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3. Supercritical CO

Author

Kamasani Chiranjeevi, Reddy, Joonho, Seo, H N, Yoon, Seonhyeok, Kim, G M, Kim, H M, Son, Seunghee, Park, and Solmoi, Park

Abstract

The phase changes in alkali-activated slag samples when exposed to supercritical carbonation were evaluated. Ground granulated blast furnace slag was activated with five different activators. The NaOH, Na

Published
2022

4. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes—Part II

Author

Minn N. Yoon, Lily (Ling) Lu, Carla Ickert, Carole A. Estabrooks, and Matthias Hoben

Subjects
Canada, Communication, Humans, Oral Health, Geriatrics and Gerontology, General Dentistry, Nursing Homes
Abstract

To evaluate the response process validity of the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items and the organisational processes for assessing nursing home (NH) residents' oral/dental status.Although care aides provide most direct care to NH residents, including oral care, they are not directly involved in structured care planning activities, including RAI assessments. This most likely affects the accuracy of RAI assessments, as well quality of care. However, we neither know how well regulated and unregulated care staff understand the RAI oral/dental items, nor what processes are used in completing oral/dental assessments.We conducted nine focus groups with 44 care aides, nurses, allied health providers, clinical specialists and managers. We discussed randomly selected RAI oral/dental assessments with focus group participants, including participants' understanding of the items and why the options were selected. Participants also explained the communication and process for completing the RAI.Participants' perceptions of the oral/dental items aligned fairly well with the item definitions. However, responses primarily focused on severe oral/dental problems with obvious physical characteristics (eg black teeth denoting caries). For non-visual oral problems, such as pain, staff relied on resident verbalisation. No formal mechanisms were described for care aides to update nurses on residents' oral health needs.Performance problems of RAI oral/dental items are largely rooted in poor communication between care aides and nurses and not integrating care aides in assessment processes. We need policies that address these problems in order to improve NH residents' poor oral health.

Published
2020
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5. Oral care practices of long‐term care home residents and caregivers: Secondary analysis of observational video recordings

Author

Minn N. Yoon, Alex Mihailidis, Rozanne Wilson, Carla Ickert, and Elizabeth Rochon

Subjects
Male, Toothbrushing, medicine.medical_specialty, Video Recording, Oral Health, Oral health, Tooth brushing, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Secondary analysis, medicine, Humans, Dementia, 030212 general & internal medicine, General Nursing, Aged, 030504 nursing, business.industry, Verbal feedback, General Medicine, medicine.disease, Long-Term Care, stomatognathic diseases, Long-term care, Caregivers, Family medicine, Female, Observational study, Natural tooth, 0305 other medical science, business
Abstract

AIMS AND OBJECTIVES To describe the proportion of toothbrushing task steps, long-term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided. BACKGROUND Poor oral health is widespread among older adults in long-term care homes; however, little is known about their actual oral health practices. DESIGN Secondary analysis of video recordings. METHODS A total of 58 video-recorded sessions were analysed from two long-term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer's disease and understood English. Eligible caregivers spoke English and had worked for at least 1 year with people with dementia. Toothbrushing success was identified by the resident's participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial versus the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analysed using content analysis. STROBE guidelines were used in reporting this study. RESULTS The two step residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 s (SD = 35.15). In 66% of observed videos, toothbrushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces. CONCLUSION Caregivers are supporting residents to independently complete toothbrushing; however, the duration and quality of toothbrushing are not sufficient to ensure optimal oral health. RELEVANCE TO CLINICAL PRACTICE Clear, detailed guidelines are required to ensure adequate oral care for long-term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.

Published
2020
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6. Analysis of e-cigarette warning letters issued by the Food and Drug Administration in 2020 and 2021

Author

Barbara A Schillo, Adrian Bertrand, Jodie Briggs, Elexis C Kierstead, Nathan A Silver, Stephanie N Yoon, and Megan C Diaz

Subjects
Health (social science), Public Health, Environmental and Occupational Health
Abstract

PurposeThis study analyses the Food and Drug Administration (FDA) warning letters sent to e-cigarette companies from 1 January 2020 to 9 September 2021. Study results can inform regulation of e-cigarettes.MethodologyWarning letters retrieved from FDA’s website were coded for company type (retailer, manufacturer or distributor), location (domestic or international), infractions listed (PMTA (premarket tobacco product application), selling to minors, advertising to youth or packaging violation/mislabelling), product type (e-liquid, device or both), flavour (fruit, candy, tobacco, menthol/mint, concept flavour) and consequence (civil money penalties, product seizure and injunction, product detention and refusal of entry to the USA, no-tobacco-sales order, criminal prosecution).ResultsOf 303 coded letters (126 from 2020 and 177 from 2021), 97.4% were sent to small online retailers. Overall, 94.1% of the companies cited were located within the USA, 75.2% of the infractions were identified by reviewing a company’s website and 70.5% were PMTA violations. In 2020, 55.6% of infractions were PMTA violations; in 2021, nearly all infractions were PMTA violations. The letters cited 880 products; 92.2% of which were e-liquid products, with 32.4% fruit and 31.1% concept flavours.DiscussionWarning letters targeted small online retailers rather than large e-cigarette brands or products most used by youth: pod mods and disposables. The focus of these enforcement actions comprises a small share of the market and the impact on use was likely minimal. With PMTA decisions pending for the largest brands of e-cigarettes, the FDA should use its enforcement powers to target manufacturers, distributors and sellers of the tobacco products that have the greatest impact on youth and products that provide no public health benefit.

Published
2022

7. Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond

Author

Heather Keller, Cindy Wei, Susan Slaughter, Minn N Yoon, Christina Lengyel, Ashwin Namasivayam-Macdonald, Laurel Martin, George Heckman, Phyllis Gaspar, Janet Mentes, and Safura Syed

Subjects
SARS-CoV-2, Drinking, COVID-19, Homes for the Aged, Humans, Medicine, General Medicine, Aged, Nursing Homes
Abstract

ObjectivesPoor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake.DesignQualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed.SettingResidential care.Participants27 invited researcher and provider experts.ResultsChallenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals).ConclusionsCOVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

Published
2022

8. Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care

Author

Heather Keller, Cindy Wei, Ashwini Namasivayam-MacDonald, Safura Syed, Christina Lengyel, Minn N. Yoon, Susan E. Slaughter, Phyllis M. Gaspar, George A. Heckman, and Janet Mentes

Subjects
Health Policy, Surveys and Questionnaires, Feasibility Studies, Humans, Female, Geriatrics and Gerontology, Gerontology, Long-Term Care, General Nursing
Abstract

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey ( N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [ Research in Gerontological Nursing, 15 (1), 27–38.]

Published
2022

12. Effect of Detailed OSCE Score Reporting on Learning and Anxiety in Medical School

Author

Minn N. Yoon, Silvia Ortiz, Vijay J. Daniels, Gurtej Sandhu, Hollis Lai, Okan Bulut, and Tracey Hillier

Subjects
Medical education, Medicine (General), R5-920, LC8-6691, education, medicine, Medical school, Computer based, Anxiety, medicine.symptom, Psychology, Special aspects of education, Clinical skills
Abstract

Introduction There is growing literature on increasing feedback from Objective Structured Clinical Examinations (OSCEs) and one approach is a score report. The purpose of this study was to implement and evaluate a score report for a second and fourth-year medical school OSCE. Methods We developed an electronic OSCE score report that displayed comments and performance by domain within and across stations (checklist items and rating scales were tagged to each domain). Our initial pilot released the score report after pass/fail decisions but subsequent iterations released the score report the same day as the exam. Our evaluation approach included both student surveys and focus groups. Results Students felt the OSCE score report was accurate, identified strengths and weaknesses, and would likely cause them to take future action, with second-year students more likely to act on the report than fourth year students. The thematic analysis revealed barriers and enablers to utilizing feedback as well as the power of the score report to reduce anxiety. Conclusions Our OSCE score report was simple to develop and implement the same day as an OSCE with an overall positive response from students with respect to accuracy and ability to use the information for future learning.

Published
2021

13. Evaluating Classification Consistency of Oral Lesion Images for Use in an Image Classification Teaching Tool

Author

Hollis Lai, Reid Friesen, Minn N. Yoon, Silvia Ortiz, and Yuxin Shen

Subjects
education, educational technology, computer.software_genre, Article, oral lesion, Lesion, Consistency (statistics), medicine, dental hygiene education, General Dentistry, Contextual image classification, business.industry, Educational technology, Rubric, RK1-715, dental education, Feature (computer vision), Dentistry, Active learning, Artificial intelligence, medicine.symptom, Psychology, business, classification consistency, computer, Natural language processing, Kappa
Abstract

A web-based image classification tool (DiLearn) was developed to facilitate active learning in the oral health profession. Students engage with oral lesion images using swipe gestures to classify each image into pre-determined categories (e.g., left for refer and right for no intervention). To assemble the training modules and to provide feedback to students, DiLearn requires each oral lesion image to be classified, with various features displayed in the image. The collection of accurate meta-information is a crucial step for enabling the self-directed active learning approach taken in DiLearn. The purpose of this study is to evaluate the classification consistency of features in oral lesion images by experts and students for use in the learning tool. Twenty oral lesion images from DiLearn’s image bank were classified by three oral lesion experts and two senior dental hygiene students using the same rubric containing eight features. Classification agreement among and between raters were evaluated using Fleiss’ and Cohen’s Kappa. Classification agreement among the three experts ranged from identical (Fleiss’ Kappa = 1) for “clinical action”, to slight agreement for “border regularity” (Fleiss’ Kappa = 0.136), with the majority of categories having fair to moderate agreement (Fleiss’ Kappa = 0.332–0.545). Inclusion of the two student raters with the experts yielded fair to moderate overall classification agreement (Fleiss’ Kappa = 0.224–0.554), with the exception of “morphology”. The feature of clinical action could be accurately classified, while other anatomical features indirectly related to diagnosis had a lower classification consistency. The findings suggest that one oral lesion expert or two student raters can provide fairly consistent meta-information for selected categories of features implicated in the creation of image classification tasks in DiLearn.

Published
2021

14. Applying the Social Vulnerability Index as a Leading Indicator to Protect Fire-Based Emergency Medical Service Responders’ Health

Author

Susan M. Moore, Megan Casey, Katherine N Yoon, Emily J. Haas, and Alexa Furek

Subjects
Emergency Medical Services, Health, Toxicology and Mutagenesis, relative weights, Vulnerability, coronavirus, emergency management, social vulnerability index, risk management, Occupational safety and health, Article, 03 medical and health sciences, 0302 clinical medicine, logit regression, Environmental health, Emergency medical services, firefighter, Humans, 030212 general & internal medicine, Socioeconomic status, Pandemics, Risk management, Emergency management, business.industry, SARS-CoV-2, Public Health, Environmental and Occupational Health, Emergency Responders, COVID-19, 030210 environmental & occupational health, total worker health, United States, Medicine, Occupational stress, business, Social vulnerability, occupational stress
Abstract

During emergencies, areas with higher social vulnerability experience an increased risk for negative health outcomes. However, research has not extrapolated this concept to understand how the workers who respond to these areas may be affected. Researchers from the National Institute for Occupational Safety and Health (NIOSH) merged approximately 160,000 emergency response calls received from three fire departments during the COVID-19 pandemic with the CDC’s publicly available Social Vulnerability Index (SVI) to examine the utility of SVI as a leading indicator of occupational health and safety risks. Multiple regressions, binomial logit models, and relative weights analyses were used to answer the research questions. Researchers found that higher social vulnerability on household composition, minority/language, and housing/transportation increase the risk of first responders’ exposure to SARS-CoV-2. Higher socioeconomic, household, and minority vulnerability were significantly associated with response calls that required emergency treatment and transport in comparison to fire-related or other calls that are also managed by fire departments. These results have implications for more strategic emergency response planning during the COVID-19 pandemic, as well as improving Total Worker Health® and future of work initiatives at the worker and workplace levels within the fire service industry.

Published
2021

15. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes—Part I

Author

Minn N. Yoon, Lily Lu, Carole A. Estabrooks, and Matthias Hoben

Subjects
Canada, medicine.medical_specialty, Response process, business.industry, Reproducibility of Results, Oral Health, 030206 dentistry, Oral health, Focus group, Nursing Homes, stomatognathic diseases, 03 medical and health sciences, Long-term care, 0302 clinical medicine, Oral problems, Family medicine, medicine, Humans, 030212 general & internal medicine, Geriatrics and Gerontology, Nursing homes, business, General Dentistry, Healthcare providers, Care staff
Abstract

OBJECTIVE To evaluate the response process validity of the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items and the organisational processes for assessing nursing home (NH) residents' oral/dental status. BACKGROUND Although care aides provide most direct care to NH residents, including oral care, they are not directly involved in structured care planning activities, including RAI assessments. This most likely affects the accuracy of RAI assessments, as well quality of care. However, we neither know how well regulated and unregulated care staff understand the RAI oral/dental items, nor what processes are used in completing oral/dental assessments. METHODS We conducted nine focus groups with 44 care aides, nurses, allied health providers, clinical specialists and managers. We discussed randomly selected RAI oral/dental assessments with focus group participants, including participants' understanding of the items and why the options were selected. Participants also explained the communication and process for completing the RAI. RESULTS Participants' perceptions of the oral/dental items aligned fairly well with the item definitions. However, responses primarily focused on severe oral/dental problems with obvious physical characteristics (eg black teeth denoting caries). For non-visual oral problems, such as pain, staff relied on resident verbalisation. No formal mechanisms were described for care aides to update nurses on residents' oral health needs. CONCLUSIONS Performance problems of RAI oral/dental items are largely rooted in poor communication between care aides and nurses and not integrating care aides in assessment processes. We need policies that address these problems in order to improve NH residents' poor oral health.

Published
2019
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16. Supercritical CO2-Induced Evolution of Alkali-Activated Slag Cements

Author

Kamasani Chiranjeevi Reddy, Joonho Seo, H. N. Yoon, Seonhyeok Kim, G. M. Kim, H. M. Son, Seunghee Park, and Solmoi Park

Subjects
alkali-activated slag, supercritical CO2, carbonation, X-ray diffraction, solid-state NMR, General Materials Science
Abstract

The phase changes in alkali-activated slag samples when exposed to supercritical carbonation were evaluated. Ground granulated blast furnace slag was activated with five different activators. The NaOH, Na2SiO3, CaO, Na2SO4, and MgO were used as activators. C-S-H is identified as the main reaction product in all samples along with other minor reaction products. The X-ray diffractograms showed the complete decalcification of C-S-H and the formation of CaCO3 polymorphs such as calcite, aragonite, and vaterite. The thermal decomposition of carbonated samples indicates a broader range of CO2 decomposition. Formation of highly cross-linked aluminosilicate gel and a reduction in unreacted slag content upon carbonation is observed through 29Si and 27Al NMR spectroscopy. The observations indicate complete decalcification of C-S-H with formation of highly cross-linked aluminosilicates upon sCO2 carbonation. A 20–30% CO2 consumption per reacted slag under supercritical conditions is observed.

Published
2022
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17. Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults

Author

Minal Patel, Stephanie N. Yoon, Donna Vallone, Alison F. Cuccia, Michael S. Amato, and Daniel K. Stephens

Subjects
Cessation, lcsh:R, Public Health, Environmental and Occupational Health, lcsh:Medicine, 030209 endocrinology & metabolism, Health Informatics, Regular Article, Odds ratio, Confidence interval, Intention to quit, 03 medical and health sciences, E-cigarettes, 0302 clinical medicine, Harm, Negatively associated, Cohort, Tobacco, 030212 general & internal medicine, Young adult, Psychology, Demography
Abstract

Highlights • Over half of young current e-cigarette users intend to quit, 15% in next 30 days. • One-third of young current e-cigarette users made a quit attempt in the past year. • Harm perceptions dependence and use frequency were associated with outcomes. • There is a critical need for programs and policies to facilitate and support e-cigarette cessation., While youth and young adult e-cigarette use has risen in the U.S., few studies have explored e-cigarette cessation behavior. This study estimates quit attempts and intentions among young people (aged 15–36) since the rise of high-nicotine products, and examines factors associated with e-cigarette quit attempts and intentions. Current e-cigarette users (past 30-day use, not already quit) were drawn from a national probability-based cohort sample. Data were collected from September to December 2019 (n = 1158). Weighted proportions of past-year quit attempts, intentions to quit in next 30 days, and general intentions to quit (at some point) were calculated. Models estimated cessation outcomes with respect to harm perceptions, friend use, dependence, use frequency, combustible use and demographic factors. Among current e-cigarette users, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30 days, and 33.3% reported a past-year quit attempt. Past-year quit attempts were associated with higher levels of harm perceptions (adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.49–2.92), dependence (aOR = 1.92, 95% CI: 1.44–2.56) and daily use (28 + days) compared to infrequent use (1–5 days) (aOR = 0.23, 95% CI: 0.12–0.43). General intentions to quit were positively associated with harm perceptions (aOR = 1.77, 95% CI: 1.23–2.56) and dependence (aOR = 1.89, 95% CI: 1.41–2.52), and negatively associated with daily use compared to infrequent use (aOR = 0.35, 95% CI: 0.19–0.65). Findings indicate that over half of young e-cigarette users want to quit, highlighting a critical need for policies and resources to promote and sustain e-cigarette cessation among young people.

Published
2021

18. Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium

Author

Mario Brondani, Kazuhiro Hori, Avanti Karve, Chris C.L. Wyatt, David Bartlett, W. Murray Thomson, Michael I. MacEntee, Frankie Hon-Ching So, Joke Duyck, Leeann Donnelly, G. Rutger Persson, Limor Avivi-Arber, Matana Kettratad-Pruksapong, Minn N. Yoon, and Martin Schimmel

Subjects
Adult, medicine.medical_specialty, Geriatrics & Gerontology, Consensus, narrative review, SCORING SYSTEM, Oral Health, Disease, Oral health, TEMPOROMANDIBULAR DISORDERS, OROFACIAL PAIN, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Clinical Protocols, QUALITY-OF-LIFE, Dentistry, Oral Surgery & Medicine, Health care, Humans, Medicine, Oral disorder, 030212 general & internal medicine, physical indicators, 610 Medicine & health, General Dentistry, Aged, DRY MOUTH, Aged, 80 and over, Geriatrics, Protocol (science), HEALTH-STATUS, Science & Technology, business.industry, CARIES, 030206 dentistry, screening for disease, GENERAL DENTAL PRACTICE, stomatognathic diseases, patient-reported outcomes, REMOVABLE PARTIAL DENTURE, Family medicine, oral health, Narrative review, WORLD WORKSHOP, Geriatrics and Gerontology, business, Life Sciences & Biomedicine
Abstract

BACKGROUND: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS: Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS: Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS: The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure. ispartof: GERODONTOLOGY vol:38 issue:1 pages:5-16 ispartof: location:England status: published

Published
2021
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19. Oral nicotine marketing claims in direct-mail advertising

Author

Stephanie N. Yoon, Shyanika W. Rose, Minal Patel, Basmah Rahman, Barbara A. Schillo, and Lauren Czaplicki

Subjects
Marketing, Nicotine, Health (social science), Direct mail, Public Health, Environmental and Occupational Health, Authorization, Advertising, Tobacco Industry, Tobacco Products, Electronic Nicotine Delivery Systems, Product (business), Tobacco, medicine, Humans, Business, Postal Service, Surveillance and monitoring, Tobacco leaf, Tobacco product, medicine.drug
Abstract

BackgroundLittle is known regarding how oral nicotine products (eg, nicotine pouches, lozenges) are marketed to consumers, including whether potential implicit reduced harm claims are used. In the current study, we explored the marketing claims present in a sample of direct-mail oral nicotine advertisements sent to US consumers (March 2018–August 2020).MethodsDirect-mail ads (n=50) were acquired from Mintel and dual-coded for the following claims: alternative to other tobacco products, ability to use anywhere, spit-free, smoke-free and product does not contain tobacco leaf. We merged the coded data with Mintel’s volume estimate (number of mail pieces sent to consumers) and calculated the proportion of oral nicotine advertisements containing claims by category.ResultsOf the 38 million pieces of oral nicotine direct-mail sent to US consumers, most featured claims that the product could be used anywhere (84%, 31.8 million pieces); was an alternative to other tobacco products (69%, 26.1 million pieces); and did not contain tobacco leaf (eg, ‘tobacco leaf-free’, ‘simple’ approach of extracting nicotine from tobacco; 55%, 20.7 million pieces). A slightly smaller proportion contained claims that oral nicotine was ‘spit-free’ (52%, 19.8 million pieces) or ‘smoke-free’ (31%, 11.7 million pieces).ConclusionOur results provide an early indication of marketing claims used to promote oral nicotine. The strategies documented, particularly the use of language to highlight oral nicotine is tobacco-free, may covey these products as lower-risk to consumers despite the lack of evidence or proper federal authorisation that oral nicotine products are a modified-risk tobacco product. Future research is needed to examine consumer perceptions of such claims.

Published
2020

20. Insights in interprofessional education: Dental hygiene students' suggestions for collaboration

Author

Madison L, Howey and Minn N, Yoon

Subjects
Attitude of Health Personnel, Interprofessional Relations, Interprofessional Education, ComputingMilieux_COMPUTERSANDEDUCATION, Humans, Oral Hygiene, Students, Original Research
Abstract

Interprofessional education (IPE) promotes team-based approaches to professional practice and lifelong collaboration. However, there is little consensus on its "best practice" in dentistry and dental hygiene curricula. This study aimed to explore dental hygiene students' perceptions and experiences of collaboration with dentistry students in an IPE program that authentically represents private practice settings and work processes. The intent was to identify what students thought would best help prepare them to work collaboratively in an oral health team once they graduated after participating in this experience.Data were collected from 40 dental hygiene student written reflections and 6 dental hygiene students through a focus group session that was audiorecorded and transcribed. Data were examined using thematic analysis.Five interrelated themes emerged: 1) understanding of roles and responsibilities; 2) hierarchical perceptions and level of experience; 3) team dynamics; 4) instructor and staff involvement and support; and 5) timing and structure of IPE activities. The findings suggest that dental hygiene students need consistent and sustained access to realistic environments in which to practise team roles and work directly with dentistry students. Opportunities to build relationships with dentistry students before working together in professional roles appear to alleviate hierarchical concerns that impede teamwork.IPE should occur throughout students' education as hierarchical perceptions appear to influence collaboration. Informal and/or non-clinical IPE opportunities should be introduced early in students' education to develop a foundation for team dynamics in later formal and/or clinical IPE activities. Students should collaborate in ways that will be reflected in professional expectations after graduation; the environment in which they learn their team role should provide the opportunity to authentically practise it.La formation interprofessionnelle (FIP) favorise les approches basées sur le travail d'équipe en matière d'exercice professionnel et de collaboration tout au long de la vie. Cependant, il y a peu de consensus quant à ses « meilleures pratiques » lorsqu'il s'agit de programmes de dentisterie et d'hygiène dentaire. La présente étude visait à explorer la perception et les expériences des étudiants en hygiène dentaire en matière de collaboration avec les étudiants en dentisterie dans le cadre d'un programme de FIP qui représente de manière authentique les contextes et les processus de travail en cabinet privé. L'intention était de définir ce qui, selon les étudiants, les préparerait le mieux à travailler en collaboration au sein d'une équipe de soins buccodentaires après avoir obtenu leur diplôme.Des données ont été recueillies à partir de réflexions écrites par 40 étudiants en hygiène dentaire et de 6 étudiants en hygiène dentaire dans le cadre d'une séance de groupe de discussion audio enregistrée et transcrite. Les données ont été examinées par analyse thématique.Cinq thèmes interdépendants ont été dégagés : 1) la compréhension des rôles et des responsabilités; 2) les perceptions hiérarchiques et le niveau d'expérience; 3) la dynamique du travail d'équipe; 4) la participation et le soutien des enseignants et du personnel; et 5) le moment choisi et la structure des activités de FIP. Les résultats suggèrent que les étudiants en hygiène dentaire ont besoin d'un accès constant et soutenu aux environnements réalistes dans lesquels ils peuvent assumer les rôles de l'équipe et travailler directement avec des étudiants en dentisterie. Les possibilités de tisser des liens avec les étudiants en dentisterie avant de travailler ensemble dans des rôles professionnels semblent réduire les préoccupations hiérarchiques qui font obstacle au travail d'équipe.La FIP doit avoir lieu tout au long de la formation des étudiants, puisque les perceptions hiérarchiques semblent influencer la collaboration. Les occasions de FIP informelles ou non cliniques doivent être introduites tôt dans la formation des étudiants afin de créer une fondation de dynamique pour l'équipe lors des activités de FIP formelles ou cliniques ultérieures. Les étudiants doivent collaborer de façons qui seront reflétées dans les attentes professionnelles après l'obtention de leur diplôme. L'environnement dans lequel ils apprennent leur rôle au sein de l'équipe devrait leur fournir l'occasion de l'exercer de manière authentique.

Published
2020

21. A General Framework to Test and Evaluate Filtering Facepiece Respirators Considered for Crisis Capacity Use as a Strategy to Optimize Supply

Author

Katherine N, Yoon, Lee A, Greenawald, Dana R, Rottach, Jonisha P, Pollard, and Patrick L, Yorio

Subjects
Article
Abstract

During a public health emergency, respirator shortages can have a profound impact on the national response, such as for the current coronavirus disease 2019 (COVID-19) pandemic. Due to a severe shortage of respirators (particularly filtering facepiece respirators [FFRs]), there may be contexts in which understanding the performance of FFRs that are approved for use as part of a crisis capacity strategy is desired. This includes FFRs that are not covered under the National Institute for Occupational Safety and Health (NIOSH) Respirator Approval Program because they have been stored past their designated shelf life, have been decontaminated, or are approved by international certification bodies other than NIOSH. The purpose of this document is to provide a general framework to assess the performance of FFRs that are only being used as a crisis capacity strategy. The intended audience are those who are responsible for managing large amounts of FFRs. This framework includes a four-step process consisting of: 1) defining the population of FFRs to be sampled; 2) providing sampling strategy options; 3) inspecting and testing the sampled units; and 4) evaluating the results. In addition to the four-step process, we provide an example of how NIOSH recently evaluated the quality of FFRs sampled from ten U.S. stockpiles.

Published
2020

22. The Study on Manufacturing Process of Printable Temperature Distribution Measuring Sensor Using the Thermocouple Metal Paste

Author

K. Song, D. Y. Jang, and C. N. Yoon

Subjects
Materials science, Constantan, 02 engineering and technology, 01 natural sciences, Temperature measurement, 010305 fluids & plasmas, 020401 chemical engineering, Thermocouple, 0103 physical sciences, Screen printing, Integrated circuit packaging, Electronics, 0204 chemical engineering, Composite material, Curing (chemistry), Electronic circuit
Abstract

Currently, as the development of highly functional products in the electronics industry is accelerated, there is a growing need for the development of new method to measure internal temperature, not surface, in the field of semiconductor packaging technology. In this study, we developed a manufacturing process for Printable Temperature Distribution Measuring Sensor(PTDMS) by screen printing method. For measuring temperature, the circuits of the sensor were formed using Cu and Constantan paste, which can constitute the multi-nodes T-type thermocouple. We researched the suitable curing and sintering conditions for the thermocouple materials to form appropriate circuits for the sensor. As a result of the test, the manufactured PTDMS has an error rate of less than ± 3 %, and derived a result that can normally measure temperature.

Published
2020
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24. Development of diagnostic score reporting for a dental hygiene structured clinical assessment

Author

Alix, Clarke, Hollis, Lai, Alexandra DE, Sheppard, and Minn N, Yoon

Subjects
Canada, Humans, Clinical Competence, Oral Hygiene, Literature Review, Feedback
Abstract

Structured clinical assessments capture key information about performance that is rarely shared with the student as feedback. The purpose of this review is to describe a general framework for applying diagnostic score reporting within the context of a structured clinical assessment and to demonstrate that framework within dental hygiene.The framework was developed using current research in the areas of structured clinical assessments, test development, feedback in higher education, and diagnostic score reporting. An assessment blueprint establishes valid diagnostic domains by linking clinical competencies and test items to the domains (e.g., knowledge or skills) the assessment intends to measure. Domain scores can be given to students as reports that identify strengths and weaknesses and provide information on how to improve.The framework for diagnostic score reporting was applied to a dental hygiene structured clinical assessment at the University of Alberta in 2016. Canadian dental hygiene entry-to-practice competencies guided the assessment blueprinting process, and a modified Delphi technique was used to validate the blueprint. The final report identified 4 competency-based skills relevant to the examination: effective communication, client-centred care, eliciting essential information, and interpreting findings. Students received reports on their performance within each domain.Diagnostic score reporting has the potential to solve many of the issues faced by administrators, such as item confidentiality and the time-consuming nature of providing individual feedback.Diagnostic score reporting offers a promising framework for providing valid and timely feedback to all students following a structured clinical assessment.Les évaluations cliniques structurées saisissent des renseignements clés sur la performance qui est rarement partagée avec les étudiants à titre de rétroaction. L’objectif de la présente étude est de définir une structure générale pour établir le suivi de la notation des diagnostics dans le cadre d’une évaluation clinique structurée et pour mettre en évidence ce cadre au sein de l’hygiène dentaire.Le cadre a été créé à l’aide de la recherche actuelle dans les domaines d’évaluations cliniques structurées, d’élaboration de tests, de la rétroaction en éducation supérieure, et du suivi de la notation des diagnostics. Un plan d’évaluation détermine les domaines diagnostiques valides en liant les compétences cliniques et les éléments de tests aux domaines (p. ex., les connaissances ou les habiletés) que l’évaluation prévoit de mesurer. La notation des domaines peut être donnée aux étudiants sous forme de rapports qui précisent les forces et les faiblesses, et fournissent de l’information sur la façon de s’améliorer.Le cadre de suivi de la notation des diagnostics a été appliqué à une évaluation clinique structurée en hygiène dentaire de l’Université de l’Alberta en 2016. Les compétences canadiennes d’entrée en pratique en hygiène dentaire ont guidé le processus de planification de l’évaluation et une technique modifiée de Delphi a été utilisée pour valider le plan. Le rapport final a ciblé quatre habiletés fondées sur des compétences, pertinentes à l’examen : communication efficace, soins axés sur le client, obtention des renseignements essentiels, et interprétation des constatations. Les étudiants ont reçu des rapports sur leur performance dans chaque domaine.Le suivi de la notation des diagnostics a le potentiel de résoudre plusieurs des enjeux auxquels sont confrontés les administrateurs, comme la confidentialité des éléments et le temps demandé pour la rétroaction individuelle.Le suivi de la notation des diagnostics offre un cadre prometteur pour fournir une rétroaction valide et rapide à tous les étudiants à la suite d’une évaluation clinique structurée.

Published
2020

25. Effect of diagnostic score reporting following a structured clinical assessment of dental hygiene student performance

Author

Alix, Clarke, Hollis, Lai, Alexandra DE, Sheppard, and Minn N, Yoon

Subjects
Students, Dental, Humans, Learning, Clinical Competence, Oral Hygiene, Feedback, Original Research
Abstract

Diagnostic score reporting is one method of providing feedback to all students following a structured clinical assessment but its effect on learning has not been studied. The objective of this study was to assess the impact of this feedback on student reflection and performance following a dental hygiene assessment.In 2016, dental hygiene students at the University of Alberta participated in a mock structured clinical assessment during which they were randomly assigned to receive a diagnostic score report (intervention group) or an overall percentage grade of performance (control group). The students later reflected upon their performance and took their regularly scheduled structured clinical assessment. Reflections underwent content analysis by diagnostic domains (eliciting essential information, effective communication, client-centred care, and interpreting findings). Results were analysed for group differences.Students performed best on eliciting essential information (92%) and poorest on interpreting findings (42%). The intervention group was more likely to view interpreting findings as a weakness,Students who received diagnostic score reporting appeared to reflect more accurately upon their weaknesses. However, this knowledge did not translate into improved performance. Modifications and enhancements to the report may be necessary before an effect on performance will be seen.Diagnostic score reporting is a promising feedback method that may aid student reflection. More research is needed to determine if these reports can improve performance.Le suivi de la notation des diagnostics est une des méthodes utilisées pour fournir de la rétroaction aux étudiants à la suite d’une évaluation clinique structurée, mais ses effets sur l’apprentissage n’ont pas été étudiés. La présente étude visait à évaluer l’effet de cette rétroaction sur la réflexion et la performance des étudiants à la suite d’une évaluation en hygiène dentaire.Les étudiants en hygiène dentaire de l’Université de l’Alberta ont participé à une évaluation clinique structurée fictive pendant laquelle ils étaient désignés de façon aléatoire pour recevoir un suivi de la notation des diagnostics (groupe d’intervention) ou une note globale en pourcentage de leur performance (groupe témoin). Les étudiants ont plus tard réfléchi à leur performance et ont fait leur évaluation clinique structurée déjà à l’horaire. Une analyse de contenu a été effectuée sur les réflexions selon les domaines de diagnostics (obtention de renseignements essentiels, communication efficace, prestation de soins axés sur le client et interprétation des constatations). Les résultats ont été analysés pour déterminer les différences entre les groupes.Les étudiants ont le mieux réussi sur l’obtention d’information essentielle (92 %) et ont le moins bien réussi sur l’interprétation des constatations (42 %). Le groupe d’intervention était plus susceptible de réfléchir à l’interprétation des constatations en tant que faiblesse,Les étudiants qui ont reçu un suivi de la notation des diagnostics semblaient réfléchir plus précisément sur leurs faiblesses. Cependant, cette connaissance ne s’est pas traduite par une performance améliorée. Des modifications et des améliorations du suivi peuvent être nécessaires avant qu’un effet sur la performance soit constaté.Le suivi de la notation des diagnostics présente une méthode de rétroaction prometteuse qui pourrait aider à la réflexion des étudiants. D’autres recherches sont nécessaires pour déterminer si ces rapports peuvent améliorer la performance.

Published
2020

26. Global injury morbidity and mortality from 1990 to 2017: Results from the global burden of disease study 2017

Author

James, S.L. Castle, C.D. Dingels, Z.V. Fox, J.T. Hamilton, E.B. Liu, Z. Roberts, N.L.S. Sylte, D.O. Henry, N.J. LeGrand, K.E. Abdelalim, A. Abdoli, A. Abdollahpour, I. Abdulkader, R.S. Abedi, A. Abosetugn, A.E. Abushouk, A.I. Adebayo, O.M. Agudelo-Botero, M. Ahmad, T. Ahmed, R. Ahmed, M.B. Aichour, M.T.E. Alahdab, F. Alamene, G.M. Alanezi, F.M. Alebel, A. Alema, N.M. Alghnam, S.A. Al-Hajj, S. Ali, B.A. Ali, S. Alikhani, M. Alinia, C. Alipour, V. Aljunid, S.M. Almasi-Hashiani, A. Almasri, N.A. Altirkawi, K. Amer, Y.S.A. Amini, S. Amit, A.M.L. Andrei, C.L. Ansari-Moghaddam, A. Antonio, C.A.T. Appiah, S.C.Y. Arabloo, J. Arab-Zozani, M. Arefi, Z. Aremu, O. Ariani, F. Arora, A. Asaad, M. Asghari, B. Awoke, N. Quintanilla, B.P.A. Ayano, G. Ayanore, M.A. Azari, S. Azarian, G. Badawi, A. Badiye, A.D. Bagli, E. Baig, A.A. Bairwa, M. Bakhtiari, A. Balachandran, A. Banach, M. Banerjee, S.K. Banik, P.C. Banstola, A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Barzegar, A. Bayati, M. Baye, B.A. Bedi, N. Behzadifar, M. Bekuma, T.T. Belete, H. Benjet, C. Bennett, D.A. Bensenor, I.M. Berhe, K. Bhardwaj, P. Bhat, A.G. Bhattacharyya, K. Bibi, S. Bijani, A. Sayeed, M.S.B. Borges, G. Borzì, A.M. Boufous, S. Brazinova, A. Briko, N.I. Budhathoki, S.S. Car, J. Cárdenas, R. Carvalho, F. Castaldelli-Maia, J.M. Castañeda-Orjuela, C.A. Castelpietra, G. Catalá-López, F. Cerin, E. Chandan, J.S. Chanie, W.F. Chattu, S.K. Chattu, V.K. Chatziralli, I. Chaudhary, N. Cho, D.Y. Chowdhury, M.A.K. Chu, D.-T. Colquhoun, S.M. Constantin, M.-M. Costa, V.M. Damiani, G. Daryani, A. Dávila-Cervantes, C.A. Demeke, F.M. Demis, A.B. Demoz, G.T. Demsie, D.G. Derakhshani, A. Deribe, K. Desai, R. Nasab, M.D. Dias da Silva, D. Forooshani, Z.S.D. Doyle, K.E. Driscoll, T.R. Dubljanin, E. Adema, B.D. Eagan, A.W. Eftekhari, A. Ehsani-Chimeh, E. El Sayed Zaki, M. Elemineh, D.A. El-Jaafary, S.I. El-Khatib, Z. Ellingsen, C.L. Emamian, M.H. Endalew, D.A. Eskandarieh, S. Faris, P.S. Faro, A. Farzadfar, F. Fatahi, Y. Fekadu, W. Ferede, T.Y. Fereshtehnejad, S.-M. Fernandes, E. Ferrara, P. Feyissa, G.T. Filip, I. Fischer, F. Folayan, M.O. Foroutan, M. Francis, J.M. Franklin, R.C. Fukumoto, T. Geberemariyam, B.S. Gebre, A.K. Gebremedhin, K.B. Gebremeskel, G.G. Gebremichael, B. Gedefaw, G.A. Geta, B. Ghafourifard, M. Ghamari, F. Ghashghaee, A. Gholamian, A. Gill, T.K. Goulart, A.C. Grada, A. Grivna, M. Gubari, M.I.M. Guimarães, R.A. Guo, Y. Gupta, G. Haagsma, J.A. Hafezi-Nejad, N. Bidgoli, H.H. Hall, B.J. Hamadeh, R.R. Hamidi, S. Haro, J.M. Hasan, M.M. Hasanzadeh, A. Hassanipour, S. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hayat, K. Hendrie, D. Heydarpour, F. Híjar, M. Ho, H.C. Hoang, C.L. Hole, M.K. Holla, R. Hossain, N. Hosseinzadeh, M. Hostiuc, S. Hu, G. Ibitoye, S.E. Ilesanmi, O.S. Ilic, I. Ilic, M.D. Inbaraj, L.R. Indriasih, E. Irvani, S.S.N. Islam, S.M.S. Mofizul Islam, M. Ivers, R.Q. Jacobsen, K.H. Jahani, M.A. Jahanmehr, N. Jakovljevic, M. Jalilian, F. Jayaraman, S. Jayatilleke, A.U. Jha, R.P. John-Akinola, Y.O. Jonas, J.B. Joseph, N. Joukar, F. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Kabir, A. Kadel, R. Kahsay, A. Kalankesh, L.R. Kalhor, R. Kamil, T.A. Kanchan, T. Kapoor, N. Karami, M. Kasaeian, A. Kassaye, H.G. Kavetskyy, T. Kebede, H.K. Keiyoro, P.N. Kelbore, A.G. Kelkay, B. Khader, Y.S. Khafaie, M.A. Khalid, N. Khalil, I.A. Khalilov, R. Khammarnia, M. Khan, E.A. Khan, M. Khanna, T. Khazaie, H. Shadmani, F.K. Khundkar, R. Kiirithio, D.N. Kim, Y.-E. Kim, D. Kim, Y.J. Kisa, A. Kisa, S. Komaki, H. Kondlahalli, S.K.M. Korshunov, V.A. Koyanagi, A. Kraemer, M.U.G. Krishan, K. Bicer, B.K. Kugbey, N. Kumar, V. Kumar, N. Anil Kumar, G. Kumar, M. Kumaresh, G. Kurmi, O.P. Kuti, O. Vecchia, C.L. Lami, F.H. Lamichhane, P. Lang, J.J. Lansingh, V.C. Laryea, D.O. Lasrado, S. Latifi, A. Lauriola, P. Leasher, J.L. Lee, S.W.H. Lenjebo, T.L. Levi, M. Li, S. Linn, S. Liu, X. Lopez, A.D. Lotufo, P.A. Lunevicius, R. Lyons, R.A. Madadin, M. El Razek, M.M.A. Mahotra, N.B. Majdan, M. Majeed, A. Malagon-Rojas, J.N. Maled, V. Malekzadeh, R. Malta, D.C. Manafi, N. Manafi, A. Manda, A.-L. Manjunatha, N. Mansour-Ghanaei, F. Mansouri, B. Mansournia, M.A. Maravilla, J.C. March, L.M. Mason-Jones, A.J. Masoumi, S.Z. Massenburg, B.B. Maulik, P.K. Meles, G.G. Melese, A. Melketsedik, Z.A. Memiah, P.T.N. Mendoza, W. Menezes, R.G. Mengesha, M.B. Mengesha, M.M. Meretoja, T.J. Meretoja, A. Merie, H.E. Mestrovic, T. Miazgowski, B. Miazgowski, T. Miller, T.R. Mini, G.K. Mirica, A. Mirrakhimov, E.M. Mirzaei-Alavijeh, M. Mithra, P. Moazen, B. Moghadaszadeh, M. Mohamadi, E. Mohammad, Y. Mohammad, K.A. Darwesh, A.M. Mezerji, N.M.G. Mohammadian-Hafshejani, A. Mohammadoo-Khorasani, M. Mohammadpourhodki, R. Mohammed, S. Mohammed, J.A. Mohebi, F. Molokhia, M. Monasta, L. Moodley, Y. Moosazadeh, M. Moradi, M. Moradi, G. Moradi-Lakeh, M. Moradpour, F. Morawska, L. Velásquez, I.M. Morisaki, N. Morrison, S.D. Mossie, T.B. Muluneh, A.G. Murthy, S. Musa, K.I. Mustafa, G. Nabhan, A.F. Nagarajan, A.J. Naik, G. Naimzada, M.D. Najafi, F. Nangia, V. Nascimento, B.R. Naserbakht, M. Nayak, V. Ndwandwe, D.E. Negoi, I. Ngunjiri, J.W. Nguyen, C.T. Nguyen, H.L.T. Nikbakhsh, R. Ningrum, D.N.A. Nnaji, C.A. Nyasulu, P.S. Ogbo, F.A. Oghenetega, O.B. Oh, I.-H. Okunga, E.W. Olagunju, A.T. Olagunju, T.O. Bali, A.O. Onwujekwe, O.E. Asante, K.O. Orpana, H.M. Ota, E. Otstavnov, N. Otstavnov, S.S. Mahesh, P.A. Padubidri, J.R. Pakhale, S. Pakshir, K. Panda-Jonas, S. Park, E.-K. Patel, S.K. Pathak, A. Pati, S. Patton, G.C. Paulos, K. Peden, A.E. Pepito, V.C.F. Pereira, J. Pham, H.Q. Phillips, M.R. Pinheiro, M. Polibin, R.V. Polinder, S. Poustchi, H. Prakash, S. Pribadi, D.R.A. Puri, P. Syed, Z.Q. Rabiee, M. Rabiee, N. Radfar, A. Rafay, A. Rafiee, A. Rafiei, A. Rahim, F. Rahimi, S. Rahimi-Movaghar, V. Rahman, M.A. Rajabpour-Sanati, A. Rajati, F. Rakovac, I. Ranganathan, K. Rao, S.J. Rashedi, V. Rastogi, P. Rathi, P. Rawaf, S. Rawal, L. Rawassizadeh, R. Renjith, V. Renzaho, A.M.N. Resnikoff, S. Rezapour, A. Ribeiro, A.I. Rickard, J. González, C.M.R. Ronfani, L. Roshandel, G. Saad, A.M. Sabde, Y.D. Sabour, S. Saddik, B. Safari, S. Safari-Faramani, R. Safarpour, H. Safdarian, M. Mohammad Sajadi, S. Salamati, P. Salehi, F. Zahabi, S.S. Rashad Salem, M.R. Salem, H. Salman, O. Salz, I. Samy, A.M. Sanabria, J. Riera, L.S. Santric Milicevic, M.M. Sarker, A.R. Sarveazad, A. Sathian, B. Sawhney, M. Sawyer, S.M. Saxena, S. Sayyah, M. Schwebel, D.C. Seedat, S. Senthilkumaran, S. Sepanlou, S.G. Seyedmousavi, S. Sha, F. Shaahmadi, F. Shahabi, S. Shaikh, M.A. Shams-Beyranvand, M. Shamsizadeh, M. Sharif-Alhoseini, M. Sharifi, H. Sheikh, A. Shigematsu, M. Shin, J.I. Shiri, R. Siabani, S. Sigfusdottir, I.D. Singh, P.K. Singh, J.A. Sinha, D.N. Smarandache, C.-G. Smith, E.U.R. Soheili, A. Soleymani, B. Soltanian, A.R. Soriano, J.B. Sorrie, M.B. Soyiri, I.N. Stein, D.J. Stokes, M.A. Mu'awiyyah, B.S. Suleria, H.A.R. Sykes, B.L. Tabarés-Seisdedos, R. Tabb, K.M. Taddele, B.W. Tadesse, D.B. Tamiru, A.T. Tarigan, I.U. Tefera, Y.M. Tehrani-Banihashemi, A. Tekle, M.G. Tekulu, G.H. Tesema, A.K. Tesfay, B.E. Thapar, R. Tilahune, A.B. Tlaye, K.G. Tohidinik, H.R. Topor-Madry, R. Tran, B.X. Tran, K.B. Tripathy, J.P. Tsai, A.C. Car, L.T. Ullah, S. Ullah, I. Umar, M. Unnikrishnan, B. Upadhyay, E. Uthman, O.A. Valdez, P.R. Vasankari, T.J. Venketasubramanian, N. Violante, F.S. Vlassov, V. Waheed, Y. Weldesamuel, G.T. Werdecker, A. Wiangkham, T. Wolde, H.F. Woldeyes, D.H. Wondafrash, D.Z. Wondmeneh, T.G. Wondmieneh, A.B. Wu, A.-M. Yadav, R. Yadollahpour, A. Yano, Y. Yaya, S. Yazdi-Feyzabadi, V. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Youm, Y. Younis, M.Z. Yousefi, Z. Yu, Y. Yu, C. Yusefzadeh, H. Moghadam, T.Z. Zaidi, Z. Zaman, S.B. Zamani, M. Zamanian, M. Zandian, H. Zarei, A. Zare, F. Zhang, Z.-J. Zhang, Y. Zodpey, S. Dandona, L. Dandona, R. Degenhardt, L. Dharmaratne, S.D. Hay, S.I. Mokdad, A.H. Reiner, R.C., Jr. Sartorius, B. Vos, T.

Abstract

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Published
2020

27. Estimating global injuries morbidity and mortality: Methods and data used in the Global Burden of Disease 2017 study

Author

James, S.L. Castle, C.D. Dingels, Z.V. Fox, J.T. Hamilton, E.B. Liu, Z. Roberts, N.L.S. Sylte, D.O. Bertolacci, G.J. Cunningham, M. Henry, N.J. Legrand, K.E. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abedi, A. Abegaz, K.H. Abosetugn, A.E. Abushouk, A.I. Adebayo, O.M. Adsuar, J.C. Advani, S.M. Agudelo-Botero, M. Ahmad, T. Ahmed, M.B. Ahmed, R. Aichour, M.T.E. Alahdab, F. Alanezi, F.M. Alema, N.M. Alemu, B.W. Alghnam, S.A. Ali, B.A. Ali, S. Alinia, C. Alipour, V. Aljunid, S.M. Almasi-Hashiani, A. Almasri, N.A. Altirkawi, K. Amer, Y.S.A. Andrei, C.L. Ansari-Moghaddam, A. Antonio, C.A.T. Anvari, D. Appiah, S.C.Y. Arabloo, J. Arab-Zozani, M. Arefi, Z. Aremu, O. Ariani, F. Arora, A. Asaad, M. Quintanilla, B.P.A. Ayano, G. Ayanore, M.A. Azarian, G. Badawi, A. Badiye, A.D. Baig, A.A. Bairwa, M. Bakhtiari, A. Balachandran, A. Banach, M. Banerjee, S.K. Banik, P.C. Banstola, A. Barker-Collo, S.L. Bärnighausen, T.W. Barzegar, A. Bayati, M. Bazargan-Hejazi, S. Bedi, N. Behzadifar, M. Belete, H. Bennett, D.A. Bensenor, I.M. Berhe, K. Bhagavathula, A.S. Bhardwaj, P. Bhat, A.G. Bhattacharyya, K. Bhutta, Z.A. Bibi, S. Bijani, A. Boloor, A. Borges, G. Borschmann, R. Borzì, A.M. Boufous, S. Braithwaite, D. Briko, N.I. Brugha, T. Budhathoki, S.S. Car, J. Cárdenas, R. Carvalho, F. Castaldelli-Maia, J.M. Castañeda-Orjuela, C.A. Castelpietra, G. Catalá-López, F. Cerin, E. Chandan, J.S. Chapman, J.R. Chattu, V.K. Chattu, S.K. Chatziralli, I. Chaudhary, N. Cho, D.Y. Choi, J.-Y.J. Chowdhury, M.A.K. Christopher, D.J. Chu, D.-T. Cicuttini, F.M. Coelho, J.M. Costa, V.M. Dahlawi, S.M.A. Daryani, A. Dávila-Cervantes, C.A. De Leo, D. Demeke, F.M. Demoz, G.T. Demsie, D.G. Deribe, K. Desai, R. Nasab, M.D. Da Silva, D.D. Forooshani, Z.S.D. Do, H.T. Doyle, K.E. Driscoll, T.R. Dubljanin, E. Adema, B.D. Eagan, A.W. Elemineh, D.A. El-Jaafary, S.I. El-Khatib, Z. Ellingsen, C.L. El Sayedzaki, M. Eskandarieh, S. Eyawo, O. Faris, P.S. Faro, A. Farzadfar, F. Fereshtehnejad, S.-M. Fernandes, E. Ferrara, P. Fischer, F. Folayan, M.O. Fomenkov, A.A. Foroutan, M. Francis, J.M. Franklin, R.C. Fukumoto, T. Geberemariyam, B.S. Gebremariam, H. Gebremedhin, K.B. Gebremeskel, L.G. Gebremeskel, G.G. Gebremichael, B. Gedefaw, G.A. Geta, B. Getenet, A.B. Ghafourifard, M. Ghamari, F. Gheshlagh, R.G. Gholamian, A. Gilani, S.A. Gill, T.K. Goudarzian, A.H. Goulart, A.C. Grada, A. Grivna, M. Guimarães, R.A. Guo, Y. Gupta, G. Haagsma, J.A. Hall, B.J. Hamadeh, R.R. Hamidi, S. Handiso, D.W. Haro, J.M. Hasanzadeh, A. Hassan, S. Hassanipour, S. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hendrie, D. Heydarpour, F. Híjar, M. Ho, H.C. Hoang, C.L. Hole, M.K. Holla, R. Hossain, N. Hosseinzadeh, M. Hostiuc, S. Hu, G. Ibitoye, S.E. Ilesanmi, O.S. Inbaraj, L.R. Irvani, S.S.N. Islam, M.M. Islam, S.M.S. Ivers, R.Q. Jahani, M.A. Jakovljevic, M. Jalilian, F. Jayaraman, S. Jayatilleke, A.U. Jha, R.P. John-Akinola, Y.O. Jonas, J.B. Jones, K.M. Joseph, N. Joukar, F. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Kabir, A. Kahsay, A. Kalankesh, L.R. Kalhor, R. Kamil, T.A. Kanchan, T. Kapoor, N. Karami, M. Kasaeian, A. Kassaye, H.G. Kavetskyy, T. Kayode, G.A. Keiyoro, P.N. Kelbore, A.G. Khader, Y.S. Khafaie, M.A. Khalid, N. Khalil, I.A. Khalilov, R. Khan, M. Khan, E.A. Khan, J. Khanna, T. Khazaei, S. Khazaie, H. Khundkar, R. Kiirithio, D.N. Kim, Y.-E. Kim, Y.J. Kim, D. Kisa, S. Kisa, A. Komaki, H. Kondlahalli, S.K.M. Koolivand, A. Korshunov, V.A. Koyanagi, A. Kraemer, M.U.G. Krishan, K. Defo, B.K. Bicer, B.K. Kugbey, N. Kumar, N. Kumar, M. Kumar, V. Kumar, N. Kumaresh, G. Lami, F.H. Lansingh, V.C. Lasrado, S. Latifi, A. Lauriola, P. Vecchia, C.L. Leasher, J.L. Lee, S.W.H. Li, S. Liu, X. Lopez, A.D. Lotufo, P.A. Lyons, R.A. Machado, D.B. Madadin, M. Abd El Razek, M.M. Mahotra, N.B. Majdan, M. Majeed, A. Maled, V. Malta, D.C. Manafi, N. Manafi, A. Manda, A.-L. Manjunatha, N. Mansour-Ghanaei, F. Mansournia, M.A. Maravilla, J.C. Mason-Jones, A.J. Masoumi, S.Z. Massenburg, B.B. Maulik, P.K. Mehndiratta, M.M. Melketsedik, Z.A. Memiah, P.T.N. Mendoza, W. Menezes, R.G. Mengesha, M.M. Meretoja, T.J. Meretoja, A. Merie, H.E. Mestrovic, T. Miazgowski, B. Miazgowski, T. Miller, T.R. Mini, G.K. Mirica, A. Mirrakhimov, E.M. Mirzaei-Alavijeh, M. Mithra, P. Moazen, B. Moghadaszadeh, M. Mohamadi, E. Mohammad, Y. Darwesh, A.M. Mohammadian-Hafshejani, A. Mohammadpourhodki, R. Mohammed, S. Mohammed, J.A. Mohebi, F. Bandpei, M.A.M. Molokhia, M. Monasta, L. Moodley, Y. Moradi, M. Moradi, G. Moradi-Lakeh, M. Moradzadeh, R. Morawska, L. Velásquez, I.M. Morrison, S.D. Mossie, T.B. Muluneh, A.G. Musa, K.I. Mustafa, G. Naderi, M. Nagarajan, A.J. Naik, G. Naimzada, M.D. Najaf, F. Nangia, V. Nascimento, B.R. Naserbakht, M. Nayak, V. Nazari, J. Ndwandwe, D.E. Negoi, I. Ngunjiri, J.W. Nguyen, T.H. Nguyen, C.T. Nguyen, D.N. Nguyen, H.L.T. Nikbakhsh, R. Ningrum, D.N.A. Nnaji, C.A. Ofori-Asenso, R. Ogbo, F.A. Oghenetega, O.B. Oh, I.-H. Olagunju, A.T. Olagunju, T.O. Bali, A.O. Onwujekwe, O.E. Orpana, H.M. Ota, E. Otstavnov, N. Otstavnov, S.S. Mahesh, A.P. Padubidri, J.R. Pakhale, S. Pakshir, K. Panda-Jonas, S. Park, E.-K. Patel, S.K. Pathak, A. Pati, S. Paulos, K. Peden, A.E. Pepito, V.C.F. Pereira, J. Phillips, M.R. Polibin, R.V. Polinder, S. Pourmalek, F. Pourshams, A. Poustchi, H. Prakash, S. Pribadi, D.R.A. Puri, P. Syed, Z.Q. Rabiee, N. Rabiee, M. Radfar, A. Rafay, A. Rafee, A. Rafei, A. Rahim, F. Rahimi, S. Rahman, M.A. Rajabpour-Sanati, A. Rajati, F. Rakovac, I. Rao, S.J. Rashedi, V. Rastogi, P. Rathi, P. Rawaf, S. Rawal, L. Rawassizadeh, R. Renjith, V. Resnikoff, S. Rezapour, A. Ribeiro, A.I. Rickard, J. González, C.M.R. Roever, L. Ronfani, L. Roshandel, G. Saddik, B. Safarpour, H. Safdarian, M. Sajadi, S.M. Salamati, P. Salem, M.R.R. Salem, H. Salz, I. Samy, A.M. Sanabria, J. Riera, L.S. Milicevic, M.M.S. Sarker, A.R. Sarveazad, A. Sathian, B. Sawhney, M. Sayyah, M. Schwebel, D.C. Seedat, S. Senthilkumaran, S. Seyedmousavi, S. Sha, F. Shaahmadi, F. Shahabi, S. Shaikh, M.A. Shams-Beyranvand, M. Sheikh, A. Shigematsu, M. Shin, J.I. Shiri, R. Siabani, S. Sigfusdottir, I.D. Singh, J.A. Singh, P.K. Sinha, D.N. Soheili, A. Soriano, J.B. Sorrie, M.B. Soyiri, I.N. Stokes, M.A. Sufiyan, M.B. Sykes, B.L. Tabarés-Seisdedos, R. Tabb, K.M. Taddele, B.W. Tefera, Y.M. Tehrani-Banihashemi, A. Tekulu, G.H. Tesema, A.K.T. Tesfay, B.E. Thapar, R. Titova, M.V. Tlaye, K.G. Tohidinik, H.R. Topor-Madry, R. Tran, K.B. Tran, B.X. Tripathy, J.P. Tsai, A.C. Tsatsakis, A. Car, L.T. Ullah, I. Ullah, S. Unnikrishnan, B. Upadhyay, E. Uthman, O.A. Valdez, P.R. Vasankari, T.J. Veisani, Y. Venketasubramanian, N. Violante, F.S. Vlassov, V. Waheed, Y. Wang, Y.-P. Wiangkham, T. Wolde, H.F. Woldeyes, D.H. Wondmeneh, T.G. Wondmieneh, A.B. Wu, A.-M. Wyper, G.M.A. Yadav, R. Yadollahpour, A. Yano, Y. Yaya, S. Yazdi-Feyzabadi, V. Ye, P. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Youm, Y. Younis, M.Z. Yousef, Z. Yu, C. Yu, Y. Moghadam, T.Z. Zaidi, Z. Zaman, S.B. Zamani, M. Zandian, H. Zarei, F. Zhang, Z.-J. Zhang, Y. Ziapour, A. Zodpey, S. Dandona, R. Dharmaratne, S.D. Hay, S.I. Mokdad, A.H. Pigott, D.M. Reiner, R.C. Vos, T.

Abstract

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC B Y. Published by BMJ.

Published
2020

28. Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care

Author

J.M. Morrison, Habib Chaudhury, Christina Lengyel, Catriona M. Steele, Lita Villalon, Heather H. Keller, George A. Heckman, Natalie Carrier, K. Stephen Brown, Minn N. Yoon, Susan E. Slaughter, Alison M. Duncan, Lisa M. Duizer, and Veronique M. Boscart

Subjects
Male, 0301 basic medicine, Gerontology, Canada, Psychological intervention, Audit, Eating, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Patient-Centered Care, Surveys and Questionnaires, Prevalence, medicine, Homes for the Aged, Humans, Dementia, 030212 general & internal medicine, Medical prescription, Geriatric Assessment, General Nursing, Aged, Aged, 80 and over, 030109 nutrition & dietetics, business.industry, Health Policy, Malnutrition, General Medicine, Poor food intake, medicine.disease, Long-Term Care, Checklist, Nursing Homes, Long-term care, Cross-Sectional Studies, Nutrition Assessment, Elder Nutritional Physiological Phenomena, Female, Geriatrics and Gerontology, business, Needs Assessment
Abstract

Objective Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. Design Multisite cross-sectional study. Setting Thirty-two nursing homes from 4 provinces in Canada. Participants From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses. Measurements Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates. Results Average age of participants was 86.3 ± 7.8 years and 69% were female. Median energy intake was 1571.9 ± 411.93 kcal and protein 58.4 ± 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment–Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time. Conclusion This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research.

Published
2017
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29. Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis

Author

Nadia Kobagi, Angelle Kent, Matthias Hoben, Kha Tu Huynh, Alix Clarke, Tianyuan Xiong, Hongjin Xiang, Huimin Hu, Kexin Yu, Minn N. Yoon, and Raíssa Pereira

Subjects
medicine.medical_specialty, Evidence-based practice, Attitude of Health Personnel, CINAHL, Nurses' Aides, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Nursing, Ambulatory care, Nursing Assistants, Health care, medicine, Humans, 030212 general & internal medicine, General Nursing, Primary nursing, Inpatients, business.industry, 030206 dentistry, Oral Hygiene, Nursing Homes, Family medicine, Quality of Life, Dental Care for Aged, business
Abstract

Background Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. Methods We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. Results We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%–77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%–47%); general difficulties in providing oral care=26% (19%–33%); lack of time=31% (17%–47%); general dislike of oral care=19% (8%–33%); and lack of staff=22% (13%–31%). Conclusions We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.

Published
2017
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30. Investigation of the Microstructure and Thermoelectric Properties of P-Type BiSbTe Alloys by Usage of Different Revolutions Per Minute (RPM) During Mechanical Milling

Author

Soon-Jik Hong, Y.-N. Yoon, Babu Madavali, and Suk-Min Yoon

Subjects
010302 applied physics, lcsh:TN1-997, Materials science, Materials processing, Metallurgy, Spark plasma sintering, Metals and Alloys, Industrial chemistry, Mechanical engineering, Mechanical milling, 02 engineering and technology, 021001 nanoscience & nanotechnology, Microstructure, 01 natural sciences, Thermoelectric properties, 0103 physical sciences, Thermoelectric effect, lcsh:TA401-492, lcsh:Materials of engineering and construction. Mechanics of materials, Mechanical alloying, 0210 nano-technology, Bi0.5Sb1.5Te3 alloys, lcsh:Mining engineering. Metallurgy, Revolutions per minute
Abstract

In this work, p-type Bi0.5Sb1.5Te3alloys were fabricated by high-energy ball milling (MA) and spark plasma sintering. Different revolutions per minute (RPM)s were used in the MA process, and their effect on microstructure, and thermoelectric properties of p-type Bi0.5Sb1.5Te3were systematically investigated. The crystal structure of milled powders and sintered samples were characterized using X-ray diffraction. All the powders exhibited the same morphology albeit with slight differences find at 1100 RPM conditions. A slight grain size refinement was observed on the fracture surfaces from 500 to 1100 RPM specimens. The temperature dependence of Seebeck coefficient, electrical conductivity, and power factors were measured as a function of temperature with different RPM conditions. The power factor shows almost same (~3.5 W/mK2at RT) for all samples due to unchanged Seebeck and electrical conductivity values. The peak ZT of 1.07 at 375K is obtained for 1100 RPM specimen due to low thermal conductivity.

Published
2017

31. Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

Author

Stanaway, J.D. Afshin, A. Gakidou, E. Lim, S.S. Abate, D. Abate, K.H. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abebe, M. Abebe, Z. Abera, S.F. Abil, O.Z. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adane, A.A. Adebayo, O.M. Adedoyin, R.A. Adekanmbi, V. Ademi, Z. Adetokunboh, O.O. Adib, M.G. Admasie, A. Adsuar, J.C. Afanvi, K.A. Afarideh, M. Agarwal, G. Aggarwal, A. Aghayan, S.A. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akbari, M.E. Akinyemiju, T. Akseer, N. Al-Aly, Z. Al-Eyadhy, A. Al-Mekhlafi, H.M. Alahdab, F. Alam, K. Alam, S. Alam, T. Alashi, A. Alavian, S.M. Alene, K.A. Ali, K. Ali, S.M. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Ammar, W. Anber, N.H. Anderson, J.A. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansha, M.G. Antó, J.M. Antonio, C.A.T. Anwari, P. Appiah, L.T. Appiah, S.C.Y. Arabloo, J. Aremu, O. Ärnlöv, J. Artaman, A. Aryal, K.K. Asayesh, H. Ataro, Z. Ausloos, M. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayer, R. Ayuk, T.B. Azzopardi, P.S. Babazadeh, A. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Ball, K. Ballew, S.H. Banach, M. Banoub, J.A.M. Barac, A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Basu, S. Baune, B.T. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Bekru, E.T. Belay, E. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Bergeron, G. Berhane, A. Bernabe, E. Bernstein, R.S. Beuran, M. Beyranvand, T. Bhala, N. Bhalla, A. Bhattarai, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bilano, V. Bililign, N. Bin Sayeed, M.S. Bisanzio, D. Biswas, T. Bjørge, T. Blacker, B.F. Bleyer, A. Borschmann, R. Bou-Orm, I.R. Boufous, S. Bourne, R. Brady, O.J. Brauer, M. Brazinova, A. Breitborde, N.J.K. Brenner, H. Briko, A.N. Britton, G. Brugha, T. Buchbinder, R. Burnett, R.T. Busse, R. Butt, Z.A. Cahill, L.E. Cahuana-Hurtado, L. Campos-Nonato, I.R. Cárdenas, R. Carreras, G. Carrero, J.J. Carvalho, F. Castañeda-Orjuela, C.A. Castillo Rivas, J. Castro, F. Catalá-López, F. Causey, K. Cercy, K.M. Cerin, E. Chaiah, Y. Chang, H.-Y. Chang, J.-C. Chang, K.-L. Charlson, F.J. Chattopadhyay, A. Chattu, V.K. Chee, M.L. Cheng, C.-Y. Chew, A. Chiang, P.P.-C. Chimed-Ochir, O. Chin, K.L. Chitheer, A. Choi, J.-Y.J. Chowdhury, R. Christensen, H. Christopher, D.J. Chung, S.-C. Cicuttini, F.M. Cirillo, M. Cohen, A.J. Collado-Mateo, D. Cooper, C. Cooper, O.R. Coresh, J. Cornaby, L. Cortesi, P.A. Cortinovis, M. Costa, M. Cousin, E. Criqui, M.H. Cromwell, E.A. Cundiff, D.K. Daba, A.K. Dachew, B.A. Dadi, A.F. Damasceno, A.A.M. Dandona, L. Dandona, R. Darby, S.C. Dargan, P.I. Daryani, A. Das Gupta, R. Das Neves, J. Dasa, T.T. Dash, A.P. Davitoiu, D.V. 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Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Published
2019

32. Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the Global Burden of Disease Study 2016

Author

Orpana, H.M. Marczak, L.B. Arora, M. Abbasi, N. Abdulkader, R.S. Abebe, Z. Abraha, H.N. Afarideh, M. Afshari, M. Ahmadi, A. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akseer, N. Al‐raddadi, R.M. Alahdab, F. Alkerwi, A. Allebeck, P. Alvis‐guzman, N. Anber, N.H. Anjomshoa, M. Antonio, C.A.T. Arora, A. Aryal, K.K. Asgedom, S.W. Awasthi, A. Quintanilla, B.P.A. Badali, H. Barker‐collo, S.L. Bärnighausen, T.W. Bazargan‐hejazi, S. Benjet, C. Bensenor, I.M. Berfeld, N. Beuran, M. Bhutta, Z.A. Biadgo, B. Bililign, N. Borges, G. Borschmann, R. Brazinova, A. Breitborde, N.J.K. Brugha, T. Butt, Z.A. Carrero, J.J. Carvalho, F. Malta, D.C. Castañeda‐orjuela, C.A. Catalá‐lópez, F. Ciobanu, L.G. Dachew, B.A. Dandona, L. Dandona, R. Dargan, P.I. Daryani, A. Davitoiu, D.V. Davletov, K. Degenhardt, L. Demoz, G.T. Jarlais, D.C.D. Dharmaratne, S.D. Djalalinia, S. Doan, L. Doku, D.T. Dubey, M. El‐khatib, Z. Eskandarieh, S. Esteghamati, A. Esteghamati, S. Faro, A. Farzadfar, F. Fekadu, W. Fernandes, E. Ferrari, A.J. Filip, I. Fischer, F. Foreman, K.J. Fukumoto, T. Gebre, A.K. Grosso, G. Gupta, R. Haagsma, J.A. Bidgoli, H.H. Haj‐mirzaian, A. Hamidi, S. Hankey, G.J. Haro, J.M. Hassen, H.Y. Hay, S.I. Heidari, B. Hendrie, D. Rad, E.H. Hosseini, S.M. Hostiuc, S. Irvani, S.S.N. Islam, S.M.S. Jakovljevic, M. James, S. Jayatilleke, A.U. Jha, R.P. Jonas, J.B. Jozwiak, J.J. Kadel, R. Kahsay, A. Kasaeian, A. Kassa, G.M. Kawakami, N. Kefale, A.T. Kemp, G.R. Khader, Y.S. Khafaie, M.A. Khalil, I.A. Khan, E.A. Khan, M.A. Khan, M.S. Khang, Y.-H. Khubchandani, J. Kiadaliri, A.A. Kieling, C. Kim, Y.-E. Kisa, A. Knudsen, A.K.S. Kokubo, Y. Koyanagi, A. Krish, V.S. Defo, B.K. Kumar, G.A. Kumar, M. Lamichhane, P. Lang, J.J. Latifi, A. Lee, P.H. Leung, J. Lim, L.-L. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Lozano, R. Lunevicius, R. Mahesh, P.A. Majdan, M. Majdzadeh, R. Malekzadeh, R. Manda, A.-L. Mansournia, M.A. Mantovani, L.G. Maravilla, J.C. Martinez‐raga, J. Mathur, M.R. Maulik, P.K. McGrath, J.J. Mehrotra, R. Mekonen, T. Mendoza, W. Meretoja, T.J. Mestrovic, T. Miller, T.R. Mini, G.K. Mirrakhimov, E.M. Mitchell, P.B. Moazen, B. Mohammad, K.A. Mohammadi, M. Mohammed, S. Mokdad, A.H. Monasta, L. Moosazadeh, M. Moradi, G. Moradi‐lakeh, M. Moradinazar, M. Velásquez, I.M. Morisaki, N. Morrison, S.D. Moschos, M.M. Mousavi, S.M. Mustafa, G. Nagel, G. Naheed, A. Naik, G. Najafi, F. Negoi, I. Negoi, R.I. Nguyen, H.L.T. Nguyen, L.H. Nixon, M.R. Ofori‐asenso, R. Ogbo, F.A. Oh, I.-H. Olagunju, A.T. Olagunju, T.O. Øverland, S. Owolabi, M.O. Panda‐jonas, S. Parry, C.D.H. Pati, S. Patten, S.B. Patton, G.C. Petzold, M. Phillips, M.R. Plana‐ripoll, O. Postma, M.J. Pourshams, A. Poustchi, H. Qorbani, M. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi‐movaghar, A. Rahimi‐movaghar, V. Rahman, M.A. Rai, R.K. Rezaeian, S. Roever, L. Ronfani, L. Roshandel, G. Rostami, A. Sachdev, P.S. Safari, H. Safiri, S. Salamati, P. Salimi, Y. Salomon, J.A. Samy, A.M. Santos, I.S. Santric‐milicevic, M.M. Sartorius, B. Sarvi, S. Satpathy, M. Sawhney, M. Schwebel, D.C. Sepanlou, S.G. Shaikh, M.A. Sharif, M. Shibuya, K. Shigematsu, M. Shiri, R. Shiue, I. Siabani, S. Siddiqi, T.J. Sigfusdottir, I.D. Silva, J.P. Singh, J.A. Filho, A.M.S. Sobhani, S. Stein, D.J. Stein, M.B. Sufiyan, M.B. Sunguya, B.F. Tabarés‐seisdedos, R. Tabb, K.M. Tavakkoli, M. Tehrani‐banihashemi, A. Temsah, M.-H. Topor‐madry, R. Tran, B.X. Tran, K.B. Ullah, I. Unutzer, J. Usman, M.S. Uthman, O.A. Valdez, P.R. Vasankari, T.J. Vasconcelos, C. Vlassov, V. Vos, T. Vujcic, I.S. Waheed, Y. Wang, Y.-P. Weiderpass, E. Werdecker, A. Westerman, R. Whiteford, H.A. Wyper, G.M.A. Yaseri, M. Yimer, E.M. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Yousefifard, M. Yu, C. Zaidi, Z. Zamani, M. Murray, C.J.L. Naghavi, M.

Abstract

Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates. © Published by the BMJ Publishing Group Limited.

Published
2019

33. Dielectric constant measurements of thin films and liquids using terahertz metamaterials

Author

Sae June Park, S. A. N. Yoon, and Yeong Hwan Ahn

Subjects
chemistry.chemical_classification, Materials science, business.industry, Terahertz radiation, General Chemical Engineering, Physics::Optics, Resonance, Metamaterial, 02 engineering and technology, General Chemistry, Dielectric, Polymer, 021001 nanoscience & nanotechnology, 01 natural sciences, 010309 optics, Split-ring resonator, Optics, chemistry, Electric field, 0103 physical sciences, Optoelectronics, Thin film, 0210 nano-technology, business
Abstract

In this paper, we demonstrate that terahertz (THz) metamaterials are powerful tools for determination of dielectric constants of polymer films and polar liquids. As we deposit a dielectric film on a metamaterial, the resonant frequency shifts, but saturates at a specific thickness due to the limited sensing volume of the metamaterial. From the saturated value, we can extract the dielectric constants of various polymers that are transparent to the THz frequency range. In addition, we fabricated a microfluidic channel that contains the metamaterials to address the real dielectric constants for a polar liquid solution. This was possible due to an extremely confined electric field near the gap area of the metamaterials, enabling us to employ very thin liquid layers. We found that the resonance shifts do not depend critically on the imaginary dielectric constants, proving that our approach can be universal in terms of various materials, including absorptive materials. As an example, the dielectric constants of sodium chloride and potassium chloride solutions have been determined with various concentrations. Our experimental findings were successfully confirmed by finite-difference time-domain simulations.

Published
2016
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34. Oral health status of long-term care residents in Canada: Results of a national cross-sectional study

Author

Carla Ickert, Natalie Carrier, Minn N. Yoon, Susan E. Slaughter, Christina Lengyel, and Heather H. Keller

Subjects
Male, medicine.medical_specialty, Canada, Activities of daily living, Cross-sectional study, medicine.medical_treatment, Oral Health, Oral health, Dental Caries, 03 medical and health sciences, Dental Care for Aged, 0302 clinical medicine, Quality of life (healthcare), medicine, Prevalence, Humans, 030212 general & internal medicine, Gingival inflammation, General Dentistry, Dentures, Aged, Aged, 80 and over, business.industry, 030206 dentistry, Long-Term Care, 3. Good health, Nursing Homes, stomatognathic diseases, Long-term care, Cross-Sectional Studies, Tooth Diseases, Family medicine, Oral health care, Female, Geriatrics and Gerontology, Mouth, Edentulous, business, Mouth Diseases
Abstract

Objective To describe the oral health and oral prosthetic status of long-term care residents in four Canadian provinces. Background Oral health can have significant impact on the health and quality of life of older adults. Seniors in long-term care are highly dependent on care staff for basic activities of daily living and are at risk for poor oral health. Materials and methods Five hundred and fifty-nine randomly selected residents were examined from thirty-two long-term care homes in Alberta, Manitoba, Ontario and New Brunswick, Canada. Four experienced registered dental hygienists, one in each province, completed a standardised oral health examination with each participant, examining lip health, breath odour, saliva appearance, natural teeth count, gingival inflammation, tooth and jaw pain, denture status, mucosal status and oral health abnormalities. Results Of the examined residents, 57.6% were dentate, with an average of 16.4 (SD = 8.0) teeth. Most dentate residents had moderate or severe inflammation on at least one tooth (79.6%). Sixty per cent of residents wore dentures, and 43.2% of edentulous residents had poor hygiene of their dentures. Nine per cent of residents required urgent dental treatment for oral health problems such as broken teeth, infection, severe decay and ulcers. Conclusion This study provides an estimate of the prevalence of oral health problems in residents living in long-term care homes across Canada and indicates that improvement in oral health care is needed. Future work on development strategies aimed at optimising oral health for long-term care residents is required.

Published
2018

35. Prevalence of inadequate micronutrient intakes of Canadian long-term care residents

Author

Christina Lengyel, George A. Heckman, K. Stephen Brown, Natalie Carrier, J.M. Morrison, Lisa M. Duizer, Susan E. Slaughter, Alison M. Duncan, Minn N. Yoon, Catriona M. Steele, Veronique Boscart, Heather H. Keller, Lita Villalon, and Habib Chaudhury

Subjects
0301 basic medicine, Male, Canada, Medicine (miscellaneous), Nutritional Status, 03 medical and health sciences, Nutrient, Environmental health, Vitamin D and neurology, Medicine, Humans, Micronutrients, Aged, Aged, 80 and over, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Mean age, Micronutrient, Long-Term Care, Long-term care, Cross-Sectional Studies, Dietary Reference Intake, Pill, Female, business, Food Analysis
Abstract

This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50–70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Published
2018

36. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: A systematic analysis for the Global Burden of Disease Study 2017

Author

Dicker, D. Nguyen, G. Abate, D. Abate, K.H. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdollahpour, I. Abdulkader, R.S. Abdurahman, A.A. Abebe, H.T. Abebe, M. Abebe, Z. Abebo, T.A. Aboyans, V. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, P. Adebayo, O.M. Adedeji, I.A. Adedoyin, R.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshin, A. Agarwal, G. Aggarwal, R. Aghayan, S.A. Agrawal, S. Agrawal, A. Ahmadi, M. Ahmadi, A. Ahmadieh, H. Ahmed, M.L.C.B. Ahmed, S. Ahmed, M.B. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alebel, A. Aleman, A.V. Alene, K.A. Al-Eyadhy, A. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Allen, C.A. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Amini, E. Ammar, W. Amoako, Y.A. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Anlay, D.Z. Ansari, H. Ansariadi, A. Ansha, M.G. Antonio, C.A.T. Appiah, S.C.Y. Aremu, O. Areri, H.A. Ärnlöv, J. Arora, M. Artaman, A. Aryal, K.K. Asadi-Lari, M. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Assadi, R. Ataro, Z. Atey, T.M.M. Athari, S.S. Atique, S. Atre, S.R. Atteraya, M.S. Attia, E.F. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Awuah, B. Ayala Quintanilla, B.P. Ayele, H.T. Ayele, Y. Ayer, R. Ayuk, T.B. Azzopardi, P.S. Azzopardi-Muscat, N. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Banach, M. Banstola, A. Barac, A. Barboza, M.A. Barquera, S. Barrero, L.H. Basaleem, H. Bassat, Q. Basu, A. Basu, S. Baune, B.T. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Belachew, A.B. Belay, A.G. Belay, E. Belay, S.A. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Berhane, A. Berman, A.E. Bernabe, E. Bernstein, R.S. Bertolacci, G.J. Beuran, M. Beyranvand, T. Bhala, N. Bhatia, E. Bhatt, S. Bhattarai, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bililign, N. Bin Sayeed, M.S. Birlik, S.M. Birungi, C. Bisanzio, D. Biswas, T. Bjørge, T. Bleyer, A. Bora Basara, B. Bose, D. Bosetti, C. Boufous, S. Bourne, R. Brady, O.J. Bragazzi, N.L. Brant, L.C. Brazinova, A. Breitborde, N.J.K. Brenner, H. Britton, G. Brugha, T. Burke, K.E. Busse, R. Butt, Z.A. Cahuana-Hurtado, L. Callender, C.S.K.H. Campos-Nonato, I.R. Campuzano Rincon, J.C. Cano, J. Car, M. Cárdenas, R. Carreras, G. Carrero, J.J. Carter, A. Carvalho, F. Castañeda-Orjuela, C.A. Castillo Rivas, J. Castro, F. Catalá-López, F. Çavlin, A. Cerin, E. Chaiah, Y. Champs, A.P. Chang, H.-Y. Chang, J.-C. Chattopadhyay, A. Chaturvedi, P. Chen, W. Chiang, P.P.-C. Chimed-Ochir, O. Chin, K.L. Chisumpa, V.H. Chitheer, A. Choi, J.-Y.J. Christensen, H. Christopher, D.J. Chung, S.-C. Cicuttini, F.M. Ciobanu, L.G. Cirillo, M. Claro, R.M. Cohen, A.J. Collado-Mateo, D. Constantin, M.-M. Conti, S. Cooper, C. Cooper, L.T. Cortesi, P.A. Cortinovis, M. Cousin, E. Criqui, M.H. Cromwell, E.A. Crowe, C.S. Crump, J.A. Cucu, A. Cunningham, M. Daba, A.K. Dachew, B.A. Dadi, A.F. Dandona, L. Dandona, R. Dang, A.K. Dargan, P.I. Daryani, A. Das, S.K. Das Gupta, R. Das Neves, J. Dasa, T.T. Dash, A.P. Davis Weaver, N. Davitoiu, D.V. Davletov, K. Dayama, A. de Courten, B. De la Hoz, F.P. De leo, D. De Neve, J.-W. Degefa, M.G. Degenhardt, L. Degfie, T.T. Deiparine, S. Dellavalle, R.P. Demoz, G.T. Demtsu, B.B. Denova-Gutiérrez, E. Deribe, K. Dervenis, N. Des Jarlais, D.C. Dessie, G.A. Dey, S. Dharmaratne, S.D. Dhimal, M. Ding, E.L. Djalalinia, S. Doku, D.T. Dolan, K.A. Donnelly, C.A. Dorsey, E.R. Douwes-Schultz, D. Doyle, K.E. Drake, T.M. Driscoll, T.R. Dubey, M. Dubljanin, E. Duken, E.E. Duncan, B.B. Duraes, A.R. Ebrahimi, H. Ebrahimpour, S. Edessa, D. Edvardsson, D. Eggen, A.E. El Bcheraoui, C. El Sayed Zaki, M. Elfaramawi, M. El-Khatib, Z. Ellingsen, C.L. Elyazar, I.R.F. Enayati, A. Endries, A.Y.Y. Er, B. Ermakov, S.P. Eshrati, B. Eskandarieh, S. Esmaeili, R. Esteghamati, A. Esteghamati, S. Fakhar, M. Fakhim, H. Farag, T. Faramarzi, M. Fareed, M. Farhadi, F. Farid, T.A. E Sá Farinha, C.S. Farioli, A. Faro, A. Farvid, M.S. Farzadfar, F. Farzaei, M.H. Fazeli, M.S. Feigin, V.L. Feigl, A.B. Feizy, F. Fentahun, N. Fereshtehnejad, S.-M. Fernandes, E. Fernandes, J.C. Feyissa, G.T. Fijabi, D.O. Filip, I. Finegold, S. Fischer, F. Flor, L.S. Foigt, N.A. Ford, J.A. Foreman, K.J. Fornari, C. Frank, T.D. Franklin, R.C. Fukumoto, T. Fuller, J.E. Fullman, N. Fürst, T. Furtado, J.M. Futran, N.D. Galan, A. Gallus, S. Gambashidze, K. Gamkrelidze, A. Gankpe, F.G. Garcia-Basteiro, A.L. Garcia-Gordillo, M.A. Gebre, T. Gebre, A.K. Gebregergs, G.B. Gebrehiwot, T.T. Gebremedhin, A.T. Gelano, T.F. Gelaw, Y.A. Geleijnse, J.M. Genova-Maleras, R. Gessner, B.D. Getachew, S. Gething, P.W. Gezae, K.E. Ghadami, M.R. Ghadimi, R. Ghasemi Falavarjani, K. Ghasemi-Kasman, M. Ghiasvand, H. Ghimire, M. Ghoshal, A.G. Gill, P.S. Gill, T.K. Gillum, R.F. Giussani, G. Goenka, S. Goli, S. Gomez, R.S. Gomez-Cabrera, M.C. Gómez-Dantés, H. Gona, P.N. Goodridge, A. Gopalani, S.V. Goto, A. Goulart, A.C. Goulart, B.N.G. Grada, A. Grosso, G. Gugnani, H.C. Guimaraes, A.L.S. Guo, Y. Gupta, P.C. Gupta, R. Gupta, R. Gupta, T. Gyawali, B. Haagsma, J.A. Hachinski, V. Hafezi-Nejad, N. Hagos, T.B. Hailegiyorgis, T.T. Hailu, G.B. Haj-Mirzaian, A. Haj-Mirzaian, A. Hamadeh, R.R. Hamidi, S. Handal, A.J. Hankey, G.J. Harb, H.L. Harikrishnan, S. Haririan, H. Haro, J.M. Hasan, M. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hay, R.J. Hay, S.I. He, Y. Hedayatizadeh-Omran, A. Hegazy, M.I. Heibati, B. Heidari, M. Hendrie, D. Henok, A. Henry, N.J. Heredia-Pi, I. Herteliu, C. Heydarpour, F. Heydarpour, P. Heydarpour, S. Hibstu, D.T. Hoek, H.W. Hole, M.K. Homaie Rad, E. Hoogar, P. Horino, M. Hosgood, H.D. Hosseini, S.M. Hosseinzadeh, M. Hostiuc, S. Hostiuc, M. Hotez, P.J. Hoy, D.G. Hsairi, M. Htet, A.S. Hu, G. Huang, J.J. Husseini, A. Hussen, M.M. Hutfless, S. Iburg, K.M. Igumbor, E.U. Ikeda, C.T. Ilesanmi, O.S. Iqbal, U. Irvani, S.S.N. Isehunwa, O.O. Islam, S.M.S. Islami, F. Jahangiry, L. Jahanmehr, N. Jain, R. Jain, S.K. Jakovljevic, M. James, S.L. Javanbakht, M. Jayaraman, S. Jayatilleke, A.U. Jee, S.H. Jeemon, P. Jha, R.P. Jha, V. Ji, J.S. Johnson, S.C. Jonas, J.B. Joshi, A. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Madhanraj, K. Kabir, Z. Kadel, R. Kahsay, A. Kahssay, M. Kalani, R. Kapil, U. Karami, M. Karami Matin, B. Karch, A. Karema, C. Karimi, N. Karimi, S.M. Karimi-Sari, H. Kasaeian, A. Kassa, G.M. Kassa, T.D. Kassa, Z.Y. Kassebaum, N.J. Katibeh, M. Katikireddi, S.V. Kaul, A. Kawakami, N. Kazemeini, H. Kazemi, Z. Kazemi Karyani, A. Prakash, K.C. Kebede, S. Keiyoro, P.N. Kemp, G.R. Kengne, A.P. Keren, A. Kereselidze, M. Khader, Y.S. Khafaie, M.A. Khajavi, A. 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Younis, M.Z. Yousefifard, M. Yu, C. Zachariah, G. Zadnik, V. Zafar, S. Zaidi, Z. Zaman, S.B. Zamani, M. Zare, Z. Zeeb, H. Zeleke, M.M. Zenebe, Z.M. Zerfu, T.A. Zhang, K. Zhang, X. Zhou, M. Zhu, J. Zodpey, S. Zucker, I. Zuhlke, L.J.J. Lopez, A.D. Gakidou, E. Murray, C.J.L. GBD 2017 Mortality Collaborators

Abstract

Background: Assessments of age-specifc mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Afairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specifc mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in diferent components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specifc mortality shows that there are remarkably complex patterns in population mortality across countries. The fndings of this study highlight global successes, such as the large decline in under-5 mortality, which refects signifcant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. © 2018 The Author(s).

Published
2018

37. Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Murray, C.J.L. Callender, C.S.K.H. Kulikoff, X.R. Srinivasan, V. Abate, D. Abate, K.H. Abay, S.M. Abbasi, N. Abbastabar, H. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdoli, N. Abdollahpour, I. Abdulkader, R.S. Abebe, H.T. Abebe, M. Abebe, Z. Abebo, T.A. Abejie, A.N. Aboyans, V. Abraha, H.N. Abreu, D.M.X. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshin, A. Agarwal, G. Agesa, K.M. Aghayan, S.A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmed, M.B. Ahmed, S. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alebel, A. Aleman, A.V. Alene, K.A. Al-Eyadhy, A. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Almasi, A. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Ammar, W. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Ansari, H. Ansha, M.G. Antonio, C.A.T. Appiah, S.C.Y. Aremu, O. Areri, H.A. Arian, N. Ärnlöv, J. Artaman, A. Aryal, K.K. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Assadi, R. Atey, T.M.M. Atique, S. Atteraya, M.S. Ausloos, M. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayele, Y. Ayer, R. Ayuk, T.B. Azzopardi, P.S. Babalola, T.K. Babazadeh, A. Badali, H. Badawi, A. Bali, A.G. Banach, M. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Basaleem, H. Bassat, Q. Basu, A. Baune, B.T. Baynes, H.W. Beghi, E. Behzadifar, M. Behzadifar, M. Bekele, B.B. Belachew, A.B. Belay, A.G. Belay, E. Belay, S.A. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Bergeron, G. Berhane, A. Berman, A.E. Bernabe, E. Bernstein, R.S. Bertolacci, G.J. Beuran, M. Bhattarai, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bililign, N. Bin Sayeed, M.S. Birlik, S.M. Birungi, C. 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Mansournia, M.A. Mantovani, L.G. Mapoma, C.C. Marami, D. Maravilla, J.C. Marcenes, W. Marina, S. Martins-Melo, F.R. März, W. Marzan, M.B. Mashamba-Thompson, T.P. Masiye, F. Mason-Jones, A.J. Massenburg, B.B. Mathur, M.R. Maulik, P.K. Mazidi, M. McGrath, J.J. Mehata, S. Mehendale, S.M. Mehndiratta, M.M. Mehrotra, R. Mehrzadi, S. Mehta, K.M. Mehta, V. Mekonnen, T.C. Meles, H.G. Meles, K.G. Melese, A. Melku, M. Memiah, P.T.N. Memish, Z.A. Mendoza, W. Mengesha, M.M. Mengistu, D.T. Mengistu, G. Mensah, G.A. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Mezgebe, H.B. Miangotar, Y. Miazgowski, B. Miazgowski, T. Miller, T.R. Miller-Petrie, M.K. Mini, G.K. Mirabi, P. Mirica, A. Mirrakhimov, E.M. Misganaw, A.T. Moazen, B. Mohammad, K.A. Mohammadi, M. Mohammadifard, N. Mohammadi-Khanaposhtani, M. Mohammed, M.A. Mohammed, S. Mokdad, A.H. Mola, G.D. Molokhia, M. Monasta, L. Montañez, J.C. Moradi, G. Moradi, M. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morgado-Da-Costa, J. Mori, R. 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GBD 2017 Population Fertility Collaborators

Abstract

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Published
2018

38. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Author

Kyu, H.H. Abate, D. Abate, K.H. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abebe, M. Abebe, Z. Abil, O.Z. Aboyans, V. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, D. Acharya, P. Ackerman, I.N. Adamu, A.A. Adebayo, O.M. Adekanmbi, V. Ademi, Z. Adetokunboh, O.O. Adib, M.G. Adsuar, J.C. Afanvi, K.A. Afarideh, M. Afshin, A. Agarwal, G. Agesa, K.M. Aggarwal, R. Aghayan, S.A. Agrawal, A. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akinyemiju, T. Akseer, N. Al-Aly, Z. Al-Eyadhy, A. Al-Mekhlafi, H.M. Al-Raddadi, R.M. Alahdab, F. Alam, K. Alam, T. Alashi, A. Alavian, S.M. Alene, K.A. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Alonso, J. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Aminde, L.N. Amini, E. Amiresmaili, M. Ammar, W. Amoako, Y.A. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansha, M.G. Antonio, C.A.T. Anwari, P. Arabloo, J. Aremu, O. Ärnlöv, J. Arora, A. Arora, M. Artaman, A. Aryal, K.K. Asayesh, H. Ataro, Z. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayer, R. Azzopardi, P.S. Babazadeh, A. Badali, H. Balakrishnan, K. Bali, A.G. Banach, M. Banoub, J.A.M. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barquera, S. Barrero, L.H. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Bekele, B.B. Bekru, E.T. Belachew, A.B. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Berhane, A. Bernabe, E. Bernstein, R.S. Beuran, M. Beyranvand, T. Bhala, N. Bhatt, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Biehl, M.H. Bijani, A. Bikbov, B. Bilano, V. Bililign, N. Bin Sayeed, M.S. Bisanzio, D. Bjorge, T. Bleyer, A. Bobasa, E.M. Bou-Orm, I.R. Boufous, S. Bourne, R. Brady, O.J. Brant, L.C. Brayne, C. Brazinova, A. Breitborde, N.J.K. Brenner, H. Briant, P.S. Briko, A.N. Britton, G. Brugha, T. Buchbinder, R. Busse, R. Butt, Z.A. Cahuana-Hurtado, L. Campuzano Rincon, J.C. Cano, J. Cárdenas, R. Carrero, J.J. Carter, A. Carvalho, F. Castaneda-Orjuela, C.A. Rivas, J.C. Castro, F. Catalá-López, F. Cercy, K.M. Cerin, E. Chaiah, Y. Chang, J.-C. Charlson, F.J. Chattu, V.K. Chiang, P.P.-C. Chitheer, A. Choi, J.-Y.J. Christensen, H. Christopher, D.J. Chung, S.-C. Cicuttini, F.M. Cirillo, M. Collado-Mateo, D. Cooper, C. Cortesi, P.A. Cortinovis, M. Cousin, E. Criqui, M.H. Cromwell, E.A. Cross, M. Crump, J.A. Daba, A.K. Dachew, B.A. Dadi, A.F. Dandona, L. Dandona, R. Dargan, P.I. Daryani, A. Das Gupta, R. Das Neves, J. Dasa, T.T. Davitoiu, D.V. De La Hoz, F.P. De Leo, D. De Neve, J.-W. De Steur, H. Degefa, M.G. Degenhardt, L. Deiparine, S. Demoz, G.T. Denova-Gutiérrez, E. Deribe, K. Dervenis, N. Des Jarlais, D.C. Dey, S. Dharmaratne, S.D. Dhimal, M. Dinberu, M.T. Dirac, M.A. Djalalinia, S. Doan, L. Dokova, K. Doku, D.T. Dorsey, E.R. Doyle, K.E. Driscoll, T.R. Dubey, M. Dubljanin, E. Duken, E.E. Duncan, B.B. Duraes, A.R. Ebrahimi, H. Ebrahimpour, S. Echko, M.M. Edessa, D. Edvardsson, D. Effiong, A. Eggen, A.E. Ehrlich, J.R. El Bcheraoui, C. El-Khatib, Z. Elyazar, I.R.F. Enayati, A. Endalifer, M.L. Endries, A.Y. Er, B. Erskine, H.E. Eskandarieh, S. Esteghamati, A. Esteghamati, S. Fakhim, H. Faramarzi, M. Fareed, M. Farhadi, F. Farid, T.A. Sá Farinha, C.S.E. Farioli, A. Faro, A. Farzadfar, F. Fazaeli, A.A. Feigin, V.L. Fentahun, N. Fereshtehnejad, S.-M. Fernandes, E. Fernandes, J.C. Ferrari, A.J. Ferreira, M.L. Filip, I. Fischer, F. Fitzmaurice, C. Foigt, N.A. Foreman, K.J. Frank, T.D. Fukumoto, T. Fullman, N. Fürst, T. Furtado, J.M. Gakidou, E. Gall, S. Gallus, S. Ganji, M. Garcia-Basteiro, A.L. Gardner, W.M. Gebre, A.K. Gebremedhin, A.T. Gebremichael, T.G. Gelano, T.F. Geleijnse, J.M. Genova-Maleras, R. Geramo, Y.C.D. Gething, P.W. Gezae, K.E. Ghadami, M.R. Ghadiri, K. Ghasemi-Kasman, M. Ghimire, M. Ghoshal, A.G. Gill, P.S. Gill, T.K. Ginawi, I.A. Giussani, G. Gnedovskaya, E.V. Goldberg, E.M. Goli, S. Gómez-Dantés, H. Gona, P.N. Gopalani, S.V. Gorman, T.M. Goulart, A.C. Goulart, B.N.G. Grada, A. Grosso, G. Gugnani, H.C. Guillemin, F. Guo, Y. Gupta, P.C. Gupta, R. Gupta, R. Gupta, T. Gutiérrez, R.A. Gyawali, B. Haagsma, J.A. Hachinski, V. Hafezi-Nejad, N. Bidgoli, H.H. Hagos, T.B. Hailegiyorgis, T.T. Haj-Mirzaian, A. Haj-Mirzaian, A. Hamadeh, R.R. Hamidi, S. Handal, A.J. Hankey, G.J. Hao, Y. Harb, H.L. Harikrishnan, S. Haririan, H. Haro, J.M. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hay, R.J. Hay, S.I. Hedayatizadeh-Omran, A. Heibati, B. Hendrie, D. Henok, A. Heredia-Pi, I. Herteliu, C. Heydarpour, F. Heydarpour, P. Hibstu, D.T. Hoek, H.W. Hoffman, H.J. Hole, M.K. Rad, E.H. Hoogar, P. Hosgood, H.D. Hosseini, S.M. Hosseinzadeh, M. Hostiuc, M. Hostiuc, S. Hotez, P.J. Hoy, D.G. Hsairi, M. Htet, A.S. Huang, J.J. Iburg, K.M. Ikeda, C.T. Ilesanmi, O.S. Irvani, S.S.N. Irvine, C.M.S. Islam, S.M.S. Islami, F. Jacobsen, K.H. Jahangiry, L. Jahanmehr, N. Jain, S.K. Jakovljevic, M. James, S.L. Jayatilleke, A.U. Jeemon, P. Jha, R.P. Jha, V. Ji, J.S. Johnson, C.O. Jonas, J.B. Jonnagaddala, J. Shushtari, Z.J. Joshi, A. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Kabir, Z. Kadel, R. Kahsay, A. Kalani, R. Kanchan, T. Kar, C. Karami, M. Karami Matin, B. Karch, A. Karema, C. Karimi, N. Karimi, S.M. Kasaeian, A. Kassa, D.H. Kassa, G.M. Kassa, T.D. Kassebaum, N.J. Katikireddi, S.V. Kaul, A. Kawakami, N. Kazemi, Z. Kazemi Karyani, A. Keighobadi, M.M. Keiyoro, P.N. Kemmer, L. Kemp, G.R. Kengne, A.P. Keren, A. Khader, Y.S. Khafaei, B. Khafaie, M.A. Khajavi, A. Khalid, N. Khalil, I.A. Khan, E.A. Khan, M.S. Khan, M.A. Khang, Y.-H. Khater, M.M. Khazaei, M. Khoja, A.T. Khosravi, A. Khosravi, M.H. Kiadaliri, A.A. Kidanemariam, Z.T. Kiirithio, D.N. Kim, C.-I. Kim, D. Kim, Y.-E. Kim, Y.J. Kimokoti, R.W. Kinfu, Y. Kisa, A. Kissimova-Skarbek, K. Knudsen, A.K.S. Kocarnik, J.M. Kochhar, S. Kokubo, Y. Kolola, T. Kopec, J.A. Kosen, S. Kotsakis, G.A. Koul, P.A. Koyanagi, A. Krishan, K. Krishnaswami, S. Krohn, K.J. Defo, B.K. Bicer, B.K. Kumar, G.A. Kumar, M. Kuzin, I. Lad, D.P. Lad, S.D. Lafranconi, A. Lalloo, R. Lallukka, T. Lami, F.H. Lang, J.J. Langan, S.M. Lansingh, V.C. Latifi, A. Lau, K.M.-M. Lazarus, J.V. Leasher, J.L. Ledesma, J.R. Lee, P.H. Leigh, J. Leili, M. Leshargie, C.T. Leung, J. Levi, M. Lewycka, S. Li, S. Li, Y. Liang, X. Liao, Y. Liben, M.L. Lim, L.-L. Lim, S.S. Limenih, M.A. Linn, S. Liu, S. Looker, K.J. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Lozano, R. Lucas, T.C.D. Lunevicius, R. Lyons, R.A. Ma, S. Macarayan, E.R.K. Mackay, M.T. Maddison, E.R. Madotto, F. Maghavani, D.P. Mai, H.T. Majdan, M. Majdzadeh, R. Majeed, A. Malekzadeh, R. Malta, D.C. Mamun, A.A. Manda, A.-L. Manguerra, H. Mansournia, M.A. Mantilla Herrera, A.M. Mantovani, L.G. Maravilla, J.C. Marcenes, W. Marks, A. Martins-Melo, F.R. Martopullo, I. März, W. Marzan, M.B. Massano, J. Massenburg, B.B. Mathur, M.R. Maulik, P.K. Mazidi, M. McAlinden, C. McGrath, J.J. McKee, M. McMahon, B.J. Mehata, S. Mehrotra, R. Mehta, K.M. Mehta, V. Mejia-Rodriguez, F. Mekonen, T. Melese, A. Melku, M. Memiah, P.T.N. Memish, Z.A. Mendoza, W. Mengistu, G. Mensah, G.A. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Miazgowski, B. Miazgowski, T. Millear, A.I. Miller, T.R. Mini, G.K. Mirarefin, M. Mirica, A. Mirrakhimov, E.M. Misganaw, A.T. Mitchell, P.B. Mitiku, H. Moazen, B. Mohajer, B. Mohammad, K.A. Mohammadi, M. Mohammadifard, N. Mohammadnia-Afrouzi, M. Mohammed, M.A. Mohammed, S. Mohebi, F. Mokdad, A.H. Molokhia, M. Monasta, L. Montanez, J.C. Moosazadeh, M. Moradi, G. Moradi, M. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morawska, L. Velásquez, I.M. Morgado-Da-Costa, J. Morrison, S.D. Moschos, M.M. Mousavi, S.M. Mruts, K.B. Muche, A.A. Muchie, K.F. Mueller, U.O. Muhammed, O.S. Mukhopadhyay, S. Muller, K. Mumford, J.E. Murthy, G.V.S. Musa, K.I. Mustafa, G. Nabhan, A.F. Nagata, C. Nagel, G. Naghavi, M. Naheed, A. Nahvijou, A. Naik, G. Najafi, F. Nam, H.S. Nangia, V. Nansseu, J.R. Neamati, N. Negoi, I. Negoi, R.I. Neupane, S. Newton, C.R.J. Ngunjiri, J.W. Nguyen, A.Q. Nguyen, G. Nguyen, H.T. Nguyen, H.L.T. Nguyen, H.T. Nguyen, L.H. Nguyen, M. Nguyen, N.B. Nguyen, S.H. Nichols, E. Ningrum, D.N.A. Nixon, M.R. Nomura, S. Noroozi, M. Norrving, B. Noubiap, J.J. Nouri, H.R. Shiadeh, M.N. Nowroozi, M.R. Nsoesie, E.O. Nyasulu, P.S. Odell, C.M. Ofori-Asenso, R. Ogbo, F.A. Oh, I.-H. Oladimeji, O. Olagunju, A.T. Olagunju, T.O. Olivares, P.R. Olsen, H.E. Olusanya, B.O. Olusanya, J.O. Ong, K.L. Ong, S.K. Oren, E. Ortiz, A. Ota, E. Otstavnov, S.S. Overland, S. Owolabi, M.O. Mahesh, P.A. Pacella, R. Pakhare, A.P. Pakpour, A.H. Pana, A. Panda-Jonas, S. Park, E.-K. Park, J. Parry, C.D.H. Parsian, H. Pasdar, Y. Patel, S. Patil, S.T. Patle, A. Patton, G.C. Paturi, V.R. Paudel, D. Paulson, K.R. Pearce, N. Pereira, A. Pereira, D.M. Perico, N. Pesudovs, K. Petzold, M. Pham, H.Q. Phillips, M.R. Pigott, D.M. Pillay, J.D. Piradov, M.A. Pirsaheb, M. Pishgar, F. Plana-Ripoll, O. Polinder, S. Popova, S. Postma, M.J. Pourshams, A. Poustchi, H. Prabhakaran, D. Prakash, S. Prakash, V. Prasad, N. Purcell, C.A. Qorbani, M. Quistberg, D.A. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi, K. Rahimi, Z. Rahimi-Movaghar, A. Rahimi-Movaghar, V. Rahman, M. Ur Rahman, M.H. Rahman, M.A. Rahman, S.U. Rai, R.K. Rajati, F. Ranjan, P. Rao, P.C. Rasella, D. Rawaf, D.L. Rawaf, S. Reddy, K.S. Reiner, R.C. Reitsma, M.B. Remuzzi, G. Renzaho, A.M.N. Resnikoff, S. Rezaei, S. Rezai, M.S. Ribeiro, A.L.P. Roberts, N.L.S. Robinson, S.R. Roever, L. Ronfani, L. Roshandel, G. Rostami, A. Roth, G.A. Rothenbacher, D. Rubagotti, E. Sachdev, P.S. Sadat, N. Sadeghi, E. Saeedi Moghaddam, S. Safari, H. Safari, Y. Safari-Faramani, R. Safdarian, M. Safi, S. Safiri, S. Sagar, R. Sahebkar, A. Sahraian, M.A. Sajadi, H.S. Salam, N. Salama, J.S. Salamati, P. Saleem, Z. Salimi, Y. Salimzadeh, H. Salomon, J.A. Salvi, S.S. Salz, I. Samy, A.M. Sanabria, J. Sanchez-Nino, M.D. Santomauro, D.F. Santos, I.S. Santos, J.V. Santric Milicevic, M.M. Sao Jose, B.P. Sardana, M. Sarker, A.R. Sarmiento-Suárez, R. Sarrafzadegan, N. Sartorius, B. Sarvi, S. Sathian, B. Satpathy, M. Sawant, A.R. Sawhney, M. Saxena, S. Schaeffner, E. Schmidt, M.I. Schneider, I.J.C. Schutte, A.E. Schwebel, D.C. Schwendicke, F. Scott, J.G. Sekerija, M. Sepanlou, S.G. Serván-Mori, E. Seyedmousavi, S. Shabaninejad, H. Shafieesabet, A. Shahbazi, M. Shaheen, A.A. Shaikh, M.A. Shams-Beyranvand, M. Shamsi, M. Sharafi, H. Sharafi, K. Sharif, M. Sharif-Alhoseini, M. Sharma, J. Sharma, R. She, J. Sheikh, A. Shi, P. Shibuya, K. Shiferaw, M.S. Shigematsu, M. Shiri, R. Shirkoohi, R. Shiue, I. Shokoohinia, Y. Shokraneh, F. Shoman, H. Shrime, M.G. Si, S. Siabani, S. Sibai, A.M. Siddiqi, T.J. Sigfusdottir, I.D. Sigurvinsdottir, R. Silva, D.A.S. Silva, J.P. Silveira, D.G.A. Singam, N.S.V. Singh, J.A. Singh, N.P. Singh, V. Sinha, D.N. Skiadaresi, E. Skirbekk, V. Sliwa, K. Smith, D.L. Smith, M. Filho, A.M.S. Sobaih, B.H. Sobhani, S. Soofi, M. Sorensen, R.J.D. Soyiri, I.N. Sposato, L.A. Sreeramareddy, C.T. Srinivasan, V. Stanaway, J.D. Starodubov, V.I. Stein, D.J. Steiner, C. Steiner, T.J. Stokes, M.A. Stovner, L.J. Subart, M.L. Sudaryanto, A. Sufiyan, M.B. Sulo, G. Sunguya, B.F. Sur, P.J. Sykes, B.L. Sylaja, P.N. Sylte, D.O. Szoeke, C.E.I. Tabarés-Seisdedos, R. Tabuchi, T. Tadakamadla, S.K. Tandon, N. Tassew, S.G. Tavakkoli, M. Taveira, N. Taylor, H.R. Tehrani-Banihashemi, A. Tekalign, T.G. Tekelemedhin, S.W. Tekle, M.G. Temsah, M.-H. Temsah, O. Terkawi, A.S. Tessema, B. Teweldemedhin, M. Thankappan, K.R. Theis, A. Thirunavukkarasu, S. Thomas, N. Tilahun, B. To, Q.G. Tonelli, M. Topor-Madry, R. Torre, A.E. Tortajada-Girbés, M. Touvier, M. Tovani-Palone, M.R. Towbin, J.A. Tran, B.X. Tran, K.B. Troeger, C.E. Tsadik, A.G. Tsoi, D. Tudor Car, L. Tyrovolas, S. Ukwaja, K.N. Ullah, I. Undurraga, E.A. Updike, R.L. Usman, M.S. Uthman, O.A. Vaduganathan, M. Vaezi, A. Valdez, P.R. Varavikova, E. Varughese, S. Vasankari, T.J. Venketasubramanian, N. Villafaina, S. Violante, F.S. Vladimirov, S.K. Vlassov, V. Vollset, S.E. Vos, T. Vosoughi, K. Vujcic, I.S. Wagnew, F.S. Waheed, Y. Wang, Y. Wang, Y.-P. Weiderpass, E. Weintraub, R.G. Weiss, D.J. Weldegebreal, F. Weldegwergs, K.G. Werdecker, A. West, T.E. Westerman, R. Whiteford, H.A. Widecka, J. Wijeratne, T. Williams, H.C. Wilner, L.B. Wilson, S. Winkler, A.S. Wiyeh, A.B. Wiysonge, C.S. Wolfe, C.D.A. Woolf, A.D. Wyper, G.M.A. Xavier, D. Xu, G. Yadgir, S. Yahyazadeh Jabbari, S.H. Yamada, T. Yan, L.L. Yano, Y. Yaseri, M. Yasin, Y.J. Yeshaneh, A. Yimer, E.M. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zadnik, V. Zaidi, Z. Zaman, S.B. Zamani, M. Zandian, H. Zar, H.J. Zenebe, Z.M. Zipkin, B. Zhou, M. Zodpey, S. Zucker, I. Zuhlke, L.J. Murray, C.J.L. GBD 2017 DALYs HALE Collaborators

Abstract

Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the ?ve leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Published
2018

39. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Author

James, S.L. Abate, D. Abate, K.H. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abebe, Z. Abera, S.F. Abil, O.Z. Abraha, H.N. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, D. Acharya, P. Ackerman, I.N. Adamu, A.A. Adebayo, O.M. Adekanmbi, V. Adetokunboh, O.O. Adib, M.G. Adsuar, J.C. Afanvi, K.A. Afarideh, M. Afshin, A. Agarwal, G. Agesa, K.M. Aggarwal, R. Aghayan, S.A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akinyemiju, T. Akseer, N. Al-Aly, Z. Al-Eyadhy, A. Al-Mekhlafi, H.M. Al-Raddadi, R.M. Alahdab, F. Alam, K. Alam, T. Alashi, A. Alavian, S.M. Alene, K.A. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Alouani, M.M.L. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Aminde, L.N. Ammar, W. Amoako, Y.A. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansha, M.G. Antonio, C.A.T. Anwari, P. Arabloo, J. Arauz, A. Aremu, O. Ariani, F. Armoon, B. Ärnlöv, J. Arora, A. Artaman, A. Aryal, K.K. Asayesh, H. Asghar, R.J. Ataro, Z. Atre, S.R. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayer, R. Azzopardi, P.S. Babazadeh, A. Badali, H. Badawi, A. Bali, A.G. Ballesteros, K.E. Ballew, S.H. Banach, M. Banoub, J.A.M. Banstola, A. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Baune, B.T. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Belachew, A.B. Belay, Y.A. Bell, M.L. Bello, A.K. Bensenor, I.M. Bernabe, E. Bernstein, R.S. Beuran, M. Beyranvand, T. Bhala, N. Bhattarai, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bilano, V. Bililign, N. Bin Sayeed, M.S. Bisanzio, D. Blacker, B.F. Blyth, F.M. Bou-Orm, I.R. Boufous, S. Bourne, R. Brady, O.J. Brainin, M. Brant, L.C. Brazinova, A. Breitborde, N.J.K. Brenner, H. Briant, P.S. Briggs, A.M. Briko, A.N. Britton, G. Brugha, T. Buchbinder, R. Busse, R. Butt, Z.A. Cahuana-Hurtado, L. Cano, J. Cárdenas, R. Carrero, J.J. Carter, A. Carvalho, F. Castañeda-Orjuela, C.A. Castillo Rivas, J. Castro, F. Catalá-López, F. Cercy, K.M. Cerin, E. Chaiah, Y. Chang, A.R. Chang, H.-Y. Chang, J.-C. Charlson, F.J. Chattopadhyay, A. Chattu, V.K. Chaturvedi, P. Chiang, P.P.-C. Chin, K.L. Chitheer, A. Choi, J.-Y.J. Chowdhury, R. Christensen, H. Christopher, D.J. Cicuttini, F.M. Ciobanu, L.G. Cirillo, M. Claro, R.M. Collado-Mateo, D. Cooper, C. Coresh, J. Cortesi, P.A. Cortinovis, M. Costa, M. Cousin, E. Criqui, M.H. Cromwell, E.A. Cross, M. Crump, J.A. Dadi, A.F. Dandona, L. Dandona, R. Dargan, P.I. Daryani, A. Das Gupta, R. Das Neves, J. Dasa, T.T. Davey, G. Davis, A.C. Davitoiu, D.V. De Courten, B. De La Hoz, F.P. De Leo, D. De Neve, J.-W. Degefa, M.G. Degenhardt, L. Deiparine, S. Dellavalle, R.P. Demoz, G.T. Deribe, K. Dervenis, N. Des Jarlais, D.C. Dessie, G.A. Dey, S. Dharmaratne, S.D. Dinberu, M.T. Dirac, M.A. Djalalinia, S. Doan, L. Dokova, K. Doku, D.T. Dorsey, E.R. Doyle, K.E. Driscoll, T.R. Dubey, M. Dubljanin, E. Duken, E.E. Duncan, B.B. Duraes, A.R. Ebrahimi, H. Ebrahimpour, S. Echko, M.M. Edvardsson, D. Effiong, A. Ehrlich, J.R. El Bcheraoui, C. El Sayed Zaki, M. El-Khatib, Z. Elkout, H. Elyazar, I.R.F. Enayati, A. Endries, A.Y. Er, B. Erskine, H.E. Eshrati, B. Eskandarieh, S. Esteghamati, A. Esteghamati, S. Fakhim, H. Fallah Omrani, V. Faramarzi, M. Fareed, M. Farhadi, F. Farid, T.A. Farinha, C.S.E. Farioli, A. Faro, A. Farvid, M.S. Farzadfar, F. Feigin, V.L. Fentahun, N. Fereshtehnejad, S.-M. Fernandes, E. Fernandes, J.C. Ferrari, A.J. Feyissa, G.T. Filip, I. Fischer, F. Fitzmaurice, C. Foigt, N.A. Foreman, K.J. Fox, J. Frank, T.D. Fukumoto, T. Fullman, N. Fürst, T. Furtado, J.M. Futran, N.D. Gall, S. Ganji, M. Gankpe, F.G. Garcia-Basteiro, A.L. Gardner, W.M. Gebre, A.K. Gebremedhin, A.T. Gebremichael, T.G. Gelano, T.F. Geleijnse, J.M. Genova-Maleras, R. Geramo, Y.C.D. Gething, P.W. Gezae, K.E. Ghadiri, K. Ghasemi Falavarjani, K. Ghasemi-Kasman, M. Ghimire, M. Ghosh, R. Ghoshal, A.G. Giampaoli, S. Gill, P.S. Gill, T.K. Ginawi, I.A. Giussani, G. Gnedovskaya, E.V. Goldberg, E.M. Goli, S. Gómez-Dantés, H. Gona, P.N. Gopalani, S.V. Gorman, T.M. Goulart, A.C. Goulart, B.N.G. Grada, A. Grams, M.E. Grosso, G. Gugnani, H.C. Guo, Y. Gupta, P.C. Gupta, R. Gupta, R. Gupta, T. Gyawali, B. Haagsma, J.A. Hachinski, V. Hafezi-Nejad, N. Haghparast Bidgoli, H. Hagos, T.B. Hailu, G.B. Haj-Mirzaian, A. Haj-Mirzaian, A. Hamadeh, R.R. Hamidi, S. Handal, A.J. Hankey, G.J. Hao, Y. Harb, H.L. Harikrishnan, S. Haro, J.M. Hasan, M. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hawley, C.N. Hay, R.J. Hay, S.I. Hedayatizadeh-Omran, A. Heibati, B. Hendrie, D. Henok, A. Herteliu, C. Heydarpour, S. Hibstu, D.T. Hoang, H.T. Hoek, H.W. Hoffman, H.J. Hole, M.K. Homaie Rad, E. Hoogar, P. Hosgood, H.D. Hosseini, S.M. Hosseinzadeh, M. Hostiuc, M. Hostiuc, S. Hotez, P.J. Hoy, D.G. Hsairi, M. Htet, A.S. Hu, G. Huang, J.J. Huynh, C.K. Iburg, K.M. Ikeda, C.T. Ileanu, B. Ilesanmi, O.S. Iqbal, U. Irvani, S.S.N. Irvine, C.M.S. Mohammed, S. Islam, S. Islami, F. Jacobsen, K.H. Jahangiry, L. Jahanmehr, N. Jain, S.K. Jakovljevic, M. Javanbakht, M. Jayatilleke, A.U. Jeemon, P. Jha, R.P. Jha, V. Ji, J.S. Johnson, C.O. Jonas, J.B. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Kabir, Z. Kadel, R. Kahsay, A. Kalani, R. Kanchan, T. Karami, M. Karami Matin, B. Karch, A. Karema, C. Karimi, N. Karimi, S.M. Kasaeian, A. Kassa, D.H. Kassa, G.M. Kassa, T.D. Kassebaum, N.J. Katikireddi, S.V. Kawakami, N. Kazemi Karyani, A. Keighobadi, M.M. Keiyoro, P.N. Kemmer, L. Kemp, G.R. Kengne, A.P. Keren, A. Khader, Y.S. Khafaei, B. Khafaie, M.A. Khajavi, A. Khalil, I.A. Khan, E.A. Khan, M.S. Khan, M.A. Khang, Y.-H. Khazaei, M. Khoja, A.T. Khosravi, A. Khosravi, M.H. Kiadaliri, A.A. Kiirithio, D.N. Kim, C.-I. Kim, D. Kim, P. Kim, Y.-E. Kim, Y.J. Kimokoti, R.W. Kinfu, Y. Kisa, A. Kissimova-Skarbek, K. Kivimäki, M. Knudsen, A.K.S. Kocarnik, J.M. Kochhar, S. Kokubo, Y. Kolola, T. Kopec, J.A. Kosen, S. Kotsakis, G.A. Koul, P.A. Koyanagi, A. Kravchenko, M.A. Krishan, K. Krohn, K.J. Kuate Defo, B. Kucuk Bicer, B. Kumar, G.A. Kumar, M. Kyu, H.H. Lad, D.P. Lad, S.D. Lafranconi, A. Lalloo, R. Lallukka, T. Lami, F.H. Lansingh, V.C. Latifi, A. Lau, K.M.-M. Lazarus, J.V. Leasher, J.L. Ledesma, J.R. Lee, P.H. Leigh, J. Leung, J. Levi, M. Lewycka, S. Li, S. Li, Y. Liao, Y. Liben, M.L. Lim, L.-L. Lim, S.S. Liu, S. Lodha, R. Looker, K.J. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Low, N. Lozano, R. Lucas, T.C.D. Lucchesi, L.R. Lunevicius, R. Lyons, R.A. Ma, S. Macarayan, E.R.K. Mackay, M.T. Madotto, F. Magdy Abd El Razek, H. Magdy Abd El Razek, M. Maghavani, D.P. Mahotra, N.B. Mai, H.T. Majdan, M. Majdzadeh, R. Majeed, A. Malekzadeh, R. Malta, D.C. Mamun, A.A. Manda, A.-L. Manguerra, H. Manhertz, T. Mansournia, M.A. Mantovani, L.G. Mapoma, C.C. Maravilla, J.C. Marcenes, W. Marks, A. Martins-Melo, F.R. Martopullo, I. März, W. Marzan, M.B. Mashamba-Thompson, T.P. Massenburg, B.B. Mathur, M.R. Matsushita, K. Maulik, P.K. Mazidi, M. McAlinden, C. McGrath, J.J. McKee, M. Mehndiratta, M.M. Mehrotra, R. Mehta, K.M. Mehta, V. Mejia-Rodriguez, F. Mekonen, T. Melese, A. Melku, M. Meltzer, M. Memiah, P.T.N. Memish, Z.A. Mendoza, W. Mengistu, D.T. Mengistu, G. Mensah, G.A. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Mezerji, N.M.G. Miazgowski, B. Miazgowski, T. Millear, A.I. Miller, T.R. Miltz, B. Mini, G.K. Mirarefin, M. Mirrakhimov, E.M. Misganaw, A.T. Mitchell, P.B. Mitiku, H. Moazen, B. Mohajer, B. Mohammad, K.A. Mohammadifard, N. Mohammadnia-Afrouzi, M. Mohammed, M.A. Mohammed, S. Mohebi, F. Moitra, M. Mokdad, A.H. Molokhia, M. Monasta, L. Moodley, Y. Moosazadeh, M. Moradi, G. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morawska, L. Moreno Velásquez, I. Morgado-Da-Costa, J. Morrison, S.D. Moschos, M.M. Mousavi, S.M. Mruts, K.B. Muche, A.A. Muchie, K.F. Mueller, U.O. Muhammed, O.S. Mukhopadhyay, S. Muller, K. Mumford, J.E. Murhekar, M. Musa, J. Musa, K.I. Mustafa, G. Nabhan, A.F. Nagata, C. Naghavi, M. Naheed, A. Nahvijou, A. Naik, G. Naik, N. Najafi, F. Naldi, L. Nam, H.S. Nangia, V. Nansseu, J.R. Nascimento, B.R. Natarajan, G. Neamati, N. Negoi, I. Negoi, R.I. Neupane, S. Newton, C.R.J. Ngunjiri, J.W. Nguyen, A.Q. Nguyen, H.T. Nguyen, H.L.T. Nguyen, H.T. Nguyen, L.H. Nguyen, M. Nguyen, N.B. Nguyen, S.H. Nichols, E. Ningrum, D.N.A. Nixon, M.R. Nolutshungu, N. Nomura, S. Norheim, O.F. Noroozi, M. Norrving, B. Noubiap, J.J. Nouri, H.R. Nourollahpour Shiadeh, M. Nowroozi, M.R. Nsoesie, E.O. Nyasulu, P.S. Odell, C.M. Ofori-Asenso, R. Ogbo, F.A. Oh, I.-H. Oladimeji, O. Olagunju, A.T. Olagunju, T.O. Olivares, P.R. Olsen, H.E. Olusanya, B.O. Ong, K.L. Ong, S.K. Oren, E. Ortiz, A. Ota, E. Otstavnov, S.S. øverland, S. Owolabi, M.O. Mahesh, P.A. Pacella, R. Pakpour, A.H. Pana, A. Panda-Jonas, S. Parisi, A. Park, E.-K. Parry, C.D.H. Patel, S. Pati, S. Patil, S.T. Patle, A. Patton, G.C. Paturi, V.R. Paulson, K.R. Pearce, N. Pereira, D.M. Perico, N. Pesudovs, K. Pham, H.Q. Phillips, M.R. Pigott, D.M. Pillay, J.D. Piradov, M.A. Pirsaheb, M. Pishgar, F. Plana-Ripoll, O. Plass, D. Polinder, S. Popova, S. Postma, M.J. Pourshams, A. Poustchi, H. Prabhakaran, D. Prakash, S. Prakash, V. Purcell, C.A. Purwar, M.B. Qorbani, M. Quistberg, D.A. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi, K. Rahimi-Movaghar, A. Rahimi-Movaghar, V. Rahman, M. Ur Rahman, M.H. Rahman, M.A. Rahman, S.U. Rai, R.K. Rajati, F. Ram, U. Ranjan, P. Ranta, A. Rao, P.C. Rawaf, D.L. Rawaf, S. Reddy, K.S. Reiner, R.C. Reinig, N. Reitsma, M.B. Remuzzi, G. Renzaho, A.M.N. Resnikoff, S. Rezaei, S. Rezai, M.S. Ribeiro, A.L.P. Robinson, S.R. Roever, L. Ronfani, L. Roshandel, G. Rostami, A. Roth, G.A. Roy, A. Rubagotti, E. Sachdev, P.S. Sadat, N. Saddik, B. Sadeghi, E. Saeedi Moghaddam, S. Safari, H. Safari, Y. Safari-Faramani, R. Safdarian, M. Safi, S. Safiri, S. Sagar, R. Sahebkar, A. Sahraian, M.A. Sajadi, H.S. Salam, N. Salama, J.S. Salamati, P. Saleem, K. Saleem, Z. Salimi, Y. Salomon, J.A. Salvi, S.S. Salz, I. Samy, A.M. Sanabria, J. Sang, Y. Santomauro, D.F. Santos, I.S. Santos, J.V. Santric Milicevic, M.M. Sao Jose, B.P. Sardana, M. Sarker, A.R. Sarrafzadegan, N. Sartorius, B. Sarvi, S. Sathian, B. Satpathy, M. Sawant, A.R. Sawhney, M. Saxena, S. Saylan, M. Schaeffner, E. Schmidt, M.I. Schneider, I.J.C. Schöttker, B. Schwebel, D.C. Schwendicke, F. Scott, J.G. Sekerija, M. Sepanlou, S.G. Serván-Mori, E. Seyedmousavi, S. Shabaninejad, H. Shafieesabet, A. Shahbazi, M. Shaheen, A.A. Shaikh, M.A. Shams-Beyranvand, M. Shamsi, M. Shamsizadeh, M. Sharafi, H. Sharafi, K. Sharif, M. Sharif-Alhoseini, M. Sharma, M. Sharma, R. She, J. Sheikh, A. Shi, P. Shibuya, K. Shigematsu, M. Shiri, R. Shirkoohi, R. Shishani, K. Shiue, I. Shokraneh, F. Shoman, H. Shrime, M.G. Si, S. Siabani, S. Siddiqi, T.J. Sigfusdottir, I.D. Sigurvinsdottir, R. Silva, J.P. Silveira, D.G.A. Singam, N.S.V. Singh, J.A. Singh, N.P. Singh, V. Sinha, D.N. Skiadaresi, E. Slepak, E.L.N. Sliwa, K. Smith, D.L. Smith, M. Soares Filho, A.M. Sobaih, B.H. Sobhani, S. Sobngwi, E. Soneji, S.S. Soofi, M. Soosaraei, M. Sorensen, R.J.D. Soriano, J.B. Soyiri, I.N. Sposato, L.A. Sreeramareddy, C.T. Srinivasan, V. Stanaway, J.D. Stein, D.J. Steiner, C. Steiner, T.J. Stokes, M.A. Stovner, L.J. Subart, M.L. Sudaryanto, A. Sufiyan, M.B. Sunguya, B.F. Sur, P.J. Sutradhar, I. Sykes, B.L. Sylte, D.O. Tabarés-Seisdedos, R. Tadakamadla, S.K. Tadesse, B.T. Tandon, N. Tassew, S.G. Tavakkoli, M. Taveira, N. Taylor, H.R. Tehrani-Banihashemi, A. Tekalign, T.G. Tekelemedhin, S.W. Tekle, M.G. Temesgen, H. Temsah, M.-H. Temsah, O. Terkawi, A.S. Teweldemedhin, M. Thankappan, K.R. Thomas, N. Tilahun, B. To, Q.G. Tonelli, M. Topor-Madry, R. Topouzis, F. Torre, A.E. Tortajada-Girbés, M. Touvier, M. Tovani-Palone, M.R. Towbin, J.A. Tran, B.X. Tran, K.B. Troeger, C.E. Truelsen, T.C. Tsilimbaris, M.K. Tsoi, D. Tudor Car, L. Tuzcu, E.M. Ukwaja, K.N. Ullah, I. Undurraga, E.A. Unutzer, J. Updike, R.L. Usman, M.S. Uthman, O.A. Vaduganathan, M. Vaezi, A. Valdez, P.R. Varughese, S. Vasankari, T.J. Venketasubramanian, N. Villafaina, S. Violante, F.S. Vladimirov, S.K. Vlassov, V. Vollset, S.E. Vosoughi, K. Vujcic, I.S. Wagnew, F.S. Waheed, Y. Waller, S.G. Wang, Y. Wang, Y.-P. Weiderpass, E. Weintraub, R.G. Weiss, D.J. Weldegebreal, F. Weldegwergs, K.G. Werdecker, A. West, T.E. Whiteford, H.A. Widecka, J. Wijeratne, T. Wilner, L.B. Wilson, S. Winkler, A.S. Wiyeh, A.B. Wiysonge, C.S. Wolfe, C.D.A. Woolf, A.D. Wu, S. Wu, Y.-C. Wyper, G.M.A. Xavier, D. Xu, G. Yadgir, S. Yadollahpour, A. Yahyazadeh Jabbari, S.H. Yamada, T. Yan, L.L. Yano, Y. Yaseri, M. Yasin, Y.J. Yeshaneh, A. Yimer, E.M. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zadnik, V. Zaidi, Z. Zaman, S.B. Zamani, M. Zare, Z. Zeleke, A.J. Zenebe, Z.M. Zhang, K. Zhao, Z. Zhou, M. Zodpey, S. Zucker, I. Vos, T. Murray, C.J.L. GBD 2017 Disease Injury Incidence Prevalence Collaborators

Abstract

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Published
2018

40. Oral cancer screening practices of Canadian dental hygienists

Author

N Kobagi, Minn N. Yoon, and AK Clarke

Subjects
Adult, Male, medicine.medical_specialty, Canada, Computer-assisted web interviewing, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Medicine, Humans, Mass Screening, Dentistry (miscellaneous), Oral hpv, Human papillomavirus, Health communication, Statistical software, Early Detection of Cancer, Oral cancer screening, business.industry, 030206 dentistry, Dental hygiene, Professional-Patient Relations, Process of care, Middle Aged, 030220 oncology & carcinogenesis, Family medicine, Female, Mouth Neoplasms, Clinical Competence, Dental Hygienists, business
Abstract

This study investigates whether dental hygienists are routinely conducting oral cancer screenings (OCSs) as per their professional capability and responsibility. Factors that may mediate provision of OCSs, and ability to discuss sensitive topics with patients, are also examined.A pretested online questionnaire was sent via national and provincial regulatory bodies to target practicing registered dental hygienists across Canada. Analysis was conducted using statistical software.Results of 256 surveys were analysed. Sixty-four per cent of dental hygienists listed an OCS as part of their regular process of care. Except for the initial examination, respondents were significantly more likely to report being responsible for the OCS than the dentist, P.001. On average, intraoral components are inspected at higher frequencies (96%) than extraoral components (73%). Confidence in OCS technique was high (70%). The majority felt prepared by their education to conduct OCSs (60%), but those with a bachelor's degree felt more prepared than those with a diploma, P=.005. The average time to conduct an OCS is 4.09 minutes, with most agreeing there is sufficient time in an appointment (57%). Only 37% felt their education prepared them to discuss sensitive topics, level of education had no effect, P.05. Only 43% of respondents felt confident in their human papillomavirus (HPV) knowledge and comfortable discussing HPV risk factors with patients.Dental hygienists in this study are regularly conducting OCSs; however, they lack comfort discussing sensitive topics such as transmission of oral HPV, and screenings may not be fully comprehensive.

Published
2017

41. Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Author

Habib Chaudhury, Christina Lengyel, George A. Heckman, Susan E. Slaughter, Lisa M. Duizer, K. Stephen Brown, Alison M. Duncan, Lita Villalon, Natalie Carrier, Catriona M. Steele, Veronique Boscart, Heather H. Keller, Minn N. Yoon, and University of Manitoba

Subjects
Adult, Male, 0301 basic medicine, Gerontology, Canada, Cross-sectional study, Drinking, Staffing, Nutritional Status, Pilot Projects, Dietary reference intake, Eating, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Food intake, Weight loss, Surveys and Questionnaires, Homes for the Aged, Humans, Medicine, 030212 general & internal medicine, Meals, Long term care homes, Determinants, Aged, 2. Zero hunger, 030109 nutrition & dietetics, business.industry, digestive, oral, and skin physiology, Long-Term Care, Nursing Homes, 3. Good health, Long-term care, Cross-Sectional Studies, Dietary Reference Intake, Food processing, Female, Geriatrics and Gerontology, medicine.symptom, business, Psychosocial
Abstract

Background Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. Methods A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. Discussion This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. Trial Registration ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.

Published
2017
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42. Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review

Author

Minn N. Yoon, Nadia Kobagi, Kha Tu Huynh, Angelle Kent, Matthias Hoben, and Alix Clarke

Subjects
Teeth, lcsh:Medicine, Oral Health, Database and Informatics Methods, 0302 clinical medicine, Health care, Medicine and Health Sciences, Homes for the Aged, Medicine, 030212 general & internal medicine, Database Searching, lcsh:Science, Aged, 80 and over, Multidisciplinary, Research Assessment, Systematic review, Neurology, Anatomy, Research Article, medicine.medical_specialty, Evidence-based practice, Systematic Reviews, Oral Medicine, MEDLINE, CINAHL, Research and Analysis Methods, 03 medical and health sciences, Nursing, Mental Health and Psychiatry, Humans, Dementia, Aged, Motivation, Behavior, business.industry, lcsh:R, Biology and Life Sciences, 030206 dentistry, medicine.disease, Nursing Homes, Self Care, Health Care, Housing for the Elderly, Jaw, Health Care Facilities, Family medicine, lcsh:Q, Mouth Diseases, business, Digestive System, Head, Oral medicine
Abstract

Background Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents’ responsive behaviors to oral care and residents’ lack of ability or motivation to perform oral care on their own. Objectives To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents’ responsive behaviors to oral care, or enable/motivate residents to perform their own oral care. Materials and methods We searched the databases Medline, EMBASE, Evidence Based Reviews–Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results. Results We included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems. Conclusions Potentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents’ responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies.

Published
2017

44. 0249 Association Between Sleep-Wake Cycle And Brain Cortical Thickness In Young Adults

Author

Inkyung Park, Dong Young Lee, Jeong Yeon Hwang, Jin Hak Lee, Y M Choe, Min Soo Byun, H N Yoon, You Jin Lee, and Dahyun Yi

Subjects
medicine.medical_specialty, business.industry, Actigraphy, Audiology, Sleep in non-human animals, Anterior cingulate gyrus, Physiology (medical), Medicine, Wakefulness, Neurology (clinical), Middle-aged adult, Circadian rhythm, Young adult, business, Association (psychology)
Published
2018
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45. Diffusion characterization of In(Ga)As/InAsSb type-II superlattices via electron beam induced current and time-resolved photoluminescence

Author

Gamini Ariyawansa, J. Mabon, John E. Scheihing, Charles J. Reyner, Daniel Wasserman, and N. Yoon

Subjects
Materials science, Photoluminescence, business.industry, Superlattice, Electron beam-induced current, chemistry.chemical_element, 02 engineering and technology, Carrier lifetime, 021001 nanoscience & nanotechnology, Thermal diffusivity, 01 natural sciences, 010309 optics, Condensed Matter::Materials Science, chemistry, 0103 physical sciences, Optoelectronics, Spontaneous emission, Diffusion (business), Gallium, 0210 nano-technology, business
Abstract

We present the temperature-dependent characterization of minority carrier diffusion length, minority carrier lifetime, diffusivity, surface recombination velocity and mobility on In(Ga)As/InAsSb type-II superlattices by using electron beam induced current and time-resolved photoluminescence measurements.

Published
2016
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46. Barriers and facilitators in providing oral health care to nursing home residents, from the perspective of care aides-a systematic review protocol

Author

Huimin Hu, Nadia Kobagi, Minn N. Yoon, Angelle Kent, Tianyuan Xiong, and Matthias Hoben

Subjects
medicine.medical_specialty, Attitude of Health Personnel, Health Services for the Aged, Allied Health Personnel, Medicine (miscellaneous), Nursing homes, CINAHL, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, Nursing, Health care, Protocol, Medicine, Homes for the Aged, Humans, 030212 general & internal medicine, Quality improvement, Unlicensed assistive personnel, Dental Health Services, Primary nursing, business.industry, Barriers and facilitators, Care aides, Quality of care, 030206 dentistry, Ambulatory care nursing, Team nursing, Systematic review, Oral health care, Research Design, Family medicine, business, Systematic Reviews as Topic
Abstract

Background Unregulated care aides provide up to 80 % of direct resident care in nursing homes. They have little formal training, manage high workloads, frequently experience responsive behaviours from residents, and are at high risk for burnout. This affects quality of resident care, including quality of oral health care. Poor quality of oral health care in nursing homes has severe consequences for residents and the health care system. Improving quality of oral health care requires tailoring interventions to identified barriers and facilitators if these interventions are to be effective. Identifying barriers and facilitators from the care aide’s perspective is crucial. Methods We will systematically search the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We will include qualitative and quantitative research studies and systematic reviews published in English that assess barriers and facilitators, as perceived by care aides, to providing oral health care to nursing home residents. Two reviewers will independently screen studies for eligibility. We will also search by hand the contents of key journals, publications of key authors, and reference lists of all the studies included. Two reviewers will independently assess the methodological quality of the studies included using four validated checklists appropriate for different research designs. Discrepancies at any stage of review will be resolved by consensus. We will conduct a thematic analysis of barriers and facilitators using all studies included. If quantitative studies are sufficiently homogeneous, we will conduct random-effects meta-analyses of the associations of barriers and facilitators with each other, with care aide practices in resident oral health care, and with residents’ oral health. If quantitative study results cannot be pooled, we will present a narrative synthesis of the results. Finally, we will compare quantitative findings to qualitative studies to identify hypothesized associations or effects not yet tested quantitatively. Discussion This review will advance the development of effective strategies for improving quality of oral health care and highlight gaps in research on barriers and facilitators to providing oral health care to nursing home residents, as perceived by care aides. Systematic review registration PROSPERO CRD42015032454 Electronic supplementary material The online version of this article (doi:10.1186/s13643-016-0231-7) contains supplementary material, which is available to authorized users.

Published
2016

47. Comprehensive study of the surface morphology evolution induced by thermal annealing in single-crystalline ZnO Films and ZnO bulks

Author

Dong Seok Lim, H. J. Ko, N. Yoon, Soon-Ku Hong, Takafumi Yao, and D. C. Oh

Subjects
Materials science, Chemical engineering, Vapor pressure, Economies of agglomeration, Annealing (metallurgy), General Physics and Astronomy, Recrystallization (metallurgy), Atmospheric temperature range, Island growth, Surface energy, Flattening
Abstract

We report on the evolution of the surface morphology induced by thermal annealing in N2 ambient over a wide temperature range of 500–1200 °C in single-crystalline ZnO films and ZnO bulks. The surface morphology is seriously changed by the annealing temperature, and the evolution can be categorized into three regions: island growth, island agglomeration, and pit formation. Island growth at low temperatures below 700 °C, is ascribed to the atomic migration to reduce surface energy, which causes surface roughening. Island agglomeration at intermediate temperatures of 700–900 °C is ascribed to the migration and the evaporation of surface atoms, which causes surface flattening. Pit formation at high temperatures above 900 °C is ascribed to the atomic evaporation by high vapor pressure, which causes surface destruction. On the other hand, the bulk lattice is continuously improved with increasing annealing temperature in the temperature regions before the surface-destruction region, which is attributed to the reduction in the numbers of point and line defects caused by recrystallization. As a result, the best surface morphology and the best bulk lattice are obtained at an annealing temperature of 900 °C. The common surface-morphology evolution of ZnO films and ZnO bulks with increasing annealing temperature can be summarized using the three steps of surface roughening by island growth, surface flattening by island agglomeration, and surface destruction by pit formation.

Published
2012
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48. Health care professionals’ perspectives on oral care for long-term care residents: Nursing staff, speech-language pathologists and dental hygienists

Author

Minn N. Yoon and Catriona M. Steele

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Population, Patient advocacy, Focus group, stomatognathic diseases, Long-term care, Health promotion, Nursing, Family medicine, Health care, Medicine, Geriatrics and Gerontology, business, education, General Dentistry, Primary nursing, Qualitative research
Abstract

doi: 10.1111/j.1741-2358.2011.00513.xHealth care professionals’ perspectives on oral care for long-term care residents: Nursing staff,speech–language pathologists and dental hygienistsBackground: Oral health has been identified as a key factor in general health and systemic disease inlong-term care populations. To optimise oral health of this population, it is important to understand theoral care perspectives held by health care professionals involved in oral care provision.Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language patholo-gists (SLPs) and dental hygienists (DHs) in long-term care institutions and to understand how their per-spectives impact activities and processes involved in the delivery of oral care.Methods: A focus group methodology was utilised. Separate focus groups for each targeted professionwere held. Transcribed data were analysed using constant comparative analysis.Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs andDHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursingstaff to provide oral care, whereas factors related to the general health consequences of poor oral healthunderlined the motivations of SLPs and DHs.Conclusions: Education and training initiatives incorporating social aspects of oral health may be moreeffective for motivating nursing staff than approaches emphasising physical risk factors. Organisations canfoster environments that support collaboration and communication amongst the members of multidisci-plinary teams in order to promote oral health as a priority.Keywords: oral health, long-term care, qualitative research.Accepted 24 February 2011

Published
2012
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49. Poster Presentations (PP01-PP67)

Author

P. Santos-Moreno, J. Bello, A. Palomino, L. Villarreal, D. Zambrano, L. Amador, O. Andrade, A. Urbina, C. Guzman, M. Cubides, A. Arbelaez, R. Valle-Onate, C. Galarza-Maldonado, K. Brickmann, F. Furst, S. Kielhauser, J. Hermann, H.-P. Brezinsek, W. Graninger, V. Ziaee, P. Sadghi, M.-H. Moradinejad, D. H. Yoo, J.-H. Woo, Y. J. Kim, J. J. Kim, C.-B. Choi, Y.-K. Sung, T.-H. Kim, J.-B. Jun, S.-C. Bae, W. Park, K. Joo, M.-J. Lim, S.-R. Kwon, K.-H. Jung., S.-Y. Bang, S.-R. Park, K. W. Lee, S. Donmez, O. N. Pamuk, G. E. Pamuk, A. Aksoy, H. Almoallim, A. Almasari, H. Khadawardi, A. Haroyan, M. Petrova, D. Shah, A. Bhatnagar, A. Wanchu, M. Okada, F. E. Ardakani, M. Owlia, S. Hesami, M. B. Owlia, H. Soleimani, H. S. Saleh-Abadi, M. Lotfi, A. Dehghan, B. Saberir, M. H. Moradinejad, G. Zamani, A. Aghamohammadi, H. Soheili, S. shahinpour, H. Abolhassani, A. Hirbod, N. Arandi, M. Tavassoli, N. Parvaneh, N. Rezaei, Z. Rezaieyazdi, M.-R. Hatef, S. Sedighi, H. Ah Kim, C. K. Chung, R. Martinez Perez, M. Leon, J. Uceda, S. Rodriguez Montero, A. Munoz, M. Velloso, J. Marenco, N. Tsiliakou, O. Giotakos, L. Koutsogeorgopoulou, D. Kassimos, N. Fernandes, V. Silva, R. Hernandez Sanchez, P. Gonzalez Moreno, J. Uceda Montanes, J. Marenco de la Fuente, E. Aytekin, S. E. Demir, S. C. Okur, N. S. Caglar, S. Tutun, S. Eroglu Demir, A. Rezvani, N. Ozaras, E. Poyraz, M. Guneser, H. K. Asik Celik, I. Batmaz, M. Sariyildiz, B. Dilek, I. Yildiz, O. Ayyildiz, K. Nas, R. Cevik, T. Gunay, Y. Garip, H. Bodur, T. Baykal, B. Seferoglu, K. Senel, M. Kara, T. Tiftik, A. Kaya, M. Engin Tezcan, M. Akif Ozturk, S. Ozel, A. Akinci, L. Ozcakar, D. Saliha Eroglu, A. Ebru, K. Ilhan, A. Teoman, D. Gulis, F. Ileana, G. Linda, P. Cristina, D. Laura, S. Simona, R. Simona, S. Ataman, S. Venkatesan, L. Ng, C. Carbone, E. Jaeggi, E. Silverman, S. Kamphuis, N. Mak, L. Lim, D. Levy, E. Ciobanu, M. Mazur, L. Mazur-Nicorici, S. Jin Park, E.-J. Cheon, C.-K. Chung, N. Tugnet, J. Dixey, C. Cheng, S. Schmidt, K. Stoy, A. Seisenbayev, G. Togizbaev, F. Gonzalez, L. Villareal, C. Galarza, E. Nikiphorou, A. MacGregor, S. Morris, D. James, A. Young, M. A. Alomari, R. Shammaa, D. M. Shqair, K. Alawneh, O. F. Khabour, T. C. Namey, S. Kolahi, A. G. Haghjoo, M.-J. Lee, C.-H. Suh, Y.-W. Park, H.-S. Lee, Y.-M. Kang, S.-C. Shim, W.-K. Lee, H. Park, J. Lee, R.-H. Wong, C.-H. Huang, J. Cheng-Chung Wei, S.-P. Chiou, Y.-C. Tu, S. Ok, J.-O. Kim, J.-S. Lee, I.-H. Sung, J.-H. Kim, S.-H. Lee, J. Choi, S. Kim, R. Song, Y.-A. Lee, S.-J. Hong, H.-I. Yang, K. Matsui, K. Yoshida, H. Oshikawa, T. Kobayashi, H. Nakano, M. Utsunomiya, M. Kimura, O. Seniz, J. Yoon, N. Yoon, S. Lee, and Y. Kim

Subjects
medicine.medical_specialty, Rheumatology, business.industry, medicine, Pharmacology (medical), Medical physics, business
Published
2012
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50. Sliding Wear Behavior of AISI 52100 Steel with Pearlitic and Bainitic Microstructures

Author

Y.S. Kim and N. Yoon

Subjects
Wear resistance, Materials science, Bainite, Metallurgy, Pearlite, Strain hardening exponent, Composite material, Microstructure, Isothermal process, Carbide, Sliding wear
Abstract

Dry sliding wear behavior of AISI 52100 steel that has a pearlite or bainite microstructure was characterized to explore the effect of microstructure on the wear of the steel. Isothermal heat treatments were employed to obtain the different microstructures. Pin-on-disk type wear tests of the steel disk were performed at loads of 25~125N in air against an alumina ball. Sliding speed and wear distance used were 0.1m/sec and 300m, respectively. Worn surfaces, wear debris and cross-sections of the worn surfaces were examined with SEM to investigate the wear mechanism of the steel. Hardness of the steel was also evaluated. Wear rate of the steel was correlated with the hardness and the microstructure. On the whole, wear resistance increased with an increase in hardness. However, the pearlite microstructure showed superior wear resistance as compared to the bainite microstructure with a similar hardness. The effect of the microstructure on the wear rate was attributed to the morphological differences of the carbide in the microstructure, which was found to have a significant effect on strain hardening during the wear.

Published
2011
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