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18 results on '"Williams, Hywel C."'

1. Realising the full potential of data-enabled trials in the UK: a call for action

Author: Sydes, Matthew R, Barbachano, Yolanda, Bowman, Louise, Denwood, Tom, Farmer, Andrew, Garfield-Birkbeck, Steph, Gibson, Martin, Gulliford, Martin C, Harrison, David A, Hewitt, Catherine, Logue, Jennifer, Navaie, Will, Norrie, John, O'Kane, Martin, Quint, Jennifer K, Rycroft-Malone, Jo, Sheffield, Jonathan, Smeeth, Liam, Sullivan, Frank, Tizzard, Juliet, Walker, Paula, Wilding, John, Williamson, Paula R, Landray, Martin, Morris, Andrew, Walker, Rhoswyn R, Williams, Hywel C, Valentine, Janet, Data Enabled Trials Group Workshop Group Members, Sydes, Matthew R [0000-0002-9323-1371], Bowman, Louise [0000-0003-1125-8616], Denwood, Tom [0000-0002-7337-2425], Farmer, Andrew [0000-0002-6170-4402], Garfield-Birkbeck, Steph [0000-0002-3181-2840], Gibson, Martin [0000-0002-1331-1524], Gulliford, Martin C [0000-0003-1898-9075], Harrison, David A [0000-0002-9002-9098], Hewitt, Catherine [0000-0002-0415-3536], Logue, Jennifer [0000-0001-9549-2738], Norrie, John [0000-0001-9823-9252], Quint, Jennifer K [0000-0003-0149-4869], Rycroft-Malone, Jo [0000-0003-3858-5625], Smeeth, Liam [0000-0002-9168-6022], Sullivan, Frank [0000-0002-6623-4964], Wilding, John [0000-0003-2839-8404], Williamson, Paula R [0000-0001-9802-6636], Landray, Martin [0000-0001-6646-827X], Morris, Andrew [0000-0002-1766-0473], Walker, Rhoswyn R [0000-0001-5605-2879], Williams, Hywel C [0000-0002-5646-3093], and Apollo - University of Cambridge Repository
Subjects: clinical trials, SARS-CoV-2, Patient Selection, statistics & research methods, COVID-19, Humans, health informatics, United Kingdom
Abstract: RATIONALE: Clinical trials are the gold standard for testing interventions. COVID-19 has further raised their public profile and emphasised the need to deliver better, faster, more efficient trials for patient benefit. Considerable overlap exists between data required for trials and data already collected routinely in electronic healthcare records (EHRs). Opportunities exist to use these in innovative ways to decrease duplication of effort and speed trial recruitment, conduct and follow-up. APPROACH: The National Institute of Health Research (NIHR), Health Data Research UK and Clinical Practice Research Datalink co-organised a national workshop to accelerate the agenda for 'data-enabled clinical trials'. Showcasing successful examples and imagining future possibilities, the plenary talks, panel discussions, group discussions and case studies covered: design/feasibility; recruitment; conduct/follow-up; collecting benefits/harms; and analysis/interpretation. REFLECTION: Some notable studies have successfully accessed and used EHR to identify potential recruits, support randomised trials, deliver interventions and supplement/replace trial-specific follow-up. Some outcome measures are already reliably collected; others, like safety, need detailed work to meet regulatory reporting requirements. There is a clear need for system interoperability and a 'route map' to identify and access the necessary datasets. Researchers running regulatory-facing trials must carefully consider how data quality and integrity would be assessed. An experience-sharing forum could stimulate wider adoption of EHR-based methods in trial design and execution. DISCUSSION: EHR offer opportunities to better plan clinical trials, assess patients and capture data more efficiently, reducing research waste and increasing focus on each trial's specific challenges. The short-term emphasis should be on facilitating patient recruitment and for postmarketing authorisation trials where research-relevant outcome measures are readily collectable. Sharing of case studies is encouraged. The workshop directly informed NIHR's funding call for ambitious data-enabled trials at scale. There is the opportunity for the UK to build upon existing data science capabilities to identify, recruit and monitor patients in trials at scale.
Published: 2021

2. Additional file 1 of Two-by-two factorial randomised study within a trial (SWAT) to evaluate strategies for follow-up in a randomised prevention trial

Author: Bradshaw, Lucy E., Montgomery, Alan A., Williams, Hywel C., Chalmers, Joanne R., and Haines, Rachel H.
Subjects: health services administration, health care economics and organizations
Abstract: Additional file 1. Sensitivity analyses, secondary outcomes and interim analyses.
Published: 2020
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3. Teledermatology for diagnosing skin cancer in adults

Author: Chuchu, Naomi, Dinnes, Jacqueline, Takwoingi, Yemisi, Matin, Rubeta N, Bayliss, Susan E, Davenport, Clare, Moreau, Jacqueline F, Bassett, Oliver, Godfrey, Kathie, O'Sullivan, Colette, Walter, Fiona M, Motley, Richard, Deeks, Jonathan J, Williams, Hywel C, Cochrane Skin Cancer Diagnostic Test Accuracy Group, Walter, Fiona [0000-0002-7191-6476], and Apollo - University of Cambridge Repository
Subjects: Adult, Skin Neoplasms, Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Photography, Humans, Dermatology, Diagnostic Errors, Melanoma, Physical Examination, Sensitivity and Specificity, Telemedicine, Data Accuracy
Abstract: BACKGROUND: Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients through the normal referral pathway. Teledermatology consultations can be 'store-and-forward' with electronic digital images of a lesion sent to a dermatologist for review at a later time, or can be live and interactive consultations using videoconferencing to connect the patient, referrer and dermatologist in real time. OBJECTIVES: To determine the diagnostic accuracy of teledermatology for the detection of any skin cancer (melanoma, BCC or cutaneous squamous cell carcinoma (cSCC)) in adults, and to compare its accuracy with that of in-person diagnosis. SEARCH METHODS: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, US National Institutes of Health Ongoing Trials Register, NIHR Clinical Research Network Portfolio Database and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA: Studies evaluating skin cancer diagnosis for teledermatology alone, or in comparison with face-to-face diagnosis by a specialist clinician, compared with a reference standard of histological confirmation or clinical follow-up and expert opinion. We also included studies evaluating the referral accuracy of teledermatology compared with a reference standard of face-to-face diagnosis by a specialist clinician. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where there were information related to the target condition of any skin cancer missing. Data permitting, we estimated summary sensitivities and specificities using the bivariate hierarchical model. Due to the scarcity of data, we undertook no covariate investigations for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for diagnostic threshold and target condition under consideration. MAIN RESULTS: The review included 22 studies reporting diagnostic accuracy data for 4057 lesions and 879 malignant cases (16 studies) and referral accuracy data for reported data for 1449 lesions and 270 'positive' cases as determined by the reference standard face-to-face decision (six studies). Methodological quality was variable with poor reporting hindering assessment. The overall risk of bias was high or unclear for participant selection, reference standard, and participant flow and timing in at least half of all studies; the majority were at low risk of bias for the index test. The applicability of study findings were of high or unclear concern for most studies in all domains assessed due to the recruitment of participants from secondary care settings or specialist clinics rather than from primary or community-based settings in which teledermatology is more likely to be used and due to the acquisition of lesion images by dermatologists or in specialist imaging units rather than by primary care clinicians.Seven studies provided data for the primary target condition of any skin cancer (1588 lesions and 638 malignancies). For the correct diagnosis of lesions as malignant using photographic images, summary sensitivity was 94.9% (95% confidence interval (CI) 90.1% to 97.4%) and summary specificity was 84.3% (95% CI 48.5% to 96.8%) (from four studies). Individual study estimates using dermoscopic images or a combination of photographic and dermoscopic images generally suggested similarly high sensitivities with highly variable specificities. Limited comparative data suggested similar diagnostic accuracy between teledermatology assessment and in-person diagnosis by a dermatologist; however, data were too scarce to draw firm conclusions. For the detection of invasive melanoma or atypical intraepidermal melanocytic variants both sensitivities and specificities were more variable. Sensitivities ranged from 59% (95% CI 42% to 74%) to 100% (95% CI 48% to 100%) and specificities from 30% (95% CI 22% to 40%) to 100% (95% CI 93% to 100%), with reported diagnostic thresholds including the correct diagnosis of melanoma, classification of lesions as 'atypical' or 'typical, and the decision to refer or to excise a lesion.Referral accuracy data comparing teledermatology against a face-to-face reference standard suggested good agreement for lesions considered to require some positive action by face-to-face assessment (sensitivities of over 90%). For lesions considered of less concern when assessed face-to-face (e.g. for lesions not recommended for excision or referral), agreement was more variable with teledermatology specificities ranging from 57% (95% CI 39% to 73%) to 100% (95% CI 86% to 100%), suggesting that remote assessment is more likely recommend excision, referral or follow-up compared to in-person decisions. AUTHORS' CONCLUSIONS: Studies were generally small and heterogeneous and methodological quality was difficult to judge due to poor reporting. Bearing in mind concerns regarding the applicability of study participants and of lesion image acquisition in specialist settings, our results suggest that teledermatology can correctly identify the majority of malignant lesions. Using a more widely defined threshold to identify 'possibly' malignant cases or lesions that should be considered for excision is likely to appropriately triage those lesions requiring face-to-face assessment by a specialist. Despite the increasing use of teledermatology on an international level, the evidence base to support its ability to accurately diagnose lesions and to triage lesions from primary to secondary care is lacking and further prospective and pragmatic evaluation is needed.
Published: 2019
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4. Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults

Author: Dinnes, Jacqueline, Deeks, Jonathan J, Chuchu, Naomi, Matin, Rubeta N, Wong, Kai Yuen, Aldridge, Roger Benjamin, Durack, Alana, Gulati, Abha, Chan, Sue Ann, Johnston, Louise, Bayliss, Susan E, Leonardi-Bee, Jo, Takwoingi, Yemisi, Davenport, Clare, O'Sullivan, Colette, Tehrani, Hamid, Williams, Hywel C, Cochrane Skin Cancer Diagnostic Test Accuracy Group, Dinnes, Jacqueline [0000-0003-1343-7335], Deeks, Jonathan J [0000-0002-8850-1971], Wong, Kai Yuen [0000-0002-6060-1487], Bayliss, Susan E [0000-0003-3025-9323], Takwoingi, Yemisi [0000-0002-5828-9746], and Apollo - University of Cambridge Repository
Subjects: Adult, Keratinocytes, Skin Neoplasms, Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Photography, Humans, Dermoscopy, Middle Aged, Physical Examination, Sensitivity and Specificity, Algorithms, Aged
Abstract: BACKGROUND: Early accurate detection of all skin cancer types is important to guide appropriate management, to reduce morbidity and to improve survival. Basal cell carcinoma (BCC) is almost always a localised skin cancer with potential to infiltrate and damage surrounding tissue, whereas a minority of cutaneous squamous cell carcinomas (cSCCs) and invasive melanomas are higher-risk skin cancers with the potential to metastasise and cause death. Dermoscopy has become an important tool to assist specialist clinicians in the diagnosis of melanoma, and is increasingly used in primary-care settings. Dermoscopy is a precision-built handheld illuminated magnifier that allows more detailed examination of the skin down to the level of the superficial dermis. Establishing the value of dermoscopy over and above visual inspection for the diagnosis of BCC or cSCC in primary- and secondary-care settings is critical to understanding its potential contribution to appropriate skin cancer triage, including referral of higher-risk cancers to secondary care, the identification of low-risk skin cancers that might be treated in primary care and to provide reassurance to those with benign skin lesions who can be safely discharged. OBJECTIVES: To determine the diagnostic accuracy of visual inspection and dermoscopy, alone or in combination, for the detection of (a) BCC and (b) cSCC, in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in person) or based on remote (image-based) assessment. SEARCH METHODS: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA: Studies of any design that evaluated visual inspection or dermoscopy or both in adults with lesions suspicious for skin cancer, compared with a reference standard of either histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic thresholds were missing. We estimated accuracy using hierarchical summary ROC methods. We undertook analysis of studies allowing direct comparison between tests. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely-developed algorithm to assist diagnosis; and observer expertise. MAIN RESULTS: We included 24 publications reporting on 24 study cohorts, providing 27 visual inspection datasets (8805 lesions; 2579 malignancies) and 33 dermoscopy datasets (6855 lesions; 1444 malignancies). The risk of bias was mainly low for the index test (for dermoscopy evaluations) and reference standard domains, particularly for in-person evaluations, and high or unclear for participant selection, application of the index test for visual inspection and for participant flow and timing. We scored concerns about the applicability of study findings as of 'high' or 'unclear' concern for almost all studies across all domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The detection of BCC was reported in 28 datasets; 15 on an in-person basis and 13 image-based. Analysis of studies by prior testing of participants and according to observer expertise was not possible due to lack of data. Studies were primarily conducted in participants referred for specialist assessment of lesions with available histological classification. We found no clear differences in accuracy between dermoscopy studies undertaken in person and those which evaluated images. The lack of effect observed may be due to other sources of heterogeneity, including variations in the types of skin lesion studied, in dermatoscopes used, or in the use of algorithms and varying thresholds for deciding on a positive test result.Meta-analysis found in-person evaluations of dermoscopy (7 evaluations; 4683 lesions and 363 BCCs) to be more accurate than visual inspection alone for the detection of BCC (8 evaluations; 7017 lesions and 1586 BCCs), with a relative diagnostic odds ratio (RDOR) of 8.2 (95% confidence interval (CI) 3.5 to 19.3; P < 0.001). This corresponds to predicted differences in sensitivity of 14% (93% versus 79%) at a fixed specificity of 80% and predicted differences in specificity of 22% (99% versus 77%) at a fixed sensitivity of 80%. We observed very similar results for the image-based evaluations.When applied to a hypothetical population of 1000 lesions, of which 170 are BCC (based on median BCC prevalence across studies), an increased sensitivity of 14% from dermoscopy would lead to 24 fewer BCCs missed, assuming 166 false positive results from both tests. A 22% increase in specificity from dermoscopy with sensitivity fixed at 80% would result in 183 fewer unnecessary excisions, assuming 34 BCCs missed for both tests. There was not enough evidence to assess the use of algorithms or structured checklists for either visual inspection or dermoscopy.Insufficient data were available to draw conclusions on the accuracy of either test for the detection of cSCCs. AUTHORS' CONCLUSIONS: Dermoscopy may be a valuable tool for the diagnosis of BCC as an adjunct to visual inspection of a suspicious skin lesion following a thorough history-taking including assessment of risk factors for keratinocyte cancer. The evidence primarily comes from secondary-care (referred) populations and populations with pigmented lesions or mixed lesion types. There is no clear evidence supporting the use of currently-available formal algorithms to assist dermoscopy diagnosis.
Published: 2018

5. Visual inspection for diagnosing cutaneous melanoma in adults

Author: Dinnes, Jacqueline, Deeks, Jonathan J, Grainge, Matthew J, Chuchu, Naomi, Ferrante Di Ruffano, Lavinia, Matin, Rubeta N, Thomson, David R, Wong, Kai Yuen, Aldridge, Roger Benjamin, Abbott, Rachel, Fawzy, Monica, Bayliss, Susan E, Takwoingi, Yemisi, Davenport, Clare, Godfrey, Kathie, Walter, Fiona M, Williams, Hywel C, Cochrane Skin Cancer Diagnostic Test Accuracy Group, Walter, Fiona [0000-0002-7191-6476], and Apollo - University of Cambridge Repository
Subjects: Adult, Skin Neoplasms, Humans, Diagnostic Errors, Middle Aged, Melanoma, Physical Examination, Sensitivity and Specificity, Algorithms, Aged
Abstract: BACKGROUND: Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. History-taking and visual inspection of a suspicious lesion by a clinician is usually the first in a series of 'tests' to diagnose skin cancer. Establishing the accuracy of visual inspection alone is critical to understating the potential contribution of additional tests to assist in the diagnosis of melanoma. OBJECTIVES: To determine the diagnostic accuracy of visual inspection for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with limited prior testing and in those referred for further evaluation of a suspicious lesion. Studies were separated according to whether the diagnosis was recorded face-to-face (in-person) or based on remote (image-based) assessment. SEARCH METHODS: We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA: Test accuracy studies of any design that evaluated visual inspection in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. We excluded studies reporting data for 'clinical diagnosis' where dermoscopy may or may not have been used. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities per algorithm and threshold using the bivariate hierarchical model. We investigated the impact of: in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; and observer expertise. MAIN RESULTS: We included 49 publications reporting on a total of 51 study cohorts with 34,351 lesions (including 2499 cases), providing 134 datasets for visual inspection. Across almost all study quality domains, the majority of study reports provided insufficient information to allow us to judge the risk of bias, while in three of four domains that we assessed we scored concerns regarding applicability of study findings as 'high'. Selective participant recruitment, lack of detail regarding the threshold for deciding on a positive test result, and lack of detail on observer expertise were particularly problematic.Attempts to analyse studies by degree of prior testing were hampered by a lack of relevant information and by the restricted inclusion of lesions selected for biopsy or excision. Accuracy was generally much higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio of 8.54, 95% CI 2.89 to 25.3, P < 0.001). Meta-analysis of in-person evaluations that could be clearly placed on the clinical pathway showed a general trade-off between sensitivity and specificity, with the highest sensitivity (92.4%, 95% CI 26.2% to 99.8%) and lowest specificity (79.7%, 95% CI 73.7% to 84.7%) observed in participants with limited prior testing (n = 3 datasets). Summary sensitivities were lower for those referred for specialist assessment but with much higher specificities (e.g. sensitivity 76.7%, 95% CI 61.7% to 87.1%) and specificity 95.7%, 95% CI 89.7% to 98.3%) for lesions selected for excision, n = 8 datasets). These differences may be related to differences in the spectrum of included lesions, differences in the definition of a positive test result, or to variations in observer expertise. We did not find clear evidence that accuracy is improved by the use of any algorithm to assist diagnosis in all settings. Attempts to examine the effect of observer expertise in melanoma diagnosis were hindered due to poor reporting. AUTHORS' CONCLUSIONS: Visual inspection is a fundamental component of the assessment of a suspicious skin lesion; however, the evidence suggests that melanomas will be missed if visual inspection is used on its own. The evidence to support its accuracy in the range of settings in which it is used is flawed and very poorly reported. Although published algorithms do not appear to improve accuracy, there is insufficient evidence to suggest that the 'no algorithm' approach should be preferred in all settings. Despite the volume of research evaluating visual inspection, further prospective evaluation of the potential added value of using established algorithms according to the prior testing or diagnostic difficulty of lesions may be warranted.
Published: 2018

6. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults

Author: Dinnes, Jacqueline, Deeks, Jonathan J, Chuchu, Naomi, Ferrante di Ruffano, Lavinia, Matin, Rubeta N, Thomson, David R, Wong, Kai Yuen, Aldridge, Roger Benjamin, Abbott, Rachel, Fawzy, Monica, Bayliss, Susan E, Grainge, Matthew J, Takwoingi, Yemisi, Davenport, Clare, Godfrey, Kathie, Walter, Fiona M, Williams, Hywel C, Cochrane Skin Cancer Diagnostic Test Accuracy Group, Walter, Fiona [0000-0002-7191-6476], and Apollo - University of Cambridge Repository
Subjects: Adult, Skin Neoplasms, Biopsy, Humans, Dermoscopy, Melanoma, Physical Examination, Sensitivity and Specificity, Algorithms, Skin
Abstract: BACKGROUND: Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Although history-taking and visual inspection of a suspicious lesion by a clinician are usually the first in a series of 'tests' to diagnose skin cancer, dermoscopy has become an important tool to assist diagnosis by specialist clinicians and is increasingly used in primary care settings. Dermoscopy is a magnification technique using visible light that allows more detailed examination of the skin compared to examination by the naked eye alone. Establishing the additive value of dermoscopy over and above visual inspection alone across a range of observers and settings is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques. OBJECTIVES: To determine the diagnostic accuracy of dermoscopy alone, or when added to visual inspection of a skin lesion, for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in-person), or based on remote (image-based), assessment. SEARCH METHODS: We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA: Studies of any design that evaluated dermoscopy in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. Data on the accuracy of visual inspection, to allow comparisons of tests, was included only if reported in the included studies of dermoscopy. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated accuracy using hierarchical summary receiver operating characteristic (SROC),methods. Analysis of studies allowing direct comparison between tests was undertaken. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; observer expertise; and dermoscopy training. MAIN RESULTS: We included a total of 104 study publications reporting on 103 study cohorts with 42,788 lesions (including 5700 cases), providing 354 datasets for dermoscopy. The risk of bias was mainly low for the index test and reference standard domains and mainly high or unclear for participant selection and participant flow. Concerns regarding the applicability of study findings were largely scored as 'high' concern in three of four domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The accuracy of dermoscopy for the detection of invasive melanoma or atypical intraepidermal melanocytic variants was reported in 86 datasets; 26 for evaluations conducted in person (dermoscopy added to visual inspection), and 60 for image-based evaluations (diagnosis based on interpretation of dermoscopic images). Analyses of studies by prior testing revealed no obvious effect on accuracy; analyses were hampered by the lack of studies in primary care, lack of relevant information and the restricted inclusion of lesions selected for biopsy or excision. Accuracy was higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio (RDOR) 4.6, 95% confidence interval (CI) 2.4 to 9.0; P < 0.001).We compared accuracy for (a), in-person evaluations of dermoscopy (26 evaluations; 23,169 lesions and 1664 melanomas),versus visual inspection alone (13 evaluations; 6740 lesions and 459 melanomas), and for (b), image-based evaluations of dermoscopy (60 evaluations; 13,475 lesions and 2851 melanomas),versus image-based visual inspection (11 evaluations; 1740 lesions and 305 melanomas). For both comparisons, meta-analysis found dermoscopy to be more accurate than visual inspection alone, with RDORs of (a), 4.7 (95% CI 3.0 to 7.5; P < 0.001), and (b), 5.6 (95% CI 3.7 to 8.5; P < 0.001). For a), the predicted difference in sensitivity at a fixed specificity of 80% was 16% (95% CI 8% to 23%; 92% for dermoscopy + visual inspection versus 76% for visual inspection), and predicted difference in specificity at a fixed sensitivity of 80% was 20% (95% CI 7% to 33%; 95% for dermoscopy + visual inspection versus 75% for visual inspection). For b) the predicted differences in sensitivity was 34% (95% CI 24% to 46%; 81% for dermoscopy versus 47% for visual inspection), at a fixed specificity of 80%, and predicted difference in specificity was 40% (95% CI 27% to 57%; 82% for dermoscopy versus 42% for visual inspection), at a fixed sensitivity of 80%.Using the median prevalence of disease in each set of studies ((a), 12% for in-person and (b), 24% for image-based), for a hypothetical population of 1000 lesions, an increase in sensitivity of (a), 16% (in-person), and (b), 34% (image-based), from using dermoscopy at a fixed specificity of 80% equates to a reduction in the number of melanomas missed of (a), 19 and (b), 81 with (a), 176 and (b), 152 false positive results. An increase in specificity of (a), 20% (in-person), and (b), 40% (image-based), at a fixed sensitivity of 80% equates to a reduction in the number of unnecessary excisions from using dermoscopy of (a), 176 and (b), 304 with (a), 24 and (b), 48 melanomas missed.The use of a named or published algorithm to assist dermoscopy interpretation (as opposed to no reported algorithm or reported use of pattern analysis), had no significant impact on accuracy either for in-person (RDOR 1.4, 95% CI 0.34 to 5.6; P = 0.17), or image-based (RDOR 1.4, 95% CI 0.60 to 3.3; P = 0.22), evaluations. This result was supported by subgroup analysis according to algorithm used. We observed higher accuracy for observers reported as having high experience and for those classed as 'expert consultants' in comparison to those considered to have less experience in dermoscopy, particularly for image-based evaluations. Evidence for the effect of dermoscopy training on test accuracy was very limited but suggested associated improvements in sensitivity. AUTHORS' CONCLUSIONS: Despite the observed limitations in the evidence base, dermoscopy is a valuable tool to support the visual inspection of a suspicious skin lesion for the detection of melanoma and atypical intraepidermal melanocytic variants, particularly in referred populations and in the hands of experienced users. Data to support its use in primary care are limited, however, it may assist in triaging suspicious lesions for urgent referral when employed by suitably trained clinicians. Formal algorithms may be of most use for dermoscopy training purposes and for less expert observers, however reliable data comparing approaches using dermoscopy in person are lacking.
Published: 2018
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7. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study

Author: Fitzmaurice, Christina, Akinyemiju, Tomi F, Al Lami, Faris Hasan, Alam, Tahiya, Alizadeh-Navaei, Reza, Allen, Christine, Alsharif, Ubai, Alvis-Guzman, Nelson, Amini, Erfan, Anderson, Benjamin O, Aremu, Olatunde, Artaman, Al, Asgedom, Solomon Weldegebreal, Assadi, Reza, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Awasthi, Ashish, Ba Saleem, Huda Omer, Barac, Aleksandra, Bennett, James R, Bensenor, Isabela M, Bhakta, Nickhill, Brenner, Hermann, Cahuana-Hurtado, Lucero, Castañeda-Orjuela, Carlos A, Catalá-López, Ferrán, Choi, Jee-Young Jasmine, Christopher, Devasahayam Jesudas, Chung, Sheng-Chia, Curado, Maria Paula, Dandona, Lalit, Dandona, Rakhi, das Neves, José, Dey, Subhojit, Dharmaratne, Samath D, Doku, David Teye, Driscoll, Tim R, Dubey, Manisha, Ebrahimi, Hedyeh, Edessa, Dumessa, El-Khatib, Ziad, Endries, Aman Yesuf, Fischer, Florian, Force, Lisa M, Foreman, Kyle J, Gebrehiwot, Solomon Weldemariam, Gopalani, Sameer Vali, Grosso, Giuseppe, Gupta, Rahul, Gyawali, Bishal, Hamadeh, Randah Ribhi, Hamidi, Samer, Harvey, James, Hassen, Hamid Yimam, Hay, Roderick J, Hay, Simon I, Heibati, Behzad, Hiluf, Molla Kahssay, Horita, Nobuyuki, Hosgood, H Dean, Ilesanmi, Olayinka S, Innos, Kaire, Islami, Farhad, Jakovljevic, Mihajlo B, Johnson, Sarah Charlotte, Jonas, Jost B, Kasaeian, Amir, Kassa, Tesfaye Dessale, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khosravi, Mohammad Hossein, Khubchandani, Jagdish, Kopec, Jacek A, Kumar, G Anil, Kutz, Michael, Lad, Deepesh Pravinkumar, Lafranconi, Alessandra, Lan, Qing, Legesse, Yirga, Leigh, James, Linn, Shai, Lunevicius, Raimundas, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Mantovani, Lorenzo G, McMahon, Brian J, Meier, Toni, Melaku, Yohannes Adama, Melku, Mulugeta, Memiah, Peter, Mendoza, Walter, Meretoja, Tuomo J, Mezgebe, Haftay Berhane, Miller, Ted R, Mohammed, Shafiu, Mokdad, Ali H, Moosazadeh, Mahmood, Moraga, Paula, Mousavi, Seyyed Meysam, Nangia, Vinay, Nguyen, Cuong Tat, Nong, Vuong Minh, Ogbo, Felix Akpojene, Olagunju, Andrew Toyin, Pa, Mahesh, Park, Eun-Kee, Patel, Tejas, Pereira, David M, Pishgar, Farhad, Postma, Maarten J, Pourmalek, Farshad, Qorbani, Mostafa, Rafay, Anwar, Rawaf, Salman, Rawaf, David Laith, Roshandel, Gholamreza, Safiri, Saeid, Salimzadeh, Hamideh, Sanabria, Juan Ramon, Santric Milicevic, Milena M, Sartorius, Benn, Satpathy, Maheswar, Sepanlou, Sadaf G, Shackelford, Katya Anne, Shaikh, Masood Ali, Sharif-Alhoseini, Mahdi, She, Jun, Shin, Min-Jeong, Shiue, Ivy, Shrime, Mark G, Sinke, Abiy Hiruye, Sisay, Mekonnen, Sligar, Amber, Sufiyan, Muawiyyah Babale, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tessema, Gizachew Assefa, Topor-Madry, Roman, Tran, Tung Thanh, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Weiderpass, Elisabete, Williams, Hywel C, Yimer, Nigus Bililign, Yonemoto, Naohiro, Younis, Mustafa Z, Murray, Christopher JL, Naghavi, Mohsen, and Global Burden of Disease Cancer Collaboration
Abstract: Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.
Published: 2018

8. 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, Hmwe Hmwe, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Molla, Abebe, Zegeye, Abil, Olifan Zewdie, Aboyans, Victor, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen M E, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Ackerman, Ilana N, Adamu, Abdu A, Adebayo, Oladimeji M, Adekanmbi, Victor, Ademi, Zanfina, Adetokunboh, Olatunji O, Adib, Mina G, Adsuar, Jose C, Afanvi, Kossivi Agbelenko, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Aggarwal, Rakesh, Aghayan, Sargis Aghasi, Agrawal, Anurag, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Ahmed, Sayem, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akinyemiju, Tomi, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Mekhlafi, Hesham M, Al-Raddadi, Rajaa M, Alahdab, Fares, Alam, Khurshid, Alam, Tahiya, Alashi, Alaa, Alavian, Seyed Moayed, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Alonso, Jordi, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Aminde, Leopold N, Amini, Erfan, Amiresmaili, Mohammadreza, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Arabloo, Jalal, Aremu, Olatunde, Ärnlöv, Johan, Arora, Amit, Arora, Megha, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Ataro, Zerihun, Ausloos, Marcel, Avila-Burgos, Leticia, Avokpaho, Euripide F G A, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Ayer, Rakesh, Azzopardi, Peter S, Babazadeh, Arefeh, Badali, Hamid, Balakrishnan, Kalpana, Bali, Ayele Geleto, Banach, Maciej, Banoub, Joseph Adel Mattar, Barac, Aleksandra, Barboza, Miguel A, Barker-Collo, Suzanne Lyn, Bärnighausen, Till Winfried, Barquera, Simon, Barrero, Lope H, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Bekele, Bayu Begashaw, Bekru, Eyasu Tamru, Belachew, Abate Bekele, Belay, Yihalem Abebe, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabe, Eduardo, Bernstein, Robert S, Beuran, Mircea, Beyranvand, Tina, Bhala, Neeraj, Bhatt, Samir, Bhaumik, Soumyadeep, Bhutta, Zulfiqar A, Biadgo, Belete, Biehl, Molly H, Bijani, Ali, Bikbov, Boris, Bilano, Ver, Bililign, Nigus, Bin Sayeed, Muhammad Shahdaat, Bisanzio, Donal, Bjørge, Tone, Bleyer, Archie, Bobasa, Eshetu Mulisa, Bou-Orm, Ibrahim R, Boufous, Soufiane, Bourne, Rupert, Brady, Oliver J, Brant, Luisa C, Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Briant, Paul Svitil, Briko, Andrey Nikolaevich, Britton, Gabrielle, Brugha, Traolach, Buchbinder, Rachelle, Busse, Reinhard, Butt, Zahid A, Cahuana-Hurtado, Lucero, Campuzano Rincon, Julio Cesar, Cano, Jorge, Cárdenas, Rosario, Carrero, Juan J, Carter, Austin, Carvalho, Félix, Castañeda-Orjuela, Carlos A, Castillo Rivas, Jacqueline, Castro, Franz, Catalá-López, Ferrán, Cercy, Kelly M, Cerin, Ester, Chaiah, Yazan, Chang, Jung-Chen, Charlson, Fiona J, Chattu, Vijay Kumar, Chiang, Peggy Pei-Chia, Chitheer, Abdulaal, Choi, Jee-Young J, Christensen, Hanne, Christopher, Devasahayam J, Chung, Sheng-Chia, Cicuttini, Flavia M, Cirillo, Massimo, Collado-Mateo, Daniel, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Cousin, Ewerton, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Daba, Alemneh Kabeta, Dachew, Berihun Assefa, Dadi, Abel Fekadu, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I, Daryani, Ahmad, Das Gupta, Rajat, Das Neves, José, Dasa, Tamirat Tesfaye, Davitoiu, Dragos Virgil, De La Hoz, Fernando Pio, De Leo, Diego, De Neve, Jan-Walter, De Steur, 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Sanjay, Krohn, Kristopher J, Kuate Defo, Barthelemy, Kucuk Bicer, Burcu, Kumar, G Anil, Kumar, Manasi, Kuzin, Igor, Lad, Deepesh P, Lad, Sheetal D, Lafranconi, Alessandra, Lalloo, Ratilal, Lallukka, Tea, Lami, Faris Hasan, Lang, Justin J, Langan, Sinéad M, Lansingh, Van C, Latifi, Arman, Lau, Kathryn Mei-Ming, Lazarus, Jeffrey V, Leasher, Janet L, Ledesma, Jorge R, Lee, Paul H, Leigh, James, Leili, Mostafa, Leshargie, Cheru Tesema, Leung, Janni, Levi, Miriam, Lewycka, Sonia, Li, Shanshan, Li, Yichong, Liang, Xiaofeng, Liao, Yu, Liben, Misgan Legesse, Lim, Lee-Ling, Lim, Stephen S, Limenih, Miteku Andualem, Linn, Shai, Liu, Shiwei, Looker, Katharine J, Lopez, Alan D, Lorkowski, Stefan, Lotufo, Paulo A, Lozano, Rafael, Lucas, Tim C D, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Stefan, Macarayan, Erlyn Rachelle King, Mackay, Mark T, Maddison, Emilie R, Madotto, Fabiana, Maghavani, Dhaval P, Mai, Hue Thi, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah 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Shanti, Patil, Snehal T, Patle, Ajay, Patton, George C, Paturi, Vishnupriya Rao, Paudel, Deepak, Paulson, Katherine R, Pearce, Neil, Pereira, Alexandre, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Pham, Hai Quang, Phillips, Michael R, Pigott, David M, Pillay, Julian David, Piradov, Michael A, Pirsaheb, Meghdad, Pishgar, Farhad, Plana-Ripoll, Oleguer, Polinder, Suzanne, Popova, Svetlana, Postma, Maarten J, Pourshams, Akram, Poustchi, Hossein, Prabhakaran, Dorairaj, Prakash, Swayam, Prakash, V, Prasad, Narayan, Purcell, Caroline A, Qorbani, Mostafa, Quistberg, D Alex, Radfar, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi, Kazem, Rahimi, Zohreh, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajati, Fatemeh, Ranjan, Prabhat, Rao, Puja C, Rasella, Davide, Rawaf, David Laith, Rawaf, Salman, Reddy, K Srinath, Reiner, Robert C, Reitsma, Marissa Bettay, Remuzzi, Giuseppe, Renzaho, Andre M N, Resnikoff, Serge, Rezaei, Satar, Rezai, Mohammad Sadegh, Ribeiro, Antonio Luiz P, Roberts, Nicholas L S, Robinson, Stephen R, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rostami, Ali, Roth, Gregory A, Rothenbacher, Dietrich, Rubagotti, Enrico, Sachdev, Perminder S, Sadat, Nafis, Sadeghi, Ehsan, Saeedi Moghaddam, Sahar, Safari, Hosein, Safari, Yahya, Safari-Faramani, Roya, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, Haniye Sadat, Salam, Nasir, Salama, Joseph S, Salamati, Payman, Saleem, Zikria, Salimi, Yahya, Salimzadeh, Hamideh, Salomon, Joshua A, Salvi, Sundeep Santosh, Salz, Inbal, Samy, Abdallah M, Sanabria, Juan, Sanchez-Niño, Maria Dolores, Santomauro, Damian Francesco, Santos, Itamar S, Santos, João Vasco, Santric Milicevic, Milena M, Sao Jose, Bruno Piassi, Sardana, Mayank, Sarker, Abdur Razzaque, Sarmiento-Suárez, Rodrigo, Sarrafzadegan, Nizal, Sartorius, Benn, Sarvi, Shahabeddin, Sathian, Brijesh, Satpathy, Maheswar, Sawant, Arundhati R, Sawhney, Monika, Saxena, Sonia, Schaeffner, Elke, Schmidt, Maria Inês, Schneider, Ione J C, Schutte, Aletta Elisabeth, Schwebel, David C, Schwendicke, Falk, Scott, James G, Sekerija, Mario, Sepanlou, Sadaf G, Serván-Mori, Edson, Seyedmousavi, Seyedmojtaba, Shabaninejad, Hosein, Shafieesabet, Azadeh, Shahbazi, Mehdi, Shaheen, Amira A, Shaikh, Masood Ali, Shams-Beyranvand, Mehran, Shamsi, Mohammadbagher, Sharafi, Heidar, Sharafi, Kiomars, Sharif, Mehdi, Sharif-Alhoseini, Mahdi, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikh, Aziz, Shi, Peilin, Shibuya, Kenji, Shiferaw, Mekonnen Sisay, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shiue, Ivy, Shokoohinia, Yalda, Shokraneh, Farhad, Shoman, Haitham, Shrime, Mark G, Si, Si, Siabani, Soraya, Sibai, Abla Mehio, Siddiqi, Tariq J, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silva, Diego Augusto Santos, Silva, João Pedro, Silveira, Dayane Gabriele Alves, Singam, Narayana Sarma Venkata, Singh, Jasvinder A, Singh, Narinder Pal, Singh, Virendra, Sinha, Dhirendra Narain, Skiadaresi, Eirini, Skirbekk, Vegard, Sliwa, Karen, Smith, David L, Smith, Mari, Soares Filho, Adauto Martins, Sobaih, Badr Hasan, Sobhani, Soheila, Soofi, Moslem, Sorensen, Reed J D, Soriano, Joan B, Soyiri, Ireneous N, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Stanaway, Jeffrey D, Starodubov, Vladimir I, Stein, Dan J, Steiner, Caitlyn, Steiner, Timothy J, Stokes, Mark A, Stovner, Lars Jacob, Subart, Michelle L, Sudaryanto, Agus, Sufiyan, Mu'awiyyah Babale, Sulo, Gerhard, Sunguya, Bruno F, Sur, Patrick John, Sykes, Bryan L, Sylaja, P N, Sylte, Dillon O, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadakamadla, Santosh Kumar, Tandon, Nikhil, Tassew, Segen Gebremeskel, Tavakkoli, Mohammad, Taveira, Nuno, Taylor, Hugh R, Tehrani-Banihashemi, Arash, Tekalign, Tigist Gashaw, Tekelemedhin, Shishay Wahdey, Tekle, Merhawi Gebremedhin, Temsah, Mohamad-Hani, Temsah, Omar, Terkawi, Abdullah Sulieman, Tessema, Belay, Teweldemedhin, Mebrahtu, Thankappan, Kavumpurathu Raman, Theis, Andrew, Thirunavukkarasu, Sathish, Thomas, Nihal, Tilahun, Binyam, To, Quyen G, Tonelli, Marcello, Topor-Madry, Roman, Torre, Anna E, Tortajada-Girbés, Miguel, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Towbin, Jeffrey A, Tran, Bach Xuan, Tran, Khanh Bao, Troeger, Christopher E, Tsadik, Afewerki Gebremeskel, Tsoi, Derrick, Tudor Car, Lorainne, Tyrovolas, Stefanos, Ukwaja, Kingsley Nnanna, Ullah, Irfan, Undurraga, Eduardo A, Updike, Rachel L, Usman, Muhammad Shariq, Uthman, Olalekan A, Vaduganathan, Muthiah, Vaezi, Afsane, Valdez, Pascual R, Varavikova, Elena, Varughese, Santosh, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Villafaina, Santos, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vosoughi, Kia, Vujcic, Isidora S, Wagnew, Fasil Shiferaw, Waheed, Yasir, Wang, Yafeng, Wang, Yuan-Pang, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Weldegebreal, Fitsum, Weldegwergs, Kidu Gidey, Werdecker, Andrea, West, T Eoin, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Wijeratne, Tissa, Williams, Hywel C, Wilner, Lauren B, Wilson, Shadrach, Winkler, Andrea Sylvia, Wiyeh, Alison B, Wiysonge, Charles Shey, Wolfe, Charles D A, Woolf, Anthony D, Wyper, Grant M A, Xavier, Denis, Xu, Gelin, Yadgir, Simon, Yahyazadeh Jabbari, Seyed Hossein, Yamada, Tomohide, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yasin, Yasin Jemal, Yeshaneh, Alex, Yimer, Ebrahim M, Yip, Paul, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Yousefifard, Mahmoud, Yu, Chuanhua, Zadnik, Vesna, Zaidi, Zoubida, Zaman, Sojib Bin, Zamani, Mohammad, Zandian, Hamed, Zar, Heather J, Zenebe, Zerihun Menlkalew, Zhou, Maigeng, Zipkin, Ben, Zodpey, Sanjay, Zucker, Inbar, Zuhlke, Liesl Joanna, and Murray, Christopher J L
Subjects: ddc
Published: 2018

9. Child And Adolescent Health From 1990 To 2015

Author: Kassebaum, Nicholas, Kyu, Hmwe Hmwe, Zoeckler, Leo, Olsen, Helen Elizabeth, Thomas, Katie, Pinho, Christine, Bhutta, Zulfiqar A., Dandona, Lalit, Ferrari, Alize, Ghiwot, Tsegaye Tewelde, Hay, Simon I., Kinfu, Yohannes, Liang, Xiaofeng, Lopez, Alan, Malta, Deborah Carvalho, Mokdad, Ali H., Naghavi, Mohsen, Patton, George C., Salomon, Joshua, Sartorius, Benn, Topor-Madry, Roman, Vollset, Stein Emil, Werdecker, Andrea, Whiteford, Harvey A., Abate, Kalkidan Hasen, Abbas, Kaja, Damtew, Solomon Abrha, Ahmed, Muktar Beshir, Akseer, Nadia, Al-Raddadi, Rajaa, Alemayohu, Mulubirhan Assefa, Altirkawi, Khalid, Abajobir, Amanuel Alemu, Amare, Azmeraw T., Antonio, Carl A. T., Arnlov, Johan, Artaman, Al, Asayesh, Hamid, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Bacha, Umar, Betsu, Balem Demtsu, Barac, Aleksandra, Bärnighausen, Till Winfried, Baye, Estifanos, Bedi, Neeraj, Bensenor, Isabela M., Berhane, Adugnaw, Bernabe, Eduardo, Bernal, Oscar Alberto, Beyene, Addisu Shunu, Biadgilign, Sibhatu, Bikbov, Boris, Boyce, Cheryl Anne, Brazinova, Alexandra, Hailu, Gessessew Bugssa, Carter, Austin, Castañeda-Orjuela, Carlos A., Catalá-López, Ferrán, Charlson, Fiona J., Chitheer, Abdulaal A., Choi, Jee-Young Jasmine, Ciobanu, Liliana G., Crump, John, Dandona, Rakhi, Dellavalle, Robert P., Deribew, Amare, deVeber, Gabrielle, Dicker, Daniel, Ding, Eric L., Dubey, Manisha, Endries, Amanuel Yesuf, Erskine, Holly E., Faraon, Emerito Jose Aquino, Faro, Andre, Farzadfar, Farshad, Fernandes, Joao C., Fijabi, Daniel Obadare, Fitzmaurice, Christina, Fleming, Thomas D., Flor, Luisa Sorio, Foreman, Kyle J., Franklin, Richard C., Fraser, Maya S., Frostad, Joseph J., Fullman, Nancy, Gebregergs, Gebremedhin Berhe, Gebru, Alemseged Aregay, Geleijnse, Johanna M., Gibney, Katherine B., Gidey Yihdego, Mahari, Ginawi, Ibrahim Abdelmageem Mohamed, Gishu, Melkamu Dedefo, Gizachew, Tessema Assefa, Glaser, Elizabeth, Gold, Audra L., Goldberg, Ellen, Gona, Philimon, Goto, Atsushi, Gugnani, Harish Chander, Jiang, Guohong, Gupta, Rajeev, Tesfay, Fisaha Haile, Hankey, Graeme J., Havmoeller, Rasmus, Hijar, Martha, Horino, Masako, Hosgood, H. Dean, Hu, Guoqing, Jacobsen, Kathryn H., Jakovljevic, Mihajlo B., Jayaraman, Sudha P., Jha, Vivekanand, Jibat, Tariku, Johnson, Catherine O., Jonas, Jost, Kasaeian, Amir, Kawakami, Norito, Keiyoro, Peter N., Khalil, Ibrahim, Khang, Young-Ho, Khubchandani, Jagdish, Ahmad Kiadaliri, Aliasghar A., Kieling, Christian, Kim, Daniel, Kissoon, Niranjan, Knibbs, Luke D., Koyanagi, Ai, Krohn, Kristopher J., Kuate Defo, Barthelemy, Kucuk Bicer, Burcu, Kulikoff, Rachel, Kumar, G. Anil, Lal, Dharmesh Kumar, Lam, Hilton Y., Larson, Heidi J., Larsson, Anders, Laryea, Dennis Odai, Leung, Janni, Lim, Stephen S., Lo, Loon-Tzian, Lo, Warren D., Looker, Katharine J., Lotufo, Paulo A., Magdy Abd El Razek, Hassan, Malekzadeh, Reza, Markos Shifti, Desalegn, Mazidi, Mohsen, Meaney, Peter A., Meles, Kidanu Gebremariam, Memiah, Peter, Mendoza, Walter, Abera Mengistie, Mubarek, Mengistu, Gebremichael Welday, Mensah, George A., Miller, Ted R., Mock, Charles, Mohammadi, Alireza, Mohammed, Shafiu, Monasta, Lorenzo, Mueller, Ulrich, Nagata, Chie, Naheed, Aliya, Nguyen, Grant, Nguyen, Quyen Le, Nsoesie, Elaine, Oh, In-Hwan, Okoro, Anselm, Olusanya, Jacob Olusegun, Olusanya, Bolajoko O., Ortiz, Alberto, Paudel, Deepak, Pereira, David M., Perico, Norberto, Petzold, Max, Phillips, Michael Robert, Polanczyk, Guilherme V., Pourmalek, Farshad, Qorbani, Mostafa, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rai, Rajesh Kumar, Ram, Usha, Rankin, Zane, Remuzzi, Giuseppe, Renzaho, Andre M. N., Roba, Hirbo Shore, Rojas-Rueda, David, Ronfani, Luca, Sagar, Rajesh, Sanabria, Juan Ramon, Kedir Mohammed, Muktar Sano, Santos, Itamar S., Satpathy, Maheswar, Sawhney, Monika, Schöttker, Ben, Schwebel, David C., Scott, James G., Sepanlou, Sadaf G., Shaheen, Amira, Shaikh, Masood Ali, She, June, Shiri, Rahman, Shiue, Ivy, Sigfusdottir, Inga Dora, Singh, Jasvinder, Silpakit, Naris, Smith, Alison, Sreeramareddy, Chandrashekhar, Stanaway, Jeffrey D., Stein, Dan J., Steiner, Caitlyn, Sufiyan, Muawiyyah Babale, Swaminathan, Soumya, Tabarés-Seisdedos, Rafael, Tabb, Karen M., Tadese, Fentaw, Tavakkoli, Mohammad, Taye, Bineyam, Teeple, Stephanie, Tegegne, Teketo Kassaw, Temam Shifa, Girma, Terkawi, Abdullah Sulieman, Thomas, Bernadette, Thomson, Alan J., Tobe-Gai, Ruoyan, Tonelli, Marcello, Tran, Bach Xuan, Troeger, Christopher, Ukwaja, Kingsley N., Uthman, Olalekan, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Weiderpass, Elisabete, Weintraub, Robert, Gebrehiwot, Solomon Weldemariam, Westerman, Ronny, Williams, Hywel C., Wolfe, Charles D. A., Woodbrook, Rachel, Yano, Yuichiro, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zuhlke, Liesl Joanna, Murray, Christopher J. L., Vos, Theo, and Halk Sağlığı
Subjects: food and beverages
Abstract: This study quantifies and describes levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.
Published: 2017

10. Supplementary material from Computational design of treatment strategies for proactive therapy on atopic dermatitis using optimal control theory

Author: Christodoulides, Panayiotis, Hirata, Yoshito, Domínguez-Hüttinger, Elisa, Danby, Simon G., Cork, Michael J., Williams, Hywel C., Aihara, Kazuyuki, and Tanaka, Reiko J.
Abstract: Atopic dermatitis (AD) is a common chronic skin disease characterized by recurrent skin inflammation and a weak skin barrier, and is known to be a precursor to other allergic diseases such as asthma. AD affects up to 25% of children worldwide and the incidence continues to rise. There is still uncertainty about the optimal treatment strategy in terms of choice of treatment, potency, duration and frequency. This study aims to develop a computational method to design optimal treatment strategies for the clinically recommended ‘proactive therapy’ for AD. Proactive therapy aims to prevent recurrent flares once the disease has been brought under initial control. Typically, this is done by using an anti-inflammatory treatment such as a potent topical corticosteroid intensively for a few weeks to ‘get control’, followed by intermittent weekly treatment to suppress subclinical inflammation to ‘keep control’. Using a hybrid mathematical model of AD pathogenesis that we recently proposed, we computationally derived the optimal treatment strategies for individual virtual patient cohorts, by recursively solving optimal control problems using a differential evolution algorithm. Our simulation results suggest that such an approach can inform the design of optimal individualized treatment schedules that include application of topical corticosteroids and emollients, based on the disease status of patients observed on their weekly hospital visits. We demonstrate the potential and the gaps of our approach to be applied to clinical settings.
Published: 2017
Full Text: View/download PDF

11. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches

Author: Sidbury, Robert, Tom, Wynnis L, Bergman, James N, Cooper, Kevin D, Silverman, Robert A, Berger, Timothy G, Chamlin, Sarah L, Cohen, David E, Cordoro, Kelly M, Davis, Dawn M, Feldman, Steven R, Hanifin, Jon M, Krol, Alfons, Margolis, David J, Paller, Amy S, Schwarzenberger, Kathryn, Simpson, Eric L, Williams, Hywel C, Elmets, Craig A, Block, Julie, Harrod, Christopher G, Smith Begolka, Wendy, and Eichenfield, Lawrence F
Subjects: topicals, Clinical Trials and Supportive Activities, Clinical Sciences, Dermatitis, complementary therapy, Atopic, aeroallergens, corticosteroids, Vaccine Related, Clinical Research, Hypersensitivity, Humans, flare, allergy testing, Skin, education, food allergy, Evidence-Based Medicine, atopic dermatitis, Prevention, Dermatology & Venereal Diseases, calcineurin inhibitors, Practice Guidelines as Topic, Dermatologic Agents, diet, Immunosuppressive Agents
Abstract: Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
Published: 2014

12. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents

Author: Sidbury, Robert, Davis, Dawn M, Cohen, David E, Cordoro, Kelly M, Berger, Timothy G, Bergman, James N, Chamlin, Sarah L, Cooper, Kevin D, Feldman, Steven R, Hanifin, Jon M, Krol, Alfons, Margolis, David J, Paller, Amy S, Schwarzenberger, Kathryn, Silverman, Robert A, Simpson, Eric L, Tom, Wynnis L, Williams, Hywel C, Elmets, Craig A, Block, Julie, Harrod, Christopher G, Begolka, Wendy Smith, Eichenfield, Lawrence F, and American Academy of Dermatology
Subjects: Clinical Sciences, Histamine Antagonists, Dermatitis, oral steroids, Atopic, methotrexate, systemic therapy, Interferon-gamma, Anti-Infective Agents, Azathioprine, oral antimicrobials, Humans, Immunologic Factors, Skin, atopic dermatitis, Inflammatory and immune system, Dermatology & Venereal Diseases, mycophenolate mofetil, oral antihistamines, Mycophenolic Acid, Phototherapy, photochemotherapy, cyclosporin A, interferon gamma, American Academy of Dermatology, Cyclosporine, Patient Safety
Abstract: Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.
Published: 2014

13. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis

Author: Eichenfield, Lawrence F, Tom, Wynnis L, Chamlin, Sarah L, Feldman, Steven R, Hanifin, Jon M, Simpson, Eric L, Berger, Timothy G, Bergman, James N, Cohen, David E, Cooper, Kevin D, Cordoro, Kelly M, Davis, Dawn M, Krol, Alfons, Margolis, David J, Paller, Amy S, Schwarzenberger, Kathryn, Silverman, Robert A, Williams, Hywel C, Elmets, Craig A, Block, Julie, Harrod, Christopher G, Smith Begolka, Wendy, and Sidbury, Robert
Subjects: Male, filaggrin, CDLQI, diagnosis, risk factors, International Study of Asthma and Allergies in Childhood, MDC, strength of recommendation taxonomy, Global Resource for Eczema Trials, Dermatitis, ISAAC, Comorbidity, Filaggrin Proteins, Severity of Illness Index, immunoglobulin E, Dermatitis Family Impact, UK, DLQI, Child, AAD, SORT, Skin, SCORing Atopic Dermatitis, screening and diagnosis, Evidence-Based Medicine, assessment scales, atopic dermatitis, interleukin, Eczema / Atopic Dermatitis, Age Factors, Prognosis, Three-Item Severity Scale, SASSAD, Detection, attention deficit hyperactivity disorder, American Academy of Dermatology, Eczema Area and Severity Index, Practice Guidelines as Topic, Neurological, clinical associations, Female, IgE, FLG, Adult, Adolescent, macrophage-derived chemoattractant, Clinical Sciences, POEM, EASI, thymus and activation-regulated chemokine, Risk Assessment, Atopic, Young Adult, SCORAD, Investigator's Global Assessment, Clinical Research, Children's Dermatology Life Quality Index, Humans, ADHD, Six Area, Physical Examination, IGA, TARC, criteria, Prevention, Dermatology & Venereal Diseases, TISS, biomarkers, AD, IL, Six Sign Atopic Dermatitis, United Kingdom, 4.1 Discovery and preclinical testing of markers and technologies, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Chronic Disease, Quality of Life, GREAT, DFI, Biomarkers
Abstract: Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and2% to 3% of adults. This guideline addresses important clinical questions that arise in the managementand care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed.Known risk factors for the development of disease are also reviewed.
Published: 2014

14. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bicer, Burcu Kucuk, Bienhoff, Kelly, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Blyth, Fiona M, Boneya, Dube Jara, Bose, Dipan, Bou-Orm, Ibrahim R, Bourne, Rupert R A, Brainin, Michael, Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J K, Briant, Paul S, Britton, Gabrielle, Brugha, Traolach S, Buchbinder, Rachelle, Bulto, Lemma Negesa Bulto, Bumgarner, Blair R, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Campos-Nonato, Ismael Ricardo, Carabin, Hélène, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Carvalho, Felix, Casey, Daniel, Castañeda-Orjuela, Carlos A, Castle, Chris D, Catalá-López, Ferrán, Chang, Jung-Chen, Charlson, Fiona J, Chaturvedi, Pankaj, Chen, Honglei, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Colombara, Danny, Cooper, Leslie Trumbull, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Dadi, Abel Fekadu, Dalal, Koustuv, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, das Neves, José, Davitoiu, Dragos V, Davletov, Kairat, de Courten, Barbora, De Leo, Diego, De Steur, Hans, Defo, Barthelemy Kuate, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Dicker, Daniel, Djalainia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Dorsey, E Ray, dos Santos, Kadine Priscila Bender, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Ebel, Beth E, Echko, Michelle, El-Khatib, Ziad Ziad, Enayati, Ahmadali, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshetie, Setegn, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fanuel, Fanuel Belayneh Bekele, Farag, Tamer, Farinha, Carla Sofia e Sa, 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Workicho, Abdulhalik, Xavier, Denis, Xu, Gelin, Yadgir, Simon, Yaghoubi, Mohsen, Yakob, Bereket, Yan, Lijing L, Yano, Yuichiro, Ye, Pengpeng, Yihdego, Mahari Gidey, Yimam, Hassen Hamid, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zenebe, Zerihun Menlkalew, Zhang, Xueying, Zheng, Yingfeng, Zhou, Maigeng, Zipkin, Ben, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, and Murray, Christopher J L
Subjects: 1. No poverty, 3. Good health

15. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Ampem, Yaw Amoako, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Arnlov, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Quintanilla, Beatriz Paulina Ayala, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Barnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Bejot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabe, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Blyth, Fiona M, Boneya, Dube Jara, Bose, Dipan, Bou-Orm, Ibrahim R, Bourne, Rupert RA, Brainin, Michael, Brayne, Carol EG, Brazinova, Alexandra, Breitborde, Nicholas JK, Briant, Paul S, Britton, Gabrielle, Brugha, Traolach S, Buchbinder, Rachelle, Bulto, Lemma Negesa Bulto, Bumgarner, Blair, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Ricardo Campos-Nonato, Ismael, Carabin, Helene, Cardenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Carvalho, Felix, Casey, Daniel, Castaneda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Castle, Chris D, Catala-Lopez, Ferran, Chang, Jung-Chen, Charlson, Fiona J, Chaturvedi, Pankaj, Chen, Honglei, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Colombara, Danny, Cooper, Leslie Trumbull, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Dadi, Abel Fekadu, Dalal, Koustuv, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, Das Neves, Jose, Davitoiu, Dragos V, Davletov, Kairat, De Courten, Barbora, De Leo, Diego, De Steur, Hans, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Dicker, Daniel, Djalalinia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Dorsey, E Ray, Bender Dos Santos, Kadine Priscila, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Ebel, Beth E, Echko, Michelle, El-Khatib, Ziad Ziad, Enayati, Ahmadali, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshetie, Setegn, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fanuel, Fanuel Belayneh Bekele, Farag, Tamer, Sofia, Carla, Farinha, Sa, Faro, Andre, Farzadfar, Farshad, Fazeli, Mir Sohail, Feigin, Valery L, Feigl, Andrea B, Fereshtehnejad, Seyed-Mohammad, Fernandes, Joao C, Ferrari, Alize J, Feyissa, Tesfaye Regassa, Filip, Irina, Fischer, Florian, Fitzmaurice, Christina, Flaxman, Abraham D, Foigt, Nataliya, Foreman, Kyle J, Franklin, Richard C, Frostad, Joseph J, Fullman, Nancy, Furst, Thomas, Furtado, Joao M, Futran, Neal D, Gakidou, Emmanuela, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Geleto, Ayele, Gemechu, Bikila Lencha, Gesesew, Hailay Abrha, Gething, Peter W, Ghajar, Alireza, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim Abdelmageem Mohamed, Gishu, Melkamu Dedefo, Giussani, Giorgia, Godwin, William W, Goel, Kashish, Goenka, Shifalika, Goldberg, Ellen M, Gona, Philimon N, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Goulart, Alessandra 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Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zenebe, Zerihun Menlkalew, Zhang, Xueying, Zheng, Yingfeng, Zhou, Maigeng, Zipkin, Ben, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, Murray, Christopher JL, and Collaborators, GBD DALYs HALE
Subjects: Adult, Aged, 80 and over, Male, 1. No poverty, Middle Aged, Global Health, Communicable Diseases, 3. Good health, Global Burden of Disease, Age Distribution, Life Expectancy, Residence Characteristics, Cause of Death, Humans, Wounds and Injuries, Disabled Persons, Female, sense organs, Quality-Adjusted Life Years, Sex Distribution, Noncommunicable Diseases, Aged
Abstract: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).

16. 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

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Ngunjiri, Josephine W, Nguyen, Anh Quynh, Nguyen, Grant, Nguyen, Ha Thu, Nguyen, Huong Lan Thi, Nguyen, Huong Thanh, Nguyen, Long Hoang, Nguyen, Minh, Nguyen, Nam Ba, Nguyen, Son Hoang, Nichols, Emma, Ningrum, Dina Nur Anggraini, Nixon, Molly R, Nomura, Shuhei, Noroozi, Mehdi, Norrving, Bo, Noubiap, Jean Jacques, Nouri, Hamid Reza, Shiadeh, Malihe Nourollahpour, Nowroozi, Mohammad Reza, Nsoesie, Elaine O, Nyasulu, Peter S, Odell, Christopher M, Ofori-Asenso, Richard, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olagunju, Andrew T, Olagunju, Tinuke O, Olivares, Pedro R, Olsen, Helen Elizabeth, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ong, Kanyin L, Ong, Sok King, Oren, Eyal, Ortiz, Alberto, Ota, Erika, Otstavnov, Stanislav S, Øverland, Simon, Owolabi, Mayowa Ojo, P A, Mahesh, Pacella, Rosana, Pakhare, Abhijit P, Pakpour, Amir H, Pana, Adrian, Panda-Jonas, Songhomitra, Park, Eun-Kee, Park, James, Parry, Charles D H, Parsian, Hadi, Pasdar, Yahya, Patel, Shanti, Patil, Snehal T, Patle, Ajay, Patton, George C, Paturi, Vishnupriya Rao, Paudel, Deepak, Paulson, Katherine R, Pearce, Neil, Pereira, Alexandre, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Pham, Hai Quang, Phillips, Michael R, Pigott, David M, Pillay, Julian David, Piradov, Michael A, Pirsaheb, Meghdad, Pishgar, Farhad, Plana-Ripoll, Oleguer, Polinder, Suzanne, Popova, Svetlana, Postma, Maarten J, Pourshams, Akram, Poustchi, Hossein, Prabhakaran, Dorairaj, Prakash, Swayam, Prakash, V, Prasad, Narayan, Purcell, Caroline A, Qorbani, Mostafa, Quistberg, D Alex, Radfar, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi, Kazem, Rahimi, Zohreh, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajati, Fatemeh, Ranjan, Prabhat, Rao, Puja C, Rasella, Davide, Rawaf, David Laith, Rawaf, Salman, Reddy, K Srinath, Reiner, Robert C, Reitsma, Marissa Bettay, Remuzzi, Giuseppe, Renzaho, Andre M N, Resnikoff, Serge, Rezaei, Satar, Rezai, Mohammad Sadegh, Ribeiro, Antonio Luiz P, Roberts, Nicholas L S, Robinson, Stephen R, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rostami, Ali, Roth, Gregory A, Rothenbacher, Dietrich, Rubagotti, Enrico, Sachdev, Perminder S, Sadat, Nafis, Sadeghi, Ehsan, Saeedi Moghaddam, Sahar, Safari, Hosein, Safari, Yahya, Safari-Faramani, Roya, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, Haniye Sadat, Salam, Nasir, Salama, Joseph S, Salamati, Payman, Saleem, Zikria, Salimi, Yahya, Salimzadeh, Hamideh, Salomon, Joshua A, Salvi, Sundeep Santosh, Salz, Inbal, Samy, Abdallah M, Sanabria, Juan, Sanchez-Niño, Maria Dolores, Santomauro, Damian Francesco, Santos, Itamar S, Santos, João Vasco, Santric Milicevic, Milena M, Sao Jose, Bruno Piassi, Sardana, Mayank, Sarker, Abdur Razzaque, Sarmiento-Suárez, Rodrigo, Sarrafzadegan, Nizal, Sartorius, Benn, Sarvi, Shahabeddin, Sathian, Brijesh, Satpathy, Maheswar, Sawant, Arundhati R, Sawhney, Monika, Saxena, Sonia, Schaeffner, Elke, Schmidt, Maria Inês, Schneider, Ione J C, Schutte, Aletta Elisabeth, Schwebel, David C, Schwendicke, Falk, Scott, James G, Sekerija, Mario, Sepanlou, Sadaf G, Serván-Mori, Edson, Seyedmousavi, Seyedmojtaba, Shabaninejad, Hosein, Shafieesabet, Azadeh, Shahbazi, Mehdi, Shaheen, Amira A, Shaikh, Masood Ali, Shams-Beyranvand, Mehran, Shamsi, Mohammadbagher, Sharafi, Heidar, Sharafi, Kiomars, Sharif, Mehdi, Sharif-Alhoseini, Mahdi, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikh, Aziz, Shi, Peilin, Shibuya, Kenji, Shiferaw, Mekonnen Sisay, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shiue, Ivy, Shokoohinia, Yalda, Shokraneh, Farhad, Shoman, Haitham, Shrime, Mark G, Si, Si, Siabani, Soraya, Sibai, Abla Mehio, Siddiqi, Tariq J, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silva, Diego Augusto Santos, Silva, João Pedro, Silveira, Dayane Gabriele Alves, Singam, Narayana Sarma Venkata, Singh, Jasvinder A, Singh, Narinder Pal, Singh, Virendra, Sinha, Dhirendra Narain, Skiadaresi, Eirini, Skirbekk, Vegard, Sliwa, Karen, Smith, David L, Smith, Mari, Soares Filho, Adauto Martins, Sobaih, Badr Hasan, Sobhani, Soheila, Soofi, Moslem, Sorensen, Reed J D, Soyiri, Ireneous N, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Stanaway, Jeffrey D, Starodubov, Vladimir I, Stein, Dan J, Steiner, Caitlyn, Steiner, Timothy J, Stokes, Mark A, Stovner, Lars Jacob, Subart, Michelle L, Sudaryanto, Agus, Sufiyan, Mu'awiyyah Babale, Sulo, Gerhard, Sunguya, Bruno F, Sur, Patrick John, Sykes, Bryan L, Sylaja, P N, Sylte, Dillon O, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadakamadla, Santosh Kumar, Tandon, Nikhil, Tassew, Segen Gebremeskel, Tavakkoli, Mohammad, Taveira, Nuno, Taylor, Hugh R, Tehrani-Banihashemi, Arash, Tekalign, Tigist Gashaw, Tekelemedhin, Shishay Wahdey, Tekle, Merhawi Gebremedhin, Temsah, Mohamad-Hani, Temsah, Omar, Terkawi, Abdullah Sulieman, Tessema, Belay, Teweldemedhin, Mebrahtu, Thankappan, Kavumpurathu Raman, Theis, Andrew, Thirunavukkarasu, Sathish, Thomas, Nihal, Tilahun, Binyam, To, Quyen G, Tonelli, Marcello, Topor-Madry, Roman, Torre, Anna E, Tortajada-Girbés, Miguel, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Towbin, Jeffrey A, Tran, Bach Xuan, Tran, Khanh Bao, Troeger, Christopher E, Tsadik, Afewerki Gebremeskel, Tsoi, Derrick, Tudor Car, Lorainne, Tyrovolas, Stefanos, Ukwaja, Kingsley Nnanna, Ullah, Irfan, Undurraga, Eduardo A, Updike, Rachel L, Usman, Muhammad Shariq, Uthman, Olalekan A, Vaduganathan, Muthiah, Vaezi, Afsane, Valdez, Pascual R, Varavikova, Elena, Varughese, Santosh, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Villafaina, Santos, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vosoughi, Kia, Vujcic, Isidora S, Wagnew, Fasil Shiferaw, Waheed, Yasir, Wang, Yafeng, Wang, Yuan-Pang, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Weldegebreal, Fitsum, Weldegwergs, Kidu Gidey, Werdecker, Andrea, West, T Eoin, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Wijeratne, Tissa, Williams, Hywel C, Wilner, Lauren B, Wilson, Shadrach, Winkler, Andrea Sylvia, Wiyeh, Alison B, Wiysonge, Charles Shey, Wolfe, Charles D A, Woolf, Anthony D, Wyper, Grant M A, Xavier, Denis, Xu, Gelin, Yadgir, Simon, Yahyazadeh Jabbari, Seyed Hossein, Yamada, Tomohide, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yasin, Yasin Jemal, Yeshaneh, Alex, Yimer, Ebrahim M, Yip, Paul, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Yousefifard, Mahmoud, Yu, Chuanhua, Zadnik, Vesna, Zaidi, Zoubida, Zaman, Sojib Bin, Zamani, Mohammad, Zandian, Hamed, Zar, Heather J, Zenebe, Zerihun Menlkalew, Zhou, Maigeng, Zipkin, Ben, Zodpey, Sanjay, Zucker, Inbar, Zuhlke, Liesl Joanna, and Murray, Christopher J L
Subjects: 1. No poverty, 3. Good health

17. Sunbed lentigines

Author: Williams, Hywel C, Salisbury, Jon, Brett, Judith, and du Vivier, Anthony
Subjects: Adult, Lentigo, Ultraviolet Rays, General Engineering, Papers and Short Reports, Humans, General Earth and Planetary Sciences, Female, General Medicine, Leg Dermatoses, Skin, General Environmental Science
Published: 1988

18. Specific allergen immunotherapy for the treatment of atopic eczema

Author: Ignacio García Núñez, Herman Tam, Helen Nankervis, Hywel C Williams, Moises A. Calderon, Stephen R. Durham, Logan Manikam, Robert J. Boyle, [Tam, Herman] Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Infect Dis, Paediat Sect, Wright Fleming Bldg,Norfolk Pl, London W2 1PG, England, [Manikam, Logan] Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Infect Dis, Paediat Sect, Wright Fleming Bldg,Norfolk Pl, London W2 1PG, England, [Boyle, Robert J.] Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Infect Dis, Paediat Sect, Wright Fleming Bldg,Norfolk Pl, London W2 1PG, England, [Calderon, Moises A.] Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Sect Inflammat Repair & Dev, Allergy & Clin Immunol, London, England, [Durham, Stephen] Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Sect Inflammat Repair & Dev, Allergy & Clin Immunol, London, England, [Nankervis, Helen] Univ Nottingham, Cochrane Skin Grp, Nottingham NG7 2RD, England, [Garcia Nunez, Ignacio] Hosp Univ Carlos Haya, Serv Alergol, Malaga, Spain, [Williams, Hywel C.] Univ Nottingham, Ctr Evidence Based Dermatol, Nottingham NG7 2RD, England, Imperial College, London, UK, University of Nottingham, UK, University of Malaga, Spain, National Institute for Health Research (NIHR), UK, NIHR, UK, National Institute for Health Research, [Tam,H, Manikam,L, Boyle,RJ] Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK. [Calderón,MA, Durham,S] Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK. [Narkervis,H] c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK. [García Núñez,I] Servicio de Alergología, Hospital Universitario Carlos Haya, Málaga, Spain. [Williams,HC] Centre of Evidence Based Dermatology, The University of Nottingham, Nottingham, UK., and Imperial College, London, UK. The University of Nottingham, UK. The University of Malaga, Spain.The National Institute for Health Research (NIHR), UK.
Subjects: Pathology, Dermatophagoides pteronyssinus, Dermatitis atópica, Cochrane Library, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 030207 dermatology & venereal diseases, 0302 clinical medicine, Alérgenos, Ensayos clínicos controlados aleatorizados como asunto, Organisms::Eukaryota::Animals [Medical Subject Headings], Pharmacology (medical), SCORAD, Child, Adjunctive treatment, Randomized Controlled Trials as Topic, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Controlled Clinical Trials as Topic::Randomized Controlled Trials as Topic [Medical Subject Headings], Dermatophagoides farinae, medicine.diagnostic_test, Adulto, Standard treatment, Double-blind, 11 Medical And Health Sciences, Organisms::Eukaryota::Animals::Invertebrates::Arthropods::Arachnida::Acari::Mites::Pyroglyphidae::Dermatophagoides farinae [Medical Subject Headings], Atopic dermatitis, Clinical improvement, Dermatophagoides-pteronyssinus, Humanos, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Immunomodulation::Immunotherapy::Immunosuppression::Desensitization, Immunologic [Medical Subject Headings], Organisms::Eukaryota::Animals::Invertebrates::Arthropods::Arachnida::Acari::Mites::Pyroglyphidae::Dermatophagoides pteronyssinus [Medical Subject Headings], Sensitized children, Niño, Adult, medicine.medical_specialty, Allergen immunotherapy, Nickel allergy, Placebo, Dermatitis, Atopic, 03 medical and health sciences, Oral hyposensitization, General & Internal Medicine, Internal medicine, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, Animals, Humans, Adverse effect, Named Groups::Persons::Age Groups::Child [Medical Subject Headings], Sublingual immunotherapy, business.industry, Diseases::Immune System Diseases::Hypersensitivity::Hypersensitivity, Immediate::Dermatitis, Atopic [Medical Subject Headings], Allergens, Desensibilización inmunológica, medicine.disease, Randomized controlled-trial, House-dust mites, 030228 respiratory system, Desensitization, Immunologic, Relative risk, Animales, Chemicals and Drugs::Biological Factors::Antigens::Allergens [Medical Subject Headings], business
Abstract: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review; BACKGROUND Specific allergen immunotherapy (SIT) is a treatment that may improve disease severity in people with atopic eczema (AE) by inducing immune tolerance to the relevant allergen. A high quality systematic review has not previously assessed the efficacy and safety of this treatment. OBJECTIVES To assess the effects of specific allergen immunotherapy (SIT), including subcutaneous, sublingual, intradermal, and oral routes, compared with placebo or a standard treatment in people with atopic eczema. SEARCH METHODS We searched the following databases up to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), Web of Science™ (from 2005), the Global Resource of EczemA Trials (GREAT database), and five trials databases. We searched abstracts from recent European and North American allergy meetings and checked the references of included studies and review articles for further references to relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of specific allergen immunotherapy that used standardised allergen extracts in people with AE. DATA COLLECTION AND ANALYSIS Two authors independently undertook study selection, data extraction (including adverse effects), assessment of risk of bias, and analyses. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 12 RCTs for inclusion in this review; the total number of participants was 733. The interventions included SIT in children and adults allergic to either house dust mite (10 trials), grass pollen, or other inhalant allergens (two trials). They were administered subcutaneously (six trials), sublingually (four trials), orally, or intradermally (two trials). Overall, the risk of bias was moderate, with high loss to follow up and lack of blinding as the main methodological concern.Our primary outcomes were 'Participant- or parent-reported global assessment of disease severity at the end of treatment'; 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'; and 'Adverse events, such as acute episodes of asthma or anaphylaxis'. SCORing Atopic Dermatitis (SCORAD) is a means of measuring the effect of atopic dermatitis by area (A); intensity (B); and subjective measures (C), such as itch and sleeplessness, which we used.For 'Participant- or parent-reported global assessment of disease severity at the end of treatment', one trial (20 participants) found improvement in 7/9 participants (78%) treated with the SIT compared with 3/11 (27%) treated with the placebo (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.02 to 7.96; P = 0.04). Another study (24 participants) found no difference: global disease severity improved in 8/13 participants (62%) treated with the SIT compared with 9/11 (81%) treated with the placebo (RR 0.75, 95% CI 0.45 to 1.26; P = 0.38). We did not perform meta-analysis because of high heterogeneity between these two studies. The quality of the evidence was low.For 'Participant- or parent-reported specific symptoms of eczema, by subjective measures', two trials (184 participants) did not find that the SIT improved SCORAD part C (mean difference (MD) -0.74, 95% CI -1.98 to 0.50) or sleep disturbance (MD -0.49, 95% CI -1.03 to 0.06) more than placebo. For SCORAD part C itch severity, these two trials (184 participants) did not find that the SIT improved itch (MD -0.24, 95% CI -1.00 to 0.52). One other non-blinded study (60 participants) found that the SIT reduced itch compared with no treatment (MD -4.20, 95% CI -3.69 to -4.71) and reduced the participants' overall symptoms (P < 0.01), but we could not pool these three studies due to high heterogeneity. The quality of the evidence was very low.Seven trials reported systemic adverse reactions: 18/282 participants (6.4%) treated with the SIT had a systemic reaction compared with 15/210 (7.1%) with no treatment (RR 0.78, 95% CI 0.41 to 1.49; the quality of the evidence was moderate). The same seven trials reported local adverse reactions: 90/280 participants (32.1%) treated with the SIT had a local reaction compared with 44/204 (21.6%) in the no treatment group (RR 1.27, 95% CI 0.89 to 1.81). As these had the same study limitations, we deemed the quality of the evidence to also be moderate.Of our secondary outcomes, there was a significant improvement in 'Investigator- or physician-rated global assessment of disease severity at the end of treatment' (six trials, 262 participants; RR 1.48, 95% CI 1.16 to 1.88). None of the studies reported our secondary outcome 'Parent- or participant-rated eczema severity assessed using a published scale', but two studies (n = 184), which have been mentioned above, used SCORAD part C, which we included as our primary outcome 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'.Our findings were generally inconclusive because of the small number of studies. We were unable to determine by subgroup analyses a particular type of allergen or a particular age or level of disease severity where allergen immunotherapy was more successful. We were also unable to determine whether sublingual immunotherapy was associated with more local adverse reactions compared with subcutaneous immunotherapy. AUTHORS' CONCLUSIONS Overall, the quality of the evidence was low. The low quality was mainly due to the differing results between studies, lack of blinding in some studies, and relatively few studies reporting participant-centred outcome measures. We found limited evidence that SIT may be an effective treatment for people with AE. The treatments used in these trials were not associated with an increased risk of local or systemic reactions. Future studies should use high quality allergen formulations with a proven track record in other allergic conditions and should include participant-reported outcome measures. Yes
Published: 2016

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18 results on '"Williams, Hywel C."'

1. Realising the full potential of data-enabled trials in the UK: a call for action

2. Additional file 1 of Two-by-two factorial randomised study within a trial (SWAT) to evaluate strategies for follow-up in a randomised prevention trial

3. Teledermatology for diagnosing skin cancer in adults

4. Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults

5. Visual inspection for diagnosing cutaneous melanoma in adults

6. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults

7. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study

8. 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

9. Child And Adolescent Health From 1990 To 2015

10. Supplementary material from Computational design of treatment strategies for proactive therapy on atopic dermatitis using optimal control theory

11. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches

12. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents

13. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis

14. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

15. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

16. 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

17. Sunbed lentigines

18. Specific allergen immunotherapy for the treatment of atopic eczema

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18 results on '"Williams, Hywel C."'

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