograft and non-resorbable hydroxyapatite granules (ProOsteon) would improve the incorporation of bone and implant fixation. We also compared the response to using ProOsteon alone against bone allograft used in isolation. We implanted two non-weight-bearing hydroxyapatite-coated implants into each proximal humerus of six dogs, with each implant surrounded by a concentric 3 mm gap. These gaps were randomly allocated to four different procedures in each dog: 1) bone allograft used on its own; 2) ProOsteon used on its own; 3) allograft and ProOsteon used together; or 4) allograft and ProOsteon with the addition of osteogenic protein-1. After three weeks osteogenic protein-1 increased bone formation and the energy absorption of implants grafted with allograft and ProOsteon. A composite of allograft, ProOsteon and osteogenic protein-1 was comparable, but not superior to, allograft used on its own. ProOsteon alone cannot be recommended as a substitute for allograft around non-cemented implants, but should be used to extend the volume of the graft, preferably with the addition of a growth factor.
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Affiliation(s)
- T B Jensen
- Orthopaedic Research Group, Odense University Hospital, DK 5000 Odense C, Denmark.
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