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1. Predictors of serum polychlorinated biphenyl concentrations in Anniston residents

Author: Pavuk, M, Olson, JR, Wattigney, WA, Dutton, ND, Sjödin, A, Shelton, C, Turner, WE, Bartell, SM, Bartell, S, Carpenter, DO, Cash, J, Foushee, R, Percy, A, Frumkin, H, Lavender, M, Moysich, K, Olson, J, Rosenbaum, P, Silverstone, A, and Weinstock, R
Subjects: Environmental Sciences
Abstract: The Anniston Community Health Survey was a community-based cross-sectional study of Anniston, Alabama, residents who live in close proximity to a former PCB production facility to identify factors associated with serum PCB levels. The survey comprises 765 Anniston residents who completed a questionnaire interview and provided a blood sample for analysis in 2005-2007. Several reports based on data from the Anniston survey have been previously published, including associations between PCB exposure and diabetes and blood pressure. In this study we examine demographic, behavioral, dietary, and occupational characteristics of Anniston survey participants as predictors of serum PCB concentrations. Of the 765 participants, 54% were White and 45% were African-American; the sample was predominantly female (70%), with a mean age of 55. years. Serum PCB concentrations varied widely between participants (range for sum of 35 PCBs: 0.11-170.4. ng/g wet weight). Linear regression models with stepwise selection were employed to examine factors associated with serum PCBs. Statistically significant positive associations were observed between serum PCB concentrations and age, race, residential variables, current smoking, and local fish consumption, as was a negative association with education level. Age and race were the most influential predictors of serum PCB levels. A small age by sex interaction was noted, indicating that the increase in PCB levels with age was steeper for women than for men. Significant interaction terms indicated that the associations between PCB levels and having ever eaten locally raised livestock and local clay were much stronger among African-Americans than among White participants. In summary, demographic variables and past consumption of locally produced foods were found to be the most important predictors of PCB concentrations in residents living in the vicinity of a former PCB manufacturing facility.
Published: 2014

2. E-watse in Africa: A serious threat to the health of children

Author: Lebbie, TS, Moyebi, OD, Asante, KA, Fobil, J, Brune-Drisse, MN, Suk, WA, Sly, Peter, Gorman, J, Carpenter, DO, Lebbie, TS, Moyebi, OD, Asante, KA, Fobil, J, Brune-Drisse, MN, Suk, WA, Sly, Peter, Gorman, J, and Carpenter, DO
Abstract: Waste electronic and electrical equipment (e-waste) consists of used and discarded electrical and electronic items ranging from refrigerators to cell phones and printed circuit boards. It is frequently moved from developed countries to developing countries where it is dismantled for valuable metals in informal settings, resulting in significant human exposure to toxic substances. E-waste is a major concern in Africa, with large sites in Ghana and Nigeria where imported e-waste is dismantled under unsafe conditions. However, as in many developing countries, used electronic and electrical devices are imported in large quantities because they are in great demand and are less expensive than new ones. Many of these used products are irreparable and are discarded with other solid waste to local landfills. These items are then often scavenged for the purpose of extracting valuable metals by heating and burning, incubating in acids and other methods. These activities pose significant health risks to workers and residents in communities near recycling sites. E-waste burning and dismantling activities are frequently undertaken at e-waste sites, often in or near homes. As a result, children and people living in the surrounding areas are exposed, even if they are not directly involved in the recycling. While toxic substances are dangerous to individuals at any age, children are more vulnerable as they are going through important developmental processes, and some adverse health impacts may have long-term impacts. We review the e-waste situation in Africa with a focus on threats to children’s health
Published: 2021

3. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Nichols, E, Szoeke, CEI, Vollset, SE, Abbasi, N, Abd-Allah, F, Abdela, J, Aichour, MTE, Akinyemi, RO, Alahdab, F, Asgedom, SW, Awasthi, A, Barker-Collo, SL, Baune, BT, Béjot, Y, Belachew, AB, Bennett, DA, Biadgo, B, Bijani, A, Bin Sayeed, MS, Brayne, C, Carpenter, DO, Carvalho, F, Catalá López, Ferrán, Cerin, E, Choi, JJ, Dang, AK, Degefa, MG, Djalalinia, S, Dubey, M, Duken, EE, Edvardsson, D, Endres, M, Eskandarieh, S, Faro, A, Farzadfar, F, Fereshtehnejad, SM, Fernandes, E, Filip, I, Fischer, F, and Gebre, AK
Subjects: Malalties mentals
Abstract: BACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide.
Published: 2019

4. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author: Wang, H, Liddell, CA, Coates, MM, Mooney, MD, Levitz, CE, Schumacher, AE, Apfel, H, Iannarone, M, Phillips, B, Lofgren, KT, Sandar, L, Dorrington, RE, Rakovac, I, Jacobs, TA, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, AA, Abera, SF, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, ZA, Allen, PJ, AlMazroa, MA, Alvarez, E, Amankwaa, AA, Amare, AT, Ammar, W, Anwari, P, Cunningham, SA, Asad, MM, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, ML, Bhutta, Z, Blore, JD, Basara, BB, Boufous, S, Breitborde, N, Bruce, NG, Bui, LN, Carapetis, JR, Cárdenas, R, Carpenter, DO, Caso, V, Castro, RE, Catalá-Lopéz, F, Cavlin, A, Che, X, Chiang, PP, Chowdhury, R, Christophi, CA, Chuang, TW, Cirillo, M, da Costa Leite, I, Courville, KJ, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, SD, Dherani, MK, Dilmen, U, Ding, EL, Edmond, KM, Ermakov, SP, Farzadfar, F, Fereshtehnejad, SM, Fijabi, DO, Foigt, N, Forouzanfar, MH, Garcia, AC, Geleijnse, JM, Gessner, BD, Goginashvili, K, Gona, P, Goto, A, Gouda, HN, Green, MA, Greenwell, KF, Gugnani, HC, Gupta, R, Hamadeh, RR, Hammami, M, Harb, HL, Hay, Simon, Hedayati, MT, Hosgood, HD, Hoy, DG, Idrisov, BT, Islami, F, Ismayilova, S, Jha, Vivekanand, Jiang, G, Jonas, JB, Juel, K, Kabagambe, EK, Kazi, DS, Kengne, AP, Kereselidze, M, Khader, YS, Khalifa, SE, Khang, YH, Kim, D, Kinfu, Y, Kinge, JM, Kokubo, Y, Kosen, S, Defo, BK, Kumar, GA, Kumar, K, Kumar, RB, Lai, T, Lan, Q, Larsson, A, Lee, JT, Leinsalu, M, Lim, SS, Lipshultz, SE, Logroscino, G, Lotufo, PA, Lunevicius, R, Lyons, RA, Ma, S, Mahdi, AA, Marzan, MB, Mashal, MT, Mazorodze, TT, McGrath, JJ, Memish, ZA, Mendoza, W, Mensah, GA, Meretoja, A, Miller, TR, Mills, EJ, Mohammad, KA, Mokdad, AH, Monasta, L, Montico, M, Moore, AR, Moschandreas, Joanna, Msemburi, WT, Mueller, UO, Muszynska, MM, Naghavi, M, Naidoo, KS, Narayan, KM, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, MJ, Nyakarahuka, L, Ohkubo, T, Omer, SB, Caicedo, AJ, Pillay-van Wyk, V, Pope, D, Pourmalek, F, Prabhakaran, D, Rahman, SU, Rana, SM, Reilly, RQ, Rojas-Rueda, D, Ronfani, L, Rushton, L, Saeedi, MY, Salomon, JA, Sampson, U, Santos, IS, Sawhney, M, Schmidt, JC, Shakh-Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, HH, Shishani, K, Shiue, I, Sigfusdottir, ID, Singh, JA, Skirbekk, V, Sliwa, K, Soshnikov, SS, Sposato, LA, Stathopoulou, VK, Stroumpoulis, K, Tabb, KM, Talongwa, RT, Teixeira, CM, Terkawi, AS, Thomson, AJ, Thorne-Lyman, AL, Toyoshima, H, Dimbuene, ZT, Uwaliraye, P, Uzun, SB, Vasankari, TJ, Vasconcelos, AM, Vlassov, VV, Vollset, SE, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, RG, Westerman, R, Wilkinson, JD, Williams, HC, Yang, YC, Yentur, GK, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, KY, El Sayed Zaki, M, Zhu, S, Vos, T, Lopez, AD, and Murray, CJ
Abstract: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.
Published: 2018

5. Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

Author: Mokdad, AH, Moradi-Lakeh, M, El Bcheraoui, C, Khalil, I, Charara, R, Afshin, A, Wang, H, Collison, M, Krohn, KJ, Chew, A, Daoud, F, Blosser, CD, Cornaby, L, Foreman, KJ, Kassebaum, NJ, Kemmer, L, Kutz, M, Liu, P, Zipkin, B, Arnlov, J, Abate, KH, Ahmadi, A, Ahmadieh, H, Ahmed, MB, Al-Aly, Z, Alam, K, Alasfoor, D, Ali, R, Alizadeh-Navaei, R, Alkaabi, JM, Alkerwi, A, Al-Raddadi, R, Altirkawi, KA, Alvis-Guzman, N, Amini, E, Anber, N, Anwari, P, Asgedom, SW, Atey, TM, Avila-Burgos, L, Awasthi, A, Azzopardi, P, Baernighausen, T, Bacha, U, Barac, A, Bazargan-Hejazi, S, Drew, CR, Geffen, D, Bedi, N, Berhe, DF, Beyene, AS, Bhutta, ZA, Bikbov, B, Birhanu, MM, Butt, ZA, Cahuana-Hurtado, L, Carpenter, DO, Carrero, JJ, Choi, J-YJJ, Danawi, H, Dharmaratne, SD, Ding, EL, Djalalinia, S, Doyle, KE, Ebrahimi, H, Endries, AY, Esteghamati, A, Farvid, MS, Fereshtehnejad, S-M, Feyissa, TR, Fischer, F, Gebrehiwot, TT, Gona, PN, Gopalani, SV, Gyawali, B, Hafezi-Nejad, N, Hamadeh, RR, Hamidi, S, Horino, M, Hsairi, M, Jakovljevic, MB, Jimenez-Corona, A, John, D, Jonas, JB, Kasaeian, A, Kengne, AP, Ketema, EB, Khader, YS, Khan, EA, Kim, D, Kim, YJ, Kinfu, Y, Kissimova-Skarbek, KA, Koyanagi, A, Larson, HJ, Larsson, A, Li, Y, Lotufo, PA, Lunevicius, R, Majeed, A, Malekzadeh, R, Malta, DC, Mazidi, M, Memish, ZA, Mendoza, W, Mengistie, MA, Mensah, GA, Mezgebe, HB, Miller, TR, Mohammed, MSK, Mohammed, S, Mueller, UO, Nagel, G, Cuong, TN, Quyen, LN, Vuong, MN, Noubiap, JJN, Ogbo, FA, Ortiz, A, Ota, E, Patel, T, Pearson-Stuttard, J, Perico, N, Petzold, M, Pishgar, F, Pourmalek, F, Qorbani, M, Rahimi-Movaghar, V, Rai, RK, Rana, SM, Rawaf, DL, Rawaf, S, Remuzzi, G, Renzaho, AMNN, Rezaei, S, Roshandel, G, Bacher, DR, Safdarian, M, Safi, S, Safiri, S, Sahraian, MA, Salamati, P, Samy, AM, Sanabria, JR, Dolores Sanchez-Nino, M, Milicevic, MMS, Sartorius, B, Sepanlou, SG, Shaikh, MA, Santos Silva, DA, Alves Silveira, DG, Sobaih, BHA, Abdulkader, RS, Tabares-Seisdedos, R, Tehrani-Banihashemi, A, Temsah, M-H, Topor-Madry, R, Tran, BX, Ukwaja, KN, Uthman, OA, van Boven, JFM, Wakayo, T, Werdecker, A, Workicho, A, Yaghoubi, M, Yano, Y, Yaseri, M, Yonemoto, N, Younis, MZ, Zhang, AL, Jumaan, AO, Vos, T, Naghavi, M, Hay, SI, Murray, CJL, Mokdad, AH, Moradi-Lakeh, M, El Bcheraoui, C, Khalil, I, Charara, R, Afshin, A, Wang, H, Collison, M, Krohn, KJ, Chew, A, Daoud, F, Blosser, CD, Cornaby, L, Foreman, KJ, Kassebaum, NJ, Kemmer, L, Kutz, M, Liu, P, Zipkin, B, Arnlov, J, Abate, KH, Ahmadi, A, Ahmadieh, H, Ahmed, MB, Al-Aly, Z, Alam, K, Alasfoor, D, Ali, R, Alizadeh-Navaei, R, Alkaabi, JM, Alkerwi, A, Al-Raddadi, R, Altirkawi, KA, Alvis-Guzman, N, Amini, E, Anber, N, Anwari, P, Asgedom, SW, Atey, TM, Avila-Burgos, L, Awasthi, A, Azzopardi, P, Baernighausen, T, Bacha, U, Barac, A, Bazargan-Hejazi, S, Drew, CR, Geffen, D, Bedi, N, Berhe, DF, Beyene, AS, Bhutta, ZA, Bikbov, B, Birhanu, MM, Butt, ZA, Cahuana-Hurtado, L, Carpenter, DO, Carrero, JJ, Choi, J-YJJ, Danawi, H, Dharmaratne, SD, Ding, EL, Djalalinia, S, Doyle, KE, Ebrahimi, H, Endries, AY, Esteghamati, A, Farvid, MS, Fereshtehnejad, S-M, Feyissa, TR, Fischer, F, Gebrehiwot, TT, Gona, PN, Gopalani, SV, Gyawali, B, Hafezi-Nejad, N, Hamadeh, RR, Hamidi, S, Horino, M, Hsairi, M, Jakovljevic, MB, Jimenez-Corona, A, John, D, Jonas, JB, Kasaeian, A, Kengne, AP, Ketema, EB, Khader, YS, Khan, EA, Kim, D, Kim, YJ, Kinfu, Y, Kissimova-Skarbek, KA, Koyanagi, A, Larson, HJ, Larsson, A, Li, Y, Lotufo, PA, Lunevicius, R, Majeed, A, Malekzadeh, R, Malta, DC, Mazidi, M, Memish, ZA, Mendoza, W, Mengistie, MA, Mensah, GA, Mezgebe, HB, Miller, TR, Mohammed, MSK, Mohammed, S, Mueller, UO, Nagel, G, Cuong, TN, Quyen, LN, Vuong, MN, Noubiap, JJN, Ogbo, FA, Ortiz, A, Ota, E, Patel, T, Pearson-Stuttard, J, Perico, N, Petzold, M, Pishgar, F, Pourmalek, F, Qorbani, M, Rahimi-Movaghar, V, Rai, RK, Rana, SM, Rawaf, DL, Rawaf, S, Remuzzi, G, Renzaho, AMNN, Rezaei, S, Roshandel, G, Bacher, DR, Safdarian, M, Safi, S, Safiri, S, Sahraian, MA, Salamati, P, Samy, AM, Sanabria, JR, Dolores Sanchez-Nino, M, Milicevic, MMS, Sartorius, B, Sepanlou, SG, Shaikh, MA, Santos Silva, DA, Alves Silveira, DG, Sobaih, BHA, Abdulkader, RS, Tabares-Seisdedos, R, Tehrani-Banihashemi, A, Temsah, M-H, Topor-Madry, R, Tran, BX, Ukwaja, KN, Uthman, OA, van Boven, JFM, Wakayo, T, Werdecker, A, Workicho, A, Yaghoubi, M, Yano, Y, Yaseri, M, Yonemoto, N, Younis, MZ, Zhang, AL, Jumaan, AO, Vos, T, Naghavi, M, Hay, SI, and Murray, CJL
Abstract: OBJECTIVES: We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990-2015. METHODS: We extracted GBD 2015 estimates for prevalence, mortality, and disability-adjusted life years (DALYs) of diabetes (including burden of low vision due to diabetes, neuropathy, and amputations and CKD-DM for 22 countries of the EMR from the GBD visualization tools. RESULTS: In 2015, 135,230 (95% UI 123,034-148,184) individuals died from diabetes and 16,470 (95% UI 13,977-18,961) from CKD-DM, 216 and 179% increases, respectively, compared to 1990. The total number of people with diabetes was 42.3 million (95% UI 38.6-46.4 million) in 2015. DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI). CONCLUSIONS: Our study showed a large and increasing burden of diabetes in the region. There is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.
Published: 2018

6. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Author: Vos, T, Barber, Rm, Bell, B, Bertozzi Villa, A, Biryukov, S, Bolliger, I, Charlson, F, Davis, A, Degenhardt, L, Dicker, D, Duan, L, Erskine, H, Feigin, Vl, Ferrari, Aj, Fitzmaurice, C, Fleming, T, Graetz, N, Guinovart, C, Haagsma, J, Hansen, Gm, Hanson, Sw, Heuton, Kr, Higashi, H, Kassebaum, N, Kyu, H, Laurie, E, Liang, X, Lofgren, K, Lozano, R, Macintyre, Mf, Moradi Lakeh, M, Naghavi, M, Nguyen, G, Odell, S, Ortblad, K, Roberts, Da, Roth, Ga, Sandar, L, Serina, Pt, Stanaway, Jd, Steiner, C, Thomas, B, Vollset, Se, Whiteford, H, Wolock, Tm, Ye, P, Zhou, M, Ãvila, Ma, Aasvang, Gm, Abbafati, C, Abbasoglu, Ozgoren, A, Abd Allah, F, Abdel, Aziz, Abera, Sf, Aboyans, V, Abraham, Jp, Abraham, B, Abubakar, I, Abu Raddad, Lj, Abu Rmeileh, Nm, Aburto, Tc, Achoki, T, Ackerman, In, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Arnlov, J, Agardh, Ee, Khabouri, Al, Alam, Ss, Alasfoor, D, Albittar, Mi, Alegretti, Ma, Aleman, Av, Alemu, Za, Alfonso Cristancho, R, Alhabib, S, Ali, R, Alla, F, Allebeck, P, Allen, Pj, Almazroa, Ma, Alsharif, U, Alvarez, E, Alvis, Guzman, Ameli, N, O, Amini, H, Ammar, W, Anderson, Bo, Anderson, Hr, Antonio, Ca, Anwari, P, Apfel, H, Arsenijevic, Vs, Artaman, A, Asghar, Rj, Assadi, R, Atkins, Ls, Atkinson, C, Badawi, A, Bahit, Mc, Bakfalouni, T, Balakrishnan, K, Balalla, S, Banerjee, A, Barker Collo, Sl, Barquera, S, Barregard, L, Barrero, Lh, Basu, S, Basu, A, Baxter, A, Beardsley, J, Bedi, N, Beghi, E, Bekele, T, Bell, Ml, Benjet, C, Bennett, Da, Bensenor, Im, Benzian, H, Bernabe, E, Beyene, Tj, Bhala, N, Bhalla, A, Bhutta, Z, Bienhoff, K, Bikbov, B, Bin, Abdulhak, Blore, Jd, Blyth, Fm, Bohensky, Ma, Bora, Basara, B, Borges, G, Bornstein, Nm, Bose, D, Boufous, S, Bourne, Rr, Boyers, Ln, Brainin, M, Brauer, M, Brayne, Ce, Brazinova, A, Breitborde, Nj, Brenner, H, Briggs, Ad, Brooks, Pm, Brown, J, Brugha, Ts, Buchbinder, R, Buckle, Gc, Bukhman, G, Bulloch, Ag, Burch, M, Burnett, R, Cardenas, R, Cabral, Nl, Campos, Nonato, Campuzano, Ir, Carapetis, Jc, Carpenter, Do, Caso, V, Castaneda Orjuela, Ca, Catala Lopez, F, Chadha, Vk, Chang, Jc, Chen, H, Chen, W, Chiang, Pp, Chimed Ochir, O, Chowdhury, R, Christensen, H, Christophi, Ca, Chugh, Ss, Cirillo, Massimo, Coggeshall, M, Cohen, A, Colistro, V, Colquhoun, Sm, Contreras, Ag, Cooper, Lt, Cooper, C, Cooperrider, K, Coresh, J, Cortinovis, M, Criqui, Mh, Crump, Ja, Cuevas Nasu, L, Dandona, R, Dandona, L, Dansereau, E, Dantes, Hg, Dargan, Pi, Davey, G, Davitoiu, Dv, Dayama, A, La, De, Cruz, Gongora, De, V, Vega, La, De, Sf, Leo, D, Del, Pozo, Cruz, Dellavalle, Rp, Deribe, K, Derrett, S, Des, Jarlais, Dessalegn, M, Deveber, Ga, Dharmaratne, Sd, Diaz Torne, C, Ding, El, Dokova, K, Dorsey, Er, Driscoll, Tr, Duber, H, Durrani, Am, Edmond, Km, Ellenbogen, Rg, Endres, M, Ermakov, Sp, Eshrati, B, Esteghamati, A, Estep, K, Fahimi, S, Farzadfar, F, Fay, Df, Felson, Dt, Fereshtehnejad, Sm, Fernandes, Jg, Ferri, Cp, Flaxman, A, Foigt, N, Foreman, Kj, Fowkes, Fg, Franklin, Rc, Furst, T, Futran, Nd, Gabbe, Bj, Gankpe, Fg, Garcia, Guerra, Geleijnse, Fa, Gessner, Bd, Gibney, Kb, Gillum, Rf, Ginawi, Ia, Giroud, M, Giussani, G, Goenka, S, Goginashvili, K, Gona, P, Gonzalez, De, Cosio, T, Gosselin, Ra, Gotay, Cc, Goto, A, Gouda, Hn, Guerrant, Rl, Gugnani, Hc, Gunnell, D, Gupta, R, Gutierrez, Ra, Hafezi Nejad, N, Hagan, H, Halasa, Y, Hamadeh, Rr, Hamavid, H, Hammami, M, Hankey, Gj, Hao, Y, Harb, Hl, Haro, Jm, Havmoeller, R, Hay, Rj, Hay, S, Hedayati, Mt, Heredia, Pi, Heydarpour, P, Hijar, M, Hoek, Hw, Hoffman, Hj, Hornberger, Jc, Hosgood, Hd, Hossain, M, Hotez, Pj, Hoy, Dg, Hsairi, M, Hu, H, Hu, G, Huang, Jj, Huang, C, Huiart, L, Husseini, A, Iannarone, M, Iburg, Km, Innos, K, Inoue, M, Jacobsen, Kh, Jassal, Sk, Jeemon, P, Jensen, Pn, Jha, V, Jiang, G, Jiang, Y, Jonas, Jb, Joseph, J, Juel, K, Kan, H, Karch, A, Karimkhani, C, Karthikeyan, G, Katz, R, Kaul, A, Kawakami, N, Kazi, Ds, Kemp, Ah, Kengne, Ap, Khader, Ys, Khalifa, Se, Khan, Ea, Khan, G, Khang, Yh, Khonelidze, I, Kieling, C, Kim, D, Kim, S, Kimokoti, Rw, Kinfu, Y, Kinge, Jm, Kissela, Bm, Kivipelto, M, Knibbs, L, Knudsen, Ak, Kokubo, Y, Kosen, S, Kramer, A, Kravchenko, M, Krishnamurthi, Rv, Krishnaswami, S, Kuate, Defo, Kucuk, B, Bicer, B, Kuipers, Ej, Kulkarni, Vs, Kumar, K, Kumar, Ga, Kwan, Gf, Lai, T, Lalloo, R, Lam, H, Lan, Q, Lansingh, Vc, Larson, H, Larsson, A, Lawrynowicz, Ae, Leasher, Jl, Lee, Jt, Leigh, J, Leung, R, Levi, M, Li, B, Li, Y, Liang, J, Lim, S, Lin, Hh, Lind, M, Lindsay, Mp, Lipshultz, Se, Liu, S, Lloyd, Bk, Lockett, Ohno, S, Logroscino, G, Looker, Kj, Lopez, Ad, Lopez Olmedo, N, Lortet Tieulent, J, Lotufo, Pa, Low, N, Lucas, Rm, Lunevicius, R, Lyons, Ra, Ma, J, Ma, S, Mackay, Mt, Majdan, M, Malekzadeh, R, Mapoma, Cc, Marcenes, W, March, Lm, Margono, C, Marks, Gb, Marzan, Mb, Masci, Jr, Mason Jones, Aj, Matzopoulos, Rg, Mayosi, Bm, Mazorodze, Tt, Mcgill, Nw, Mcgrath, Jj, Mckee, M, Mclain, A, Mcmahon, Bj, Meaney, Pa, Mehndiratta, Mm, Mejia Rodriguez, F, Mekonnen, W, Melaku, Ya, Meltzer, M, Memish, Za, Mensah, G, Meretoja, A, Mhimbira, Fa, Micha, R, Miller, Tr, Mills, Ej, Mitchell, Pb, Mock, Cn, Moffitt, Te, Mohamed, Ibrahim, N, Mohammad, Ka, Mokdad, Ah, Mola, Gl, Monasta, L, Montico, M, Montine, Tj, Moore, Ar, Moran, Ae, Morawska, L, Mori, R, Moschandreas, J, Moturi, Wn, Moyer, M, Mozaffarian, D, Mueller, Uo, Mukaigawara, M, Murdoch, Me, Murray, J, Murthy, Ks, Naghavi, P, Nahas, Z, Naheed, A, Naidoo, Ks, Naldi, L, Nand, D, Nangia, V, Narayan, Km, Nash, D, Nejjari, C, Neupane, Sp, Newman, Lm, Newton, Cr, Ng, M, Ngalesoni, Fn, Nhung, Nt, Nisar, Mi, Nolte, S, Norheim, Of, Norman, Re, Norrving, B, Nyakarahuka, L, Ih, Oh, Ohkubo, T, Omer, Sb, Opio, Jn, Ortiz, A, Pandian, Jd, Panelo, Ci, Papachristou, C, Park, Ek, Parry, Cd, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pedraza, Ls, Pellegrini, Ca, Pereira, Dm, Perez Ruiz, Fp, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, Cb, Petzold, M, Phillips, Mr, Phillips, D, Phillips, B, Piel, Fb, Plass, D, Poenaru, D, Polanczyk, Gv, Polinder, S, Pope, Ca, Popova, S, Poulton, Rg, Pourmalek, F, Prabhakaran, D, Prasad, Nm, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi Movaghar, V, Rahman, Su, Raju, M, Rakovac, I, Rana, Sm, Razavi, H, Refaat, A, Rehm, J, Remuzzi, G, Resnikoff, S, Ribeiro, Al, Riccio, Pm, Richardson, L, Richardus, Jh, Riederer, Am, Robinson, M, Roca, A, Rodriguez, A, Rojas Rueda, D, Ronfani, L, Rothenbacher, D, Roy, N, Ruhago, Gm, Sabin, N, Sacco, Rl, Ksoreide, K, Saha, S, Sahathevan, R, Sahraian, Ma, Sampson, U, Sanabria, Jr, Sanchez Riera, L, Santos, Is, Satpathy, M, Saunders, Je, Sawhney, M, Saylan, Mi, Scarborough, P, Schoettker, B, Schneider, Ij, Schwebel, Dc, Scott, Jg, Seedat, S, Sepanlou, Sg, Serdar, B, Servan Mori, Ee, Shackelford, K, Shaheen, A, Shahraz, S, Shamah, Levy, T, Shangguan, S, She, J, Sheikhbahaei, S, Shepard, Ds, Shi, P, Shibuya, K, Shinohara, Y, Shiri, R, Shishani, K, Shiue, I, Shrime, Mg, Sigfusdottir, Id, Silberberg, Dh, Simard, Ep, Sindi, S, Singh, Ja, Singh, L, Skirbekk, V, Sliwa, K, Soljak, M, Soneji, S, Soshnikov, Ss, Speyer, P, Sposato, La, Sreeramareddy, Ct, Stoeckl, H, Stathopoulou, Vk, Steckling, N, Stein, Mb, Stein, Dj, Steiner, Tj, Stewart, A, Stork, E, Stovner, Lj, Stroumpoulis, K, Sturua, L, Sunguya, Bf, Swaroop, M, Sykes, Bl, Tabb, Km, Takahashi, K, Tan, F, Tandon, N, Tanne, D, Tanner, M, Tavakkoli, M, Taylor, Hr, Ao, Te, Temesgen, Am, Ten, Have, M, Tenkorang, Ey, Terkawi, As, Theadom, Am, Thomas, E, Thorne Lyman, Al, Thrift, Ag, Tleyjeh, Im, Tonelli, M, Topouzis, F, Towbin, Ja, Toyoshima, H, Traebert, J, Tran, Bx, Trasande, L, Trillini, M, Truelsen, T, Trujillo, U, Tsilimbaris, M, Tuzcu, Em, Ukwaja, Kn, Undurraga, Ea, Uzun, Sb, Van, Brakel, Van, Wh, Vijver, De, Van, S, Dingenen, R, Van, Gool, Varakin, Yy, Vasankari, Tj, Vavilala, Ms, Veerman, Lj, Velasquez, Melendez, G, Venketasubramanian, N, Vijayakumar, L, Villalpando, S, Violante, Fs, Vlassov, Vv, Waller, S, Wallin, Mt, Wan, X, Wang, L, Wang, J, Wang, Y, Warouw, Ts, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Werdecker, A, Wessells, Kr, Westerman, R, Wilkinson, Jd, Williams, Hc, Williams, Tn, Woldeyohannes, Sm, Wolfe, Cd, Wong, Jq, Wong, H, Woolf, Ad, Wright, Jl, Wurtz, B, Xu, G, Yang, G, Yano, Y, Yenesew, Ma, Yentur, Gk, Yip, P, Yonemoto, N, Yoon, Sj, Younis, M, Yu, C, Kim, Ky, Zaki, Mel, Zhang, Y, Zhao, Z, Zhao, Y, Zhu, J, Zonies, D, Zunt, Jr, Salomon, Ja, Murray, C. J., Vos, T, Barber, Rm, Bell, B, Bertozzi-Villa, A, Biryukov, S, Bolliger, I, Charlson, F, Davis, A, Degenhardt, L, Dicker, D, Duan, L, Erskine, H, Feigin, Vl, Ferrari, Aj, Fitzmaurice, C, Fleming, T, Graetz, N, Guinovart, C, Haagsma, J, Hansen, Gm, Hanson, Sw, Heuton, Kr, Higashi, H, Kassebaum, N, Kyu, H, Laurie ELiang, X, Lofgren, K, Lozano, R, Macintyre, Mf, Moradi-Lakeh, M, Naghavi, M, Nguyen, G, Odell, S, Ortblad, K, Roberts, Da, Roth, Ga, Sandar, L, Serina, Pt, Stanaway, Jd, Steiner, C, Thomas, B, Vollset, Se, Whiteford, H, Wolock, Tm, Ye, P, Zhou, M, Ãvila, Ma, Aasvang, Gm, Abbafati, C, Abbasoglu Ozgoren, A, Abd-Allah, F, Abdel Aziz MI, Abera, Sf, Aboyans, V, Abraham, Jp, Abraham, B, Abubakar, I, Abu-Raddad, Lj, Abu-Rmeileh, Nm, Aburto, Tc, Achoki TAckerman IN, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Arnlov, J, Agardh, Ee, Al Khabouri MJ, Alam, S, Alasfoor, D, Albittar, Mi, Alegretti MAAleman AV, Alemu, Za, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Alla, F, Allebeck, P, Allen, Pj, Almazroa, Ma, Alsharif, U, Alvarez, E, Alvis-Guzman NAmeli, O, Amini, H, Ammar, W, Anderson, Bo, Anderson, Hr, Antonio, Ca, Anwari, P, Apfel, H, Arsenijevic, V, Artaman, A, Asghar, Rj, Assadi, R, Atkins, L, Atkinson, C, Badawi, A, Bahit, Mc, Bakfalouni, T, Balakrishnan, K, Balalla, S, Banerjee, A, Barker-Collo, Sl, Barquera, S, Barregard, L, Barrero LHBasu, S, Basu, A, Baxter, A, Beardsley, J, Bedi, N, Beghi, E, Bekele, T, Bell, Ml, Benjet, C, Bennett, Da, Bensenor, Im, Benzian, H, Bernabe, E, Beyene TJBhala, N, Bhalla, A, Bhutta, Z, Bienhoff, K, Bikbov, B, Bin Abdulhak, A, Blore, Jd, Blyth, Fm, Bohensky, Ma, Bora Basara, B, Borges, G, Bornstein, Nm, Bose, D, Boufous, S, Bourne, Rr, Boyers, Ln, Brainin, M, Brauer, M, Brayne, Ce, Brazinova, A, Breitborde, Nj, Brenner, H, Briggs, Ad, Brooks, Pm, Brown JBrugha TS, Buchbinder, R, Buckle, Gc, Bukhman, G, Bulloch, Ag, Burch, M, Burnett, R, Cardenas, R, Cabral, Nl, Campos Nonato IR, Campuzano JCCarapetis JR, Carpenter, Do, Caso, V, Castaneda-Orjuela, Ca, Catala-Lopez, F, Chadha, Vk, Chang, Jc, Chen, H, Chen, W, Chiang, Pp, Chimed-Ochir, O, Chowdhury, R, Christensen, H, Christophi, Ca, Chugh, S, Cirillo, M, Coggeshall, M, Cohen, A, Colistro, V, Colquhoun, Sm, Contreras, Ag, Cooper LTCooper, C, Cooperrider, K, Coresh, J, Cortinovis, M, Criqui, Mh, Crump, Ja, Cuevas-Nasu, L, Dandona, R, Dandona, L, Dansereau, E, Dantes, Hg, Dargan, Pi, Davey, G, Davitoiu, Dv, Dayama, A, De la Cruz-Gongora, V, de la Vega SF, De Leo, D, del Pozo-Cruz, B, Dellavalle, Rp, Deribe, K, Derrett, S, Des Jarlais DC, Dessalegn, M, Deveber, Ga, Dharmaratne, Sd, Diaz-Torne, C, Ding, El, Dokova, K, Dorsey, Er, Driscoll, Tr, Duber, H, Durrani, Am, Edmond, Km, Ellenbogen, Rg, Endres, M, Ermakov, Sp, Eshrati, B, Esteghamati, A, Estep, K, Fahimi, S, Farzadfar, F, Fay, Df, Felson, Dt, Fereshtehnejad SMFernandes JG, Ferri, Cp, Flaxman, A, Foigt, N, Foreman, Kj, Fowkes, Fg, Franklin, Rc, Furst, T, Futran, Nd, Gabbe, Bj, Gankpe, Fg, Garcia-Guerra FAGeleijnse JM, Gessner, Bd, Gibney, Kb, Gillum, Rf, Ginawi, Ia, Giroud, M, Giussani, G, Goenka, S, Goginashvili, K, Gona, P, Gonzalez de Cosio TGosselin RA, Gotay, Cc, Goto, A, Gouda, Hn, Guerrant, Rl, Gugnani, Hc, Gunnell, D, Gupta, R, Gutierrez, Ra, Hafezi-Nejad, N, Hagan HHalasa, Y, Hamadeh, Rr, Hamavid, H, Hammami, M, Hankey, Gj, Hao, Y, Harb, Hl, Haro, Jm, Havmoeller, R, Hay, Rj, Hay, S, Hedayati, Mt, Heredia Pi IB, Heydarpour, P, Hijar, M, Hoek, Hw, Hoffman, Hj, Hornberger, Jc, Hosgood, Hd, Hossain, M, Hotez, Pj, Hoy, Dg, Hsairi, M, Hu, H, Hu, G, Huang JJHuang, C, Huiart, L, Husseini, A, Iannarone, M, Iburg, Km, Innos, K, Inoue, M, Jacobsen, Kh, Jassal, Sk, Jeemon, P, Jensen, Pn, Jha, V, Jiang, G, Jiang YJonas JB, Joseph, J, Juel, K, Kan, H, Karch, A, Karimkhani, C, Karthikeyan, G, Katz, R, Kaul, A, Kawakami, N, Kazi, D, Kemp, Ah, Kengne, Ap, Khader, Y, Khalifa, Se, Khan, Ea, Khan, G, Khang, Yh, Khonelidze, I, Kieling, C, Kim, D, Kim, S, Kimokoti, Rw, Kinfu, Y, Kinge, Jm, Kissela, Bm, Kivipelto MKnibbs, L, Knudsen, Ak, Kokubo, Y, Kosen, S, Kramer, A, Kravchenko, M, Krishnamurthi, Rv, Krishnaswami, S, Kuate Defo, B, Kucuk Bicer, B, Kuipers EJKulkarni VS, Kumar, K, Kumar, Ga, Kwan, Gf, Lai, T, Lalloo, R, Lam, H, Lan, Q, Lansingh, Vc, Larson, H, Larsson, A, Lawrynowicz, Ae, Leasher, Jl, Lee, Jt, Leigh, J, Leung, R, Levi, M, Li, B, Li, Y, Liang, J, Lim, S, Lin, Hh, Lind, M, Lindsay, Mp, Lipshultz, Se, Liu, S, Lloyd, Bk, Lockett Ohno, S, Logroscino, G, Looker, Kj, Lopez, Ad, Lopez-Olmedo, N, Lortet-Tieulent, J, Lotufo, Pa, Low, N, Lucas, Rm, Lunevicius, R, Lyons, Ra, Ma, J, Ma, S, Mackay MTMajdan, M, Malekzadeh, R, Mapoma, Cc, Marcenes, W, March, Lm, Margono, C, Marks, Gb, Marzan, Mb, Masci, Jr, Mason-Jones, Aj, Matzopoulos RGMayosi BM, Mazorodze, Tt, Mcgill, Nw, Mcgrath, Jj, Mckee, M, Mclain, A, Mcmahon, Bj, Meaney, Pa, Mehndiratta, Mm, Mejia-Rodriguez, F, Mekonnen, W, Melaku, Ya, Meltzer, M, Memish, Za, Mensah, G, Meretoja, A, Mhimbira, Fa, Micha, R, Miller, Tr, Mills, Ej, Mitchell, Pb, Mock, Cn, Moffitt TEMohamed Ibrahim, N, Mohammad, Ka, Mokdad, Ah, Mola, Gl, Monasta, L, Montico, M, Montine, Tj, Moore, Ar, Moran, Ae, Morawska, L, Mori RMoschandreas, J, Moturi, Wn, Moyer, M, Mozaffarian, D, Mueller, Uo, Mukaigawara, M, Murdoch, Me, Murray, J, Murthy, K, Naghavi, P, Nahas ZNaheed, A, Naidoo, K, Naldi, L, Nand, D, Nangia, V, Narayan, Km, Nash, D, Nejjari, C, Neupane, Sp, Newman, Lm, Newton, Cr, Ng, M, Ngalesoni FNNhung NT, Nisar, Mi, Nolte, S, Norheim, Of, Norman, Re, Norrving, B, Nyakarahuka, L, Oh, Ih, Ohkubo, T, Omer, Sb, Opio, Jn, Ortiz, A, Pandian JDPanelo CI, Papachristou, C, Park, Ek, Parry, Cd, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pedraza, L, Pellegrini, Ca, Pereira, Dm, Perez-Ruiz, Fp, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, Cb, Petzold, M, Phillips, Mr, Phillips, D, Phillips, B, Piel, Fb, Plass, D, Poenaru, D, Polanczyk GVPolinder, S, Pope, Ca, Popova, S, Poulton, Rg, Pourmalek, F, Prabhakaran, D, Prasad, Nm, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, Su, Raju, M, Rakovac, I, Rana, Sm, Razavi, H, Refaat, A, Rehm, J, Remuzzi, G, Resnikoff, S, Ribeiro, Al, Riccio, Pm, Richardson, L, Richardus, Jh, Riederer, Am, Robinson, M, Roca, A, Rodriguez, A, Rojas-Rueda, D, Ronfani, L, Rothenbacher, D, Roy, N, Ruhago, Gm, Sabin, N, Sacco, Rl, Ksoreide, K, Saha, S, Sahathevan, R, Sahraian, Ma, Sampson, U, Sanabria, Jr, Sanchez-Riera, L, Santos, I, Satpathy, M, Saunders, Je, Sawhney, M, Saylan MIScarborough, P, Schoettker, B, Schneider, Ij, Schwebel, Dc, Scott, Jg, Seedat, S, Sepanlou, Sg, Serdar, B, Servan-Mori, Ee, Shackelford, K, Shaheen AShahraz, S, Shamah Levy, T, Shangguan, S, She, J, Sheikhbahaei, S, Shepard, D, Shi, P, Shibuya, K, Shinohara, Y, Shiri, R, Shishani, K, Shiue, I, Shrime, Mg, Sigfusdottir, Id, Silberberg, Dh, Simard, Ep, Sindi, S, Singh, Ja, Singh, L, Skirbekk, V, Sliwa, K, Soljak, M, Soneji, S, Soshnikov, S, Speyer PSposato LA, Sreeramareddy, Ct, Stoeckl, H, Stathopoulou, Vk, Steckling, N, Stein, Mb, Stein, Dj, Steiner, Tj, Stewart, A, Stork, E, Stovner LJStroumpoulis, K, Sturua, L, Sunguya, Bf, Swaroop, M, Sykes, Bl, Tabb, Km, Takahashi, K, Tan, F, Tandon, N, Tanne, D, Tanner, M, Tavakkoli, M, Taylor, Hr, Te Ao BJ, Temesgen, Am, Ten Have, M, Tenkorang, Ey, Terkawi, A, Theadom, Am, Thomas, E, Thorne-Lyman, Al, Thrift, Ag, Tleyjeh, Im, Tonelli, M, Topouzis, F, Towbin, Ja, Toyoshima, H, Traebert, J, Tran, Bx, Trasande, L, Trillini, M, Truelsen, T, Trujillo, U, Tsilimbaris, M, Tuzcu, Em, Ukwaja KNUndurraga EA, Uzun, Sb, van Brakel WH, van de Vijver, S, Van Dingenen, R, van Gool CH, Varakin, Yy, Vasankari, Tj, Vavilala, M, Veerman LJVelasquez-Melendez, G, Venketasubramanian, N, Vijayakumar, L, Villalpando, S, Violante, F, Vlassov, Vv, Waller, S, Wallin, Mt, Wan, X, Wang, L, Wang, J, Wang, Y, Warouw, T, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Werdecker, A, Wessells, Kr, Westerman, R, Wilkinson, Jd, Williams HCWilliams TN, Woldeyohannes, Sm, Wolfe, Cd, Wong, Jq, Wong, H, Woolf, Ad, Wright, Jl, Wurtz, B, Xu, G, Yang, G, Yano, Y, Yenesew, Ma, Yentur GKYip, P, Yonemoto, N, Yoon, Sj, Younis, M, Yu, C, Kim, Ky, Zaki Mel, S, Zhang, Y, Zhao, Z, Zhao, Y, Zhu, J, Zonies, D, Zunt, Jr, Salomon, Ja, Murray, Cj., Vos, Theo, Barber, Ryan M., Bell, Brad, Bertozzi-Villa, Amelia, Biryukov, Stan, Bolliger, Ian, Charlson, Fiona, Davis, Adrian, Degenhardt, Louisa, Dicker, Daniel, Duan, Leilei, Erskine, Holly, Feigin, Valery L., Ferrari, Alize J., Fitzmaurice, Christina, Fleming, Thoma, Graetz, Nichola, Guinovart, Caterina, Haagsma, Juanita, Hansen, Gillian M., Hanson, Sarah Wulf, Heuton, Kyle R., Higashi, Hideki, Kassebaum, Nichola, Kyu, Hmwe, Laurie, Evan, Liang, Xiofeng, Lofgren, Katherine, Lozano, Rafael, Macintyre, Michael F., Moradi-Lakeh, Maziar, Naghavi, Mohsen, Nguyen, Grant, Odell, Shaun, Ortblad, Katrina, Roberts, David Allen, Roth, Gregory A., Sandar, Logan, Serina, Peter T., Stanaway, Jeffrey D., Steiner, Caitlyn, Thomas, Bernadette, Vollset, Stein Emil, Whiteford, Harvey, Wolock, Timothy M., Ye, Pengpeng, Zhou, Maigeng, Ãvila, Marco A., Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Aziz, Muna I. Abdel, Abera, Semaw F., Aboyans, Victor, Abraham, Jerry P., Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M.E., Aburto, Tania C., Achoki, Tom, Ackerman, Ilana N., Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène K., Adsuar, Josef C., Arnlov, Johan, Agardh, Emilie E., Al Khabouri, Mazin J., Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I., Alegretti, Miguel A., Aleman, Alicia V., Alemu, Zewdie A., Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Francoi, Allebeck, Peter, Allen, Peter J., Almazroa, Mohammad Abdulaziz, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O., Anderson, H. Ro, Antonio, Carl Abelardo T., Anwari, Palwasha, Apfel, Henry, Arsenijevic, Valentain S. Arsic, Artaman, Al, Asghar, Rana J., Assadi, Reza, Atkins, Lydia S., Atkinson, Charle, Badawi, Alaa, Bahit, Maria C., Bakfalouni, Talal, Balakrishnan, Kalpana, Balalla, Shivanthi, Banerjee, Amitava, Barker-Collo, Suzanne L., Barquera, Simon, Barregard, Lar, Barrero, Lope H., Basu, Sanjay, Basu, Arindam, Baxter, Amanda, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L., Benjet, Corina, Bennett, Derrick A., Bensenor, Isabela M., Benzian, Habib, Bernabe, Eduardo, Beyene, Tariku J., Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar, Bienhoff, Kelly, Bikbov, Bori, Abdulhak, Aref Bin, Blore, Jed D., Blyth, Fiona M., Bohensky, Megan A., Basara, Berrak Bora, Borges, Guilherme, Bornstein, Natan M., Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R., Boyers, Lindsay N., Brainin, Michael, Brauer, Michael, Brayne, Carol E.G., Brazinova, Alexandra, Breitborde, Nicholas J.K., Brenner, Hermann, Briggs, Adam D.M., Brooks, Peter M., Brown, Jonathan, Brugha, Traolach S., Buchbinder, Rachelle, Buckle, Geoffrey C., Bukhman, Gene, Bulloch, Andrew G., Burch, Michael, Burnett, Richard, Cardenas, Rosario, Cabral, Norberto L., Campos-Nonato, Ismael R., Campuzano, Julio C., Carapetis, Jonathan R., Carpenter, David O., Caso, Valeria, Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Chadha, Vineet K., Chang, Jung-Chen, Chen, Honglei, Chen, Wanqing, Chiang, Peggy P., Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A., Chugh, Sumeet S., Cirillo, Massimo, Coggeshall, Megan, Cohen, Aaron, Colistro, Valentina, Colquhoun, Samantha M., Contreras, Alejandra G., Cooper, Leslie T., Cooper, Cyru, Cooperrider, Kimberly, Coresh, Josef, Cortinovis, Monica, Criqui, Michael H., Crump, John A., Cuevas-Nasu, Lucia, Dandona, Rakhi, Dandona, Lalit, Dansereau, Emily, Dantes, Hector G., Dargan, Paul I., Davey, Gail, Davitoiu, Dragos V., Dayama, Anand, De La Cruz-Gongora, Vanessa, De La Vega, Shelley F., De Leo, Diego, Del Pozo-Cruz, Borja, Dellavalle, Robert P., Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C., Dessalegn, Muluken, Deveber, Gabrielle A., Dharmaratne, Samath D., Diaz-Torne, Cesar, Ding, Eric L., Dokova, Klara, Dorsey, E.R., Driscoll, Tim R., Duber, Herbert, Durrani, Adnan M., Edmond, Karen M., Ellenbogen, Richard G., Endres, Matthia, Ermakov, Sergey P., Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fahimi, Saman, Farzadfar, Farshad, Fay, Derek F.J., Felson, David T., Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G., Ferri, Cluesa P., Flaxman, Abraham, Foigt, Nataliya, Foreman, Kyle J., Fowkes, F Gerry R., Franklin, Richard C., Furst, Thoma, Futran, Neal D., Gabbe, Belinda J., Gankpe, Fortune G., Garcia-Guerra, Francisco A., Geleijnse, Johanna M., Gessner, Bradford D., Gibney, Katherine B., Gillum, Richard F., Ginawi, Ibrahim A., Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goginashvili, Ketevan, Gona, Philimon, De Cosio, Teresita Gonzalez, Gosselin, Richard A., Gotay, Carolyn C., Goto, Atsushi, Gouda, Hebe N., Guerrant, Richard L., Gugnani, Harish C., Gunnell, David, Gupta, Rajeev, Gupta, Rahul, Gutierrez, Reyna A., Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara, Hamadeh, Randah R., Hamavid, Hannah, Hammami, Mouhanad, Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Haro, Josep Maria, Havmoeller, Rasmu, Hay, Roderick J., Hay, Simon, Hedayati, Mohammad T., Pi, Ileana B. Heredia, Heydarpour, Pouria, Hijar, Martha, Hoek, Hans W., Hoffman, Howard J., Hornberger, John C., Hosgood, H. Dean, Hossain, Mazeda, Hotez, Peter J., Hoy, Damian G., Hsairi, Mohamed, Hu, Howard, Hu, Guoqing, Huang, John J., Huang, Cheng, Huiart, Laetitia, Husseini, Abdullatif, Iannarone, Marissa, Iburg, Kim M., Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H., Jassal, Simerjot K., Jeemon, Panniyammakal, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B., Joseph, Jonathan, Juel, Knud, Kan, Haidong, Karch, Andre, Karimkhani, Chante, Karthikeyan, Ganesan, Katz, Ronit, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S., Kemp, Andrew H., Kengne, Andre P., Khader, Yousef S., Khalifa, Shams Eldin A.H., Khan, Ejaz A., Khan, Gulfaraz, Khang, Young-Ho, Khonelidze, Irma, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kimokoti, Ruth W., Kinfu, Yohanne, Kinge, Jonas M., Kissela, Brett M., Kivipelto, Miia, Knibbs, Luke, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Kramer, Alexander, Kravchenko, Michael, Krishnamurthi, Rita V., Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J., Kulkarni, Veena S., Kumar, Kaushalendra, Kumar, G Anil, Kwan, Gene F., Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Lansingh, Van C., Larson, Heidi, Larsson, Ander, Lawrynowicz, Alicia E.B., Leasher, Janet L., Lee, Jong-Tae, Leigh, Jame, Leung, Ricky, Levi, Miriam, Li, Bin, Li, Yichong, Li, Yongmei, Liang, Juan, Lim, Stephen, Lin, Hsien-Ho, Lind, Margaret, Lindsay, M Patrice, Lipshultz, Steven E., Liu, Shiwei, Lloyd, Belinda K., Ohno, Summer Lockett, Logroscino, Giancarlo, Looker, Katharine J., Lopez, Alan D., Lopez-Olmedo, Nancy, Lortet-Tieulent, Joannie, Lotufo, Paulo A., Low, Nicola, Lucas, Robyn M., Lunevicius, Raimunda, Lyons, Ronan A., Ma, Jixiang, Ma, Stefan, Mackay, Mark T., Majdan, Marek, Malekzadeh, Reza, Mapoma, Christopher C., Marcenes, Wagner, March, Lyn M., Margono, Chri, Marks, Guy B., Marzan, Melvin B., Masci, Joseph R., Mason-Jones, Amanda J., Matzopoulos, Richard G., Mayosi, Bongani M., Mazorodze, Tasara T., Mcgill, Neil W., Mcgrath, John J., Mckee, Martin, Mclain, Abby, Mcmahon, Brian J., Meaney, Peter A., Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Wubegzier, Melaku, Yohannes A., Meltzer, Michele, Memish, Ziad A., Mensah, George, Meretoja, Atte, Mhimbira, Francis A., Micha, Renata, Miller, Ted R., Mills, Edward J., Mitchell, Philip B., Mock, Charles N., Moffitt, Terrie E., Ibrahim, Norlinah Mohamed, Mohammad, Karzan A., Mokdad, Ali H., Mola, Glen L., Monasta, Lorenzo, Montico, Marcella, Montine, Thomas J., Moore, Ami R., Moran, Andrew E., Morawska, Lidia, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N., Moyer, Madeline, Mozaffarian, Dariush, Mueller, Ulrich O., Mukaigawara, Mitsuru, Murdoch, Michele E., Murray, Joseph, Murthy, Kinnari S., Naghavi, Paria, Nahas, Ziad, Naheed, Aliya, Naidoo, Kovin S., Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K.M. Venkat, Nash, Deni, Nejjari, Chakib, Neupane, Sudan P., Newman, Lori M., Newton, Charles R., Ng, Marie, Ngalesoni, Frida N., Nhung, Nguyen T., Nisar, Muhammad I., Nolte, Sandra, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Oh, In Hwan, Ohkubo, Takayoshi, Omer, Saad B., Opio, John Nelson, Ortiz, Alberto, Pandian, Jeyaraj D., Panelo, Carlo Irwin A., Papachristou, Christina, Park, Eun-Kee, Parry, Charles D., Caicedo, Angel J. Paternina, Patten, Scott B., Paul, Vinod K., Pavlin, Boris I., Pearce, Neil, Pedraza, Lilia S., Pellegrini, Carlos A., Pereira, David M., Perez-Ruiz, Fernando P., Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B., Petzold, Max, Phillips, Michael R., Phillips, David, Phillips, Bryan, Piel, Frederic B., Plass, Dietrich, Poenaru, Dan, Polanczyk, Guilherme V., Polinder, Suzanne, Pope, C.A., Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M., Qato, Dima, Quistberg, D.A., Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Sajjad Ur, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M., Razavi, Homie, Refaat, Amany, Rehm, Jurgen, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Riccio, Patricia M., Richardson, Lee, Richardus, Jan Hendrik, Riederer, Anne M., Robinson, Margot, Roca, Anna, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Rothenbacher, Dietrich, Roy, Nobhojit, Ruhago, George M., Sabin, Nsanzimana, Sacco, Ralph L., Ksoreide, Kjetil, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Sampson, Uchechukwu, Sanabria, Juan R., Sanchez-Riera, Lidia, Santos, Itamar S., Satpathy, Maheswar, Saunders, James E., Sawhney, Monika, Saylan, Mete I., Scarborough, Peter, Schoettker, Ben, Schneider, Ione J.C., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Serdar, Berrin, Servan-Mori, Edson E., Shackelford, Katya, Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shepard, Donald S., Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga D., Silberberg, Donald H., Simard, Edgar P., Sindi, Shireen, Singh, Jasvinder A., Singh, Lavanya, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Soshnikov, Sergey S., Speyer, Peter, Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stoeckl, Heidi, Stathopoulou, Vasiliki Kalliopi, Steckling, Nadine, Stein, Murray B., Stein, Dan J., Steiner, Timothy J., Stewart, Andrea, Stork, Eden, Stovner, Lars J., Stroumpoulis, Konstantino, Sturua, Lela, Sunguya, Bruno F., Swaroop, Mamta, Sykes, Bryan L., Tabb, Karen M., Takahashi, Ken, Tan, Feng, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R., Te Ao, Braden J., Temesgen, Awoke Misganaw, Have, Margreet Ten, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Theadom, Alice M., Thomas, Elissa, Thorne-Lyman, Andrew L., Thrift, Amanda G., Tleyjeh, Imad M., Tonelli, Marcello, Topouzis, Foti, Towbin, Jeffrey A., Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X., Trasande, Leonardo, Trillini, Matia, Truelsen, Thoma, Trujillo, Ulise, Tsilimbaris, Miltiadi, Tuzcu, Emin M., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen B., Van Brakel, Wim H., Van De Vijver, Steven, Dingenen, Rita Van, Van Gool, Coen H., Varakin, Yuri Y., Vasankari, Tommi J., Vavilala, Monica S., Veerman, Lennert J., Velasquez-Melendez, Gustavo, Venketasubramanian, Narayanaswamy, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S., Vlassov, Vasiliy V., Waller, Stephen, Wallin, Mitchell T., Wan, Xia, Wang, Linhong, Wang, Jianli, Wang, Yanping, Warouw, Tati S., Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Wessells, K. Ryan, Westerman, Ronny, Wilkinson, James D., Williams, Hywel C., Williams, Thomas N., Woldeyohannes, Solomon M., Wolfe, Charles D.A., Wong, John Q., Wong, Haidong, Woolf, Anthony D., Wright, Jonathan L., Wurtz, Brittany, Xu, Gelin, Yang, Gonghuan, Yano, Yuichiro, Yenesew, Muluken A., Yentur, Gokalp K., Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa, Yu, Chuanhua, Kim, Kim Yun, Zaki, Maysaa El Sayed, Zhang, Yong, Zhao, Zheng, Zhao, Yong, Zhu, Jun, Zonies, David, Zunt, Joseph R., Salomon, Joshua A., Murray, Christopher J.L., Cell biology, Gastroenterology & Hepatology, Epidemiology, Health Technology Assessment (HTA), and Public Health
Subjects: Male, Gerontology, Nutrition and Disease, Epidemiology, years lived with disability, Global burden of disease, acute and chronic diseases, countries, Prevalence, Disease, Global Health, Medical and Health Sciences, Conduct disorder, Otitis-media, Cost of Illness, Residence Characteristics, Voeding en Ziekte, 80 and over, Global health, 2.2 Factors relating to the physical environment, 2.1 Biological and endogenous factors, countries, Aetiology, Child, Aged, 80 and over, Medicine(all), education.field_of_study, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, Incidence, Mortality rate, Incidence (epidemiology), Pain Research, Neglected Diseases, Alcohol dependence, General Medicine, Middle Aged, Global burden of disease, Global Burden of Disease Study 2013 Collaborators, Mental Health, Infectious Diseases, Attention deficit/Hyperactivity disorder, Burden of Illness, Child, Preschool, Acute Disease, Female, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Adolescent, GBD 2013, Population, acute and chronic diseases, Young Adult, Mental-disorders, Age Distribution, Medicine, General & Internal, Weights, General & Internal Medicine, medicine, Humans, Life Science, Disabled Persons, Sex Distribution, Preschool, education, Developing Countries, VLAG, Aged, Science & Technology, business.industry, Developed Countries, Cutaneous Leishmaniasis, Infant, Newborn, Infant, Health outcomes, Newborn, medicine.disease, Comorbidity, Brain Disorders, years lived with disability, Good Health and Well Being, Disease, injury, incidence, prevalence, YLDs, GBD 2010, Chronic Disease, Wounds and Injuries, business, 2.4 Surveillance and distribution, Iron-deficiency, Demography
Abstract: Summary Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. Funding Bill & Melinda Gates Foundation. Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. Funding Bill & Melinda Gates Foundation.
Published: 2015

7. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Wang, H, Abajobir, AA, Abate, KH, Abbafati, C, Abbas, KM, Abd-Allah, F, Abera, SF, Abraha, HN, Abu-Raddad, LJ, Abu-Rmeileh, NME, Adedeji, IA, Adedoyin, RA, Adetifa, IMO, Adetokunboh, O, Afshin, A, Aggarwal, R, Agrawal, A, Agrawal, S, Kiadaliri, AA, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Aiyar, S, Akanda, S, Akinyemiju, TF, Akseer, N, Al-Eyadhy, A, Al Lami, FH, Alabed, S, Alahdab, F, Al-Aly, Z, Alam, K, Alam, N, Alasfoor, D, Aldridge, RW, Alene, KA, Alhabib, S, Ali, R, Alizadeh-Navaei, R, Aljunid, SM, Alkaabi, JM, Alkerwi, A, Alla, F, Allam, SD, Allebeck, P, Al-Raddadi, R, Alsharif, U, Altirkawi, KA, Martin, EA, Alvis-Guzman, N, Amare, AT, Ameh, EA, Amini, E, Ammar, W, Amoako, YA, Anber, N, Andrei, CL, Androudi, S, Ansari, H, Ansha, MG, Antonio, CAT, Anwari, P, Arnlov, J, Arora, M, Al, A, Aryal, KK, Asayesh, H, Asgedom, SW, Asghar, RJ, Assadi, R, Atey, TM, Atre, SR, Avila-Burgos, L, Avokpaho, EFGA, Awasthi, A, Quintanilla, BPA, Babalola, TK, Bacha, U, Badawi, A, Balakrishnan, K, Balalla, S, Barac, A, Barber, RM, Barboza, MA, Barker-Collo, SL, Barnighausen, T, Barquera, S, Barregard, L, Barrero, LH, Baune, BT, Bazargan-Hejazi, S, Bedi, N, Beghi, E, Bejot, Y, Bekele, BB, Bell, ML, Bello, AK, Bennett, DA, Bennett, JR, Bensenor, IM, Benson, J, Berhane, A, Berhe, DF, Bernabe, E, Beuran, M, Beyene, AS, Bhala, N, Bhansali, A, Bhaumik, S, Bhutta, ZA, Bikbov, B, Birungi, C, Biryukov, S, Bisanzio, D, Bizuayehu, HM, Bjerregaard, P, Blosser, CD, Boneya, DJ, Boufous, S, Bourne, RRA, Brazinova, A, Breitborde, NJK, Brenner, H, Brugha, TS, Bukhman, G, Negesa, L, Bulto, B, Bumgarner, BR, Burch, M, Butt, ZA, Cahill, LE, Cahuana-Hurtado, L, Campos-Nonato, IR, Car, J, Car, M, Crdenas, R, Carpenter, DO, Carrero, JJ, Carter, A, Castaneda-Orjuela, CA, Rivas, JC, Castro, FF, Castro, RE, Catala-Lopez, F, Chen, H, Chiang, PP-C, Chibalabala, M, Chisumpa, VH, Chitheer, AA, Choi, J-YJ, Christensen, H, Christopher, DJ, Ciobanu, LG, Cirillo, M, Cohen, AJ, Colquhoun, SM, Coresh, J, Criqui, MH, Cromwell, EA, Crump, JA, Dandona, L, Dandona, R, Dargan, PI, das Neves, J, Davey, G, Davitoiu, DV, Davletov, K, de Courten, B, De Leo, D, Degenhardt, L, Deiparine, S, Dellavalle, RP, Deribe, K, Deribew, A, Des Jarlais, DC, Dey, S, Dharmaratne, SD, Dherani, MK, Diaz-Torne, C, Ding, EL, Dixit, P, Djalalinia, S, Huyen, PD, Doku, DT, Donnelly, CA, Priscila, K, dos Santos, B, Douwes-Schultz, D, Driscoll, TR, Duan, L, Dubey, M, Duncan, BB, Dwivedi, LK, Ebrahimi, H, El Bcheraoui, C, Ellingsen, CL, Enayati, A, Endries, AY, Ermakov, SP, Eshetie, S, Eshrati, B, Eskandarieh, S, Esteghamati, A, Estep, K, Fanuel, BBF, Faro, A, Farvid, MS, Farzadfar, F, Feigin, VL, Fereshtehnejad, S-M, Fernandes, JG, Fernandes, JC, Feyissa, TR, Filip, I, Fischer, F, Foigt, N, Foreman, KJ, Frank, T, Franklin, RC, Fraser, M, Friedman, J, Frostad, JJ, Fullman, N, Furst, T, Furtado, JM, Futran, ND, Gakidou, E, Gambashidze, K, Gamkrelidze, A, Gankpe, FG, Garcia-Basteiro, AL, Gebregergs, GB, 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Natarajan, G, Negoi, I, Cuong, TN, Ningrum, DNA, Nisar, MI, Nomura, M, Vuong, MN, Norheim, OF, Norrving, B, Noubiap, JJN, Nyakarahuka, L, Obermeyer, CM, O'Donnell, MJ, Ogbo, FA, Oh, I-H, Okoro, A, Oladimeji, O, Olagunju, AT, Olusanya, BO, Olusanya, JO, Oren, E, Ortiz, A, Osgood-Zimmerman, A, Ota, E, Owolabi, MO, Oyekale, AS, Pa, M, Pacella, RE, Pakhale, S, Pana, A, Panda, BK, Panda-Jonas, S, Park, E-K, Parsaeian, M, Patel, T, Patten, SB, Patton, GC, Paudel, D, Pereira, DM, Perez-Padilla, R, Perez-Ruiz, F, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, CB, Petri, WA, Petzold, M, Phillips, MR, Piel, FB, Pigott, DM, Pishgar, F, Plass, D, Polinder, S, Popova, S, Postma, MJ, Poulton, RG, Pourmalek, F, Prasad, N, Purwar, M, Qorbani, M, Rabiee, RHS, Radfar, A, Rafay, A, Rahimi-Movaghar, A, Rahimi-Movaghar, V, Rahman, M, Rahman, MHU, Rahman, SU, Rai, RK, Rajsic, S, Ram, U, Rana, SM, Ranabhat, CL, Rao, PV, Rawaf, S, Ray, SE, Rego, MAS, Rehm, J, Reiner, RC, Remuzzi, G, Renzaho, AMNN, Resnikoff, S, Rezaei, S, Rezai, MS, Ribeiro, AL, Rokni, MB, Ronfani, L, Roshandel, G, Roth, GA, Rothenbacher, D, Roy, A, Rubagotti, E, Ruhago, GM, Saadat, S, Sabde, YD, Sachdev, PS, Sadat, N, Safdarian, M, Safiri, SSS, Sagar, R, Sahathevan, R, Sahebkar, A, Sahraian, MA, Salama, J, Salamati, P, Salomon, JA, Salvi, SS, Samy, AM, Sanabria, JR, Sanchez-Nino, MD, Santos, IS, Milicevic, MMS, Sarmiento-Suarez, R, Sartorius, B, Satpathy, M, Sawhney, M, Saxena, S, Saylan, MI, Schmidt, MI, Schneider, IJC, Schutte, AE, Schwebel, DC, Schwendicke, F, Seedat, S, Seid, AM, Sepanlou, SG, Servan-Mori, EE, Shackelford, KA, Shaheen, A, Shahraz, S, Shaikh, MA, Shamsipour, M, Shamsizadeh, M, Islam, SMS, Sharma, J, Sharma, R, She, J, Shen, J, Shetty, BP, Shi, P, Shibuya, K, Shigematsu, M, Shiri, R, Shiue, I, Shrime, MG, Sigfusdottir, ID, Silberberg, DH, Silpakit, N, Silva, DAS, Silva, JP, Silveira, DGA, Sindi, S, Singh, A, Singh, JA, Singh, PK, Singh, V, Sinha, DN, Skiadaresi, E, Sligar, A, Smith, DL, Sobaih, BHA, Sobngwi, E, Soneji, S, Soriano, JB, Sreeramareddy, CT, Srinivasan, V, Stathopoulou, V, Steel, N, Stein, DJ, Steiner, C, Stockl, H, Stokes, MA, Strong, M, Sufiyan, MB, Suliankatchi, RA, Sunguya, BF, Sur, PJ, Swaminathan, S, Sykes, BL, Szoeke, CEI, Tabares-Seisdedos, R, Tadakamadla, SK, Tadese, F, Tandon, N, Tanne, D, Tarajia, M, Tavakkoli, M, Taveira, N, Tehrani-Banihashemi, A, Tekelab, T, Tekle, DY, Shifa, GT, Temsah, M-H, Terkawi, AS, Tesema, CL, Tesssema, B, Theis, A, Thomas, N, Thompson, AH, Thomson, AJ, Thrift, AG, Tiruye, TY, Tobe-Gai, R, Tonelli, M, Topor-Madry, R, Topouzis, F, Tortajada, M, Tran, BX, Trujillo, TTU, Tsilimparis, N, Tuem, KB, Tuzcu, EM, Tyrovolas, S, Ukwaja, KN, Undurraga, EA, Uthman, OA, Uzochukwu, BSC, van Boven, JFM, Varakin, YY, Varughese, S, Vasankari, T, Vasconcelos, AMN, Venketasubramanian, N, Vidavalur, R, Violante, FS, Vishnu, A, Vladimirov, SK, Vlassov, VV, Vollset, SE, Vos, T, Waid, JL, Wakayo, T, Wang, Y-P, Weichenthal, S, Weiderpass, E, Weintraub, RG, Werdecker, A, Wesana, J, Wijeratne, T, Wilkinson, JD, Wiysonge, CS, Woldeyes, BG, Wolfe, CDA, Workicho, A, Workie, SB, Xavier, D, Xu, G, Yaghoubi, M, Yakob, B, Yalew, AZ, Yan, LL, Yano, Y, Yaseri, M, Ye, P, Yimam, HH, Yip, P, Yirsaw, BD, Yonemoto, N, Yoon, S-J, Yotebieng, M, Younis, MZ, Zaidi, Z, Zaki, MES, Zeeb, H, Zenebe, ZM, Zerfu, TA, Zhang, AL, Zhang, X, Zodpey, S, Zuhlke, LJ, Lopez, AD, and Murray, CJL
Published: 2017

8. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author: Soriano, JB, Abajobir, AA, Abate, KH, Abera, SF, Agrawal, A, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Alam, K, Alam, N, Alkaabi, JM, Al-Maskari, F, Alvis-Guzman, N, Amberbir, A, Amoako, YA, Ansha, MG, Anto, JM, Asayesh, H, Atey, TM, Avokpaho, EFGA, Barac, A, Basu, S, Bedi, N, Bensenor, IM, Berhane, A, Beyene, AS, Bhutta, ZA, Biryukov, S, Boneya, DJ, Brauer, M, Carpenter, DO, Casey, D, Christopher, DJ, Dandona, L, Dandona, R, Dharmaratne, SD, Huyen, PD, Fischer, F, Geleto, A, Ghoshal, AG, Gillum, RF, Ginawi, IAM, Gupta, V, Hay, SI, Hedayati, MT, Horita, N, Hosgood, HD, Jakovljevic, MMB, James, SL, Jonas, JB, Kasaeian, A, Khader, YS, Khalil, IA, Khan, EA, Khang, Y-H, Khubchandani, J, Knibbs, LD, Kosen, S, Koul, PA, Kumar, GA, Leshargie, CT, Liang, X, Abd El Razek, HM, Majeed, A, Malta, DC, Manhertz, T, Marquez, N, Mehari, A, Mensah, GA, Miller, TR, Mohammad, KA, Mohammed, KE, Mohammed, S, Mokdad, AH, Naghavi, M, Cuong, TN, Nguyen, G, Quyen, LN, Trang, HN, Ningrum, DNA, Vuong, MN, Obi, JI, Odeyemi, YE, Ogbo, FA, Oren, E, Mahesh, PA, Park, E-K, Patton, GC, Paulson, K, Qorbani, M, Quansah, R, Rafay, A, Rahman, MHU, Rai, RK, Rawaf, S, Reinig, N, Safiri, S, Sarmiento-Suarez, R, Sartorius, B, Savic, M, Sawhney, M, Shigematsu, M, Smith, M, Tadese, F, Thurston, GD, Topor-Madry, R, Tran, BX, Ukwaja, KN, van Boven, JFM, Vlassov, VV, Vollset, SE, Wan, X, Werdecker, A, Hanson, SW, Yano, Y, Yimam, HH, Yonemoto, N, Yu, C, Zaidi, Z, Zaki, MES, Murray, CJL, Vos, T, Soriano, JB, Abajobir, AA, Abate, KH, Abera, SF, Agrawal, A, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Alam, K, Alam, N, Alkaabi, JM, Al-Maskari, F, Alvis-Guzman, N, Amberbir, A, Amoako, YA, Ansha, MG, Anto, JM, Asayesh, H, Atey, TM, Avokpaho, EFGA, Barac, A, Basu, S, Bedi, N, Bensenor, IM, Berhane, A, Beyene, AS, Bhutta, ZA, Biryukov, S, Boneya, DJ, Brauer, M, Carpenter, DO, Casey, D, Christopher, DJ, Dandona, L, Dandona, R, Dharmaratne, SD, Huyen, PD, Fischer, F, Geleto, A, Ghoshal, AG, Gillum, RF, Ginawi, IAM, Gupta, V, Hay, SI, Hedayati, MT, Horita, N, Hosgood, HD, Jakovljevic, MMB, James, SL, Jonas, JB, Kasaeian, A, Khader, YS, Khalil, IA, Khan, EA, Khang, Y-H, Khubchandani, J, Knibbs, LD, Kosen, S, Koul, PA, Kumar, GA, Leshargie, CT, Liang, X, Abd El Razek, HM, Majeed, A, Malta, DC, Manhertz, T, Marquez, N, Mehari, A, Mensah, GA, Miller, TR, Mohammad, KA, Mohammed, KE, Mohammed, S, Mokdad, AH, Naghavi, M, Cuong, TN, Nguyen, G, Quyen, LN, Trang, HN, Ningrum, DNA, Vuong, MN, Obi, JI, Odeyemi, YE, Ogbo, FA, Oren, E, Mahesh, PA, Park, E-K, Patton, GC, Paulson, K, Qorbani, M, Quansah, R, Rafay, A, Rahman, MHU, Rai, RK, Rawaf, S, Reinig, N, Safiri, S, Sarmiento-Suarez, R, Sartorius, B, Savic, M, Sawhney, M, Shigematsu, M, Smith, M, Tadese, F, Thurston, GD, Topor-Madry, R, Tran, BX, Ukwaja, KN, van Boven, JFM, Vlassov, VV, Vollset, SE, Wan, X, Werdecker, A, Hanson, SW, Yano, Y, Yimam, HH, Yonemoto, N, Yu, C, Zaidi, Z, Zaki, MES, Murray, CJL, and Vos, T
Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common diseases with a heterogeneous distribution worldwide. Here, we present methods and disease and risk estimates for COPD and asthma from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 study. The GBD study provides annual updates on estimates of deaths, prevalence, and disability-adjusted life years (DALYs), a summary measure of fatal and non-fatal disease outcomes, for over 300 diseases and injuries, for 188 countries from 1990 to the most recent year. METHODS: We estimated numbers of deaths due to COPD and asthma using the GBD Cause of Death Ensemble modelling (CODEm) tool. First, we analysed data from vital registration and verbal autopsy for the aggregate category of all chronic respiratory diseases. Subsequently, models were run for asthma and COPD relying on covariates to predict rates in countries that have incomplete or no vital registration data. Disease estimates for COPD and asthma were based on systematic reviews of published papers, unpublished reports, surveys, and health service encounter data from the USA. We used the Global Initiative of Chronic Obstructive Lung Disease spirometry-based definition as the reference for COPD and a reported diagnosis of asthma with current wheeze as the definition of asthma. We used a Bayesian meta-regression tool, DisMod-MR 2.1, to derive estimates of prevalence and incidence. We estimated population-attributable fractions for risk factors for COPD and asthma from exposure data, relative risks, and a theoretical minimum exposure level. Results were stratified by Socio-demographic Index (SDI), a composite measure of income per capita, mean years of education over the age of 15 years, and total fertility rate. FINDINGS: In 2015, 3·2 million people (95% uncertainty interval [UI] 3·1 million to 3·3 million) died from COPD worldwide, an increase of 11·6% (95% UI 5·3 to 19·8) compared with 1990. There was a decrease in age-stan
Published: 2017

9. The global burden of cancer 2013 global burden of disease cancer collaboration

Author: Fitzmaurice, C, Dicker, D, Pain, A, Hamavid, H, Moradi-Lakeh, M, Maclntyre, MF, Allen, C, Hansen, G, Woodbrook, R, Wolfe, C, Hamadeh, RR, Antonio, CA, Castaneda-Orjuela, C, Van Gool, CH, Violante, F, Oh, I-H, Deribe, K, Soreide, K, Knibbs, L, Kereselidze, M, Green, M, Moore, A, Cardenas, R, Roy, N, Tillmann, T, Li, Y, Krueger, H, Monasta, L, Dey, S, Sheikhbahaei, S, Hafezi-Nejad, N, Kumar, GA, Werdecker, A, Sreeramareddy, CT, Dandona, L, Wang, H, Vollset, SE, Mokdad, A, Salomon, JA, Lozano, R, Vos, T, Forouzanfar, M, Lopez, A, Gessner, BD, Murray, C, Naghavi, M, Te Ao, B, McMahon, B, Karimkhani, C, Yu, C, Cooke, GS, Schwebel, DC, Carpenter, DO, Pereira, DM, Nash, D, Kazi, DS, De Leo, D, Plass, D, Ukwaja, KN, Thurston, GD, Jin, KY, Simard, EP, Mills, E, Park, E-K, Catala-Lopez, F, DeVeber, G, Gotay, C, Khan, G, Hosgood, HD, Santos, IS, Leasher, JL, Singh, J, Leigh, J, Jonas, JB, Sanabria, J, Beardsley, J, Jacobsen, KH, Takahashi, K, Franklin, RC, Ronfani, L, Montico, M, Naldi, L, Tonelli, M, Geleijnse, J, Petzold, M, Shrime, MG, Younis, M, Yonemoto, N, Breitborde, N, Yip, P, Pourmalek, F, Lotufo, PA, Esteghamati, A, Hankey, GJ, Ali, R, Lunevicius, R, Malekzadeh, R, Dellavalle, R, Weintraub, R, Lucas, R, Hay, R, Rojas-Rueda, D, Westerman, R, Sepanlou, SG, Nolte, S, Patten, S, Weichenthal, S, Abera, SF, Fereshtehnejad, S-M, Shiue, I, Driscoll, T, Vasankari, T, Alsharif, U, Rahimi-Movaghar, V, Vlassov, VV, Marcenes, WS, Mekonnen, W, Melaku, YA, Yano, Y, Al, A, Campos, I, MacLachlan, J, Mueller, U, Kim, D, Trillini, M, Eshrati, B, Williams, HC, Shibuya, K, Dandona, R, Murthy, K, Cowie, B, and Amare, AT
Subjects: CHINESE WOMEN, Adult, Male, Time Factors, Adolescent, HEPATITIS-B-VIRUS, 187 COUNTRIES, Global Health, Disability Evaluation, Young Adult, LUNG-CANCER, Age Distribution, Life Expectancy, Sex Factors, Risk Factors, HEPATOCELLULAR-CARCINOMA, Neoplasms, SYSTEMATIC ANALYSIS, Prevalence, Humans, Sex Distribution, Child, 21 REGIONS, Aged, Aged, 80 and over, Science & Technology, Incidence, Age Factors, Middle Aged, Prognosis, Oncology, Global Burden of Disease Cancer Collaboration, Child, Preschool, RENAL-CELL CANCER, RISK-FACTORS, Female, CIGARETTE-SMOKING, Life Sciences & Biomedicine
Abstract: Importance Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. Objective To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. Evidence Review The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs. Findings In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. Conclusions and Relevance Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.
Published: 2015

10. Health Consequences of Environmental Exposures in Early Life: Coping with a Changing World in the Post-MDG Era

Author: Suk, W, Ruchirawat, M, Stein, RT, Diaz-Barriga, F, Carpenter, DO, Neira, M, Sly, Peter, Suk, W, Ruchirawat, M, Stein, RT, Diaz-Barriga, F, Carpenter, DO, Neira, M, and Sly, Peter
Published: 2016

11. E-waste and harm to vulnerable populations: A growing global problem

Author: Heacock, M, Kelly, CB, Asante, KA, Birnbaum, LS, Bergman, ÅL, Bruné, MN, Buka, I, Carpenter, DO, Chen, A, Huo, X, Kamel, M, Landrigan, PJ, Magalini, F, Diaz-Barriga, F, Neira, M, Omar, M, Pascale, A, Ruchirawat, M, Sly, L, Sly, Peter, van den Berg, M, Suk, WA, Heacock, M, Kelly, CB, Asante, KA, Birnbaum, LS, Bergman, ÅL, Bruné, MN, Buka, I, Carpenter, DO, Chen, A, Huo, X, Kamel, M, Landrigan, PJ, Magalini, F, Diaz-Barriga, F, Neira, M, Omar, M, Pascale, A, Ruchirawat, M, Sly, L, Sly, Peter, van den Berg, M, and Suk, WA
Published: 2016

12. Environmental pollution: An underrecognized threat to children’s health, especially in low- and middle-income countries

Author: Suk, WA, Ahanchian, H, Asante, KA, Carpenter, DO, Diaz-Barriga, F, Ha, EH, Huo, X, King, M, Ruchirawat, M, da Silva, ER, Sly, L, Sly, Peter, Stein, RT, van den Berg, M, Zar, H, Landrigan, PJ, Suk, WA, Ahanchian, H, Asante, KA, Carpenter, DO, Diaz-Barriga, F, Ha, EH, Huo, X, King, M, Ruchirawat, M, da Silva, ER, Sly, L, Sly, Peter, Stein, RT, van den Berg, M, Zar, H, and Landrigan, PJ
Published: 2016

13. Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology

Author: Sly, Peter, Carpenter, DO, Van den Berg, M, Stein, RT, Landrigan, PJ, Brune-Drisse, MN, Suk, W, Sly, Peter, Carpenter, DO, Van den Berg, M, Stein, RT, Landrigan, PJ, Brune-Drisse, MN, and Suk, W
Published: 2016

14. Effects of cholesterol and docosahexaenoic acid on cell viability and (Ca2+)i levels in acutely isolated mouse thymocytes

Author: Sandal, S, Tuneva, J, Yılmaz, B, Carpenter, DO, Sandal, S., Tuneva, J., Yılmaz, B., Carpenter, D.O., Yeditepe Üniversitesi, Sandal, S, Tuneva, J, Yılmaz, B, and Carpenter, DO
Subjects: Cell death, Propidium iodide, lipids (amino acids, peptides, and proteins), Flow cytometry, Immune function, Fluo-3
Abstract: We investigated the effects of lipids oil thymocyte function. The effects of application of cholesterol or docosahexaenoic acid (DHA). a C22, omega-3 (n-3) polyunsaturated fatty acid (PUFA), on viability and intracellular calcium concentrations of acutely isolated mouse thymocytes were investigated using flow cytometry. Cholesterol (100 mu M) caused significant cell death after 30-60 min whether or not calcium was present in the medium. Cell death was associated with an elevation of intracellular calcium whether or not calcium was present in the extracellular medium. However, the elevation of calcium concentration was not responsible for the cell death since calcium levels in the presence of ionomycin rose higher without significant cell death. DHA had similar actions but was more potent, causing significant cell death and elevation of calcium concentration within 5 min at 1 mu M. In the absence of extracellular calcium 1 mu M DHA caused 100% cell death within 15 min. Linolenic acid, a C18 omega-3 fatty acid also Caused cytotoxicity at low concentrations whether or not albumin was present, but omega-6 or saturated C22 fatty acids were much less effective. These observations demonstrate that thymocyte viability is very sensitive to acute exposure to low concentrations of omega-3 fatty acids. Copyright (c) 2009 John Wiley & Soils, Ltd. TUBITAK-NATOTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK); Institute for Health and the Environment Supported by a TUBITAK-NATO grant to Bayram Yilmaz and by the Institute for Health and the Environment.
Published: 2009

15. Serum concentrations of polychlorinated biphenyls (PCBs) in participants of the Anniston Community Health Survey

Author: Pavuk, M, Olson, JR, Sjödin, A, Wolff, P, Turner, WE, Shelton, C, Dutton, ND, Bartell, S, Carter, S, Carpenter, DO, Cash, J, Percy, A, Frumkin, H, Lavender, M, Moysich, K, Rosenbaum, P, Silverstone, A, and Weinstock, R
Abstract: Serum concentrations of 35 ortho-substituted polychlorinated biphenyl congeners (PCBs) were measured in 765 adults from Anniston, Alabama, where PCBs were manufactured between 1929 and 1971. As part of the Anniston Community Health Survey (ACHS), demographic data, questionnaire information, and blood samples were collected from participants in 2005-2007. Forty-six percent of study participants were African-American, 70% were female, and the median age was 56. years. The median concentration of the sum of 35 PCB congeners (σPCBs) was 528. ng/g lipid, with a 90th percentile of 2600. ng/g lipid, minimum of 17.0. ng/g lipid, and maximum of 27,337. ng/g lipid. The least square geometric mean σPCBs was more than 2.5 times higher for African-American participants than for White participants (866. ng/g lipid vs. 331. ng/g lipid); this difference did not change materially after adjustment for age, sex, body mass index (BMI) and current smoking. In spite of large differences in absolute PCB levels, relative contributions of individual congeners to σPCBs were quite similar between race groups. Nevertheless, while percent contributions to σPCBs for most of the most abundant penta- to heptachlorobiphenyls were higher among African-Americans, the percentages were higher in Whites for the lower-chlorinated PCBs 28 and 74 and for octa- to decachlorinated PCBs. No major differences were observed in geometric mean σPCBs between women and men when adjusted for age, race, BMI and current smoking (516. ng/g lipid vs. 526. ng/g lipid). Principal component analysis revealed groups of co-varying congeners that appear to be determined by chlorine substitution patterns. These congener groupings were similar between ACHS participants and the National Health and Nutrition Examination Survey (NHANES) 2003-04 sample of the general United States population, despite ACHS participants having serum concentrations of σPCBs two to three times higher than those in comparable age and race groups from NHANES. © 2013 .
Published: 2014

16. Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead

Author: Goodson, WH, Lowe, L, Carpenter, DO, Gilbertson, M, Ali, AM, de Cerain Salsamendi, AL, Lasfar, A, Carnero, A, Azqueta, A, Amedei, A, Charles, AK, Collins, AR, Ward, A, Salzberg, AC, Colacci, A, Olsen, A-K, Berg, A, Barclay, BJ, Zhou, BP, Blanco-Aparicio, C, Baglole, CJ, Dong, C, Mondello, C, Hsu, C-W, Naus, CC, Yedjou, C, Curran, CS, Laird, DW, Koch, DC, Carlin, DJ, Felsher, DW, Roy, D, Brown, DG, Ratovitski, E, Ryan, EP, Corsini, E, Rojas, E, Moon, E-Y, Laconi, E, Marongiu, F, Al-Mulla, F, Chiaradonna, F, Darroudi, F, Martin, FL, Van Schooten, FJ, Goldberg, GS, Wagemaker, G, Nangami, G, Calaf, GM, Williams, G, Wolf, GT, Koppen, G, Brunborg, G, Lyerly, HK, Krishnan, H, Ab Hamid, H, Yasaei, H, Sone, H, Kondoh, H, Salem, HK, Hsu, H-Y, Park, HH, Koturbash, I, Miousse, IR, Scovassi, AI, Klaunig, JE, Vondracek, J, Raju, J, Roman, J, Wise, JP, Whitfield, JR, Woodrick, J, Christopher, JA, Ochieng, J, Fernando Martinez-Leal, J, Weisz, J, Kravchenko, J, Sun, J, Prudhomme, KR, Narayanan, KB, Cohen-Solal, KA, Moorwood, K, Gonzalez, L, Soucek, L, Jian, L, D'Abronzo, LS, Lin, L-T, Li, L, Gulliver, L, McCawley, LJ, Memeo, L, Vermeulen, L, Leyns, L, Zhang, L, Valverde, M, Khatami, M, Romano, MF, Chapellier, M, Williams, MA, Wade, M, Manjili, MH, Lleonart, M, Xia, M, Gonzalez, MJ, Karamouzis, MV, Kirsch-Volders, M, Vaccari, M, Kuemmerle, NB, Singh, N, Cruickshanks, N, Kleinstreuer, N, van Larebeke, N, Ahmed, N, Ogunkua, O, Krishnakumar, PK, Vadgama, P, Marignani, PA, Ghosh, PM, Ostrosky-Wegman, P, Thompson, P, Dent, P, Heneberg, P, Darbre, P, Leung, PS, Nangia-Makker, P, Cheng, QS, Robey, RB, Al-Temaimi, R, Roy, R, Andrade-Vieira, R, Sinha, RK, Mehta, R, Vento, R, Di Fiore, R, Ponce-Cusi, R, Dornetshuber-Fleiss, R, Nahta, R, Castellino, RC, Palorini, R, Abd Hamid, R, Langie, SAS, Eltom, S, Brooks, SA, Ryeom, S, Wise, SS, Bay, SN, Harris, SA, Papagerakis, S, Romano, S, Pavanello, S, Eriksson, S, Forte, S, Casey, SC, Luanpitpong, S, Lee, T-J, Otsuki, T, Chen, T, Massfelder, T, Sanderson, T, Guarnieri, T, Hultman, T, Dormoy, V, Odero-Marah, V, Sabbisetti, V, Maguer-Satta, V, Rathmell, WK, Engstrom, W, Decker, WK, Bisson, WH, Rojanasakul, Y, Luqmani, Y, Chen, Z, Hu, Z, Goodson, WH, Lowe, L, Carpenter, DO, Gilbertson, M, Ali, AM, de Cerain Salsamendi, AL, Lasfar, A, Carnero, A, Azqueta, A, Amedei, A, Charles, AK, Collins, AR, Ward, A, Salzberg, AC, Colacci, A, Olsen, A-K, Berg, A, Barclay, BJ, Zhou, BP, Blanco-Aparicio, C, Baglole, CJ, Dong, C, Mondello, C, Hsu, C-W, Naus, CC, Yedjou, C, Curran, CS, Laird, DW, Koch, DC, Carlin, DJ, Felsher, DW, Roy, D, Brown, DG, Ratovitski, E, Ryan, EP, Corsini, E, Rojas, E, Moon, E-Y, Laconi, E, Marongiu, F, Al-Mulla, F, Chiaradonna, F, Darroudi, F, Martin, FL, Van Schooten, FJ, Goldberg, GS, Wagemaker, G, Nangami, G, Calaf, GM, Williams, G, Wolf, GT, Koppen, G, Brunborg, G, Lyerly, HK, Krishnan, H, Ab Hamid, H, Yasaei, H, Sone, H, Kondoh, H, Salem, HK, Hsu, H-Y, Park, HH, Koturbash, I, Miousse, IR, Scovassi, AI, Klaunig, JE, Vondracek, J, Raju, J, Roman, J, Wise, JP, Whitfield, JR, Woodrick, J, Christopher, JA, Ochieng, J, Fernando Martinez-Leal, J, Weisz, J, Kravchenko, J, Sun, J, Prudhomme, KR, Narayanan, KB, Cohen-Solal, KA, Moorwood, K, Gonzalez, L, Soucek, L, Jian, L, D'Abronzo, LS, Lin, L-T, Li, L, Gulliver, L, McCawley, LJ, Memeo, L, Vermeulen, L, Leyns, L, Zhang, L, Valverde, M, Khatami, M, Romano, MF, Chapellier, M, Williams, MA, Wade, M, Manjili, MH, Lleonart, M, Xia, M, Gonzalez, MJ, Karamouzis, MV, Kirsch-Volders, M, Vaccari, M, Kuemmerle, NB, Singh, N, Cruickshanks, N, Kleinstreuer, N, van Larebeke, N, Ahmed, N, Ogunkua, O, Krishnakumar, PK, Vadgama, P, Marignani, PA, Ghosh, PM, Ostrosky-Wegman, P, Thompson, P, Dent, P, Heneberg, P, Darbre, P, Leung, PS, Nangia-Makker, P, Cheng, QS, Robey, RB, Al-Temaimi, R, Roy, R, Andrade-Vieira, R, Sinha, RK, Mehta, R, Vento, R, Di Fiore, R, Ponce-Cusi, R, Dornetshuber-Fleiss, R, Nahta, R, Castellino, RC, Palorini, R, Abd Hamid, R, Langie, SAS, Eltom, S, Brooks, SA, Ryeom, S, Wise, SS, Bay, SN, Harris, SA, Papagerakis, S, Romano, S, Pavanello, S, Eriksson, S, Forte, S, Casey, SC, Luanpitpong, S, Lee, T-J, Otsuki, T, Chen, T, Massfelder, T, Sanderson, T, Guarnieri, T, Hultman, T, Dormoy, V, Odero-Marah, V, Sabbisetti, V, Maguer-Satta, V, Rathmell, WK, Engstrom, W, Decker, WK, Bisson, WH, Rojanasakul, Y, Luqmani, Y, Chen, Z, and Hu, Z
Abstract: Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology.
Published: 2015

17. Blood Pressure in Relation to Concentrations of PCB Congeners and Chlorinated Pesticides

Author: Goncharov, A, Pavuk, M, Foushee, HR, Carpenter, DO, and Consort, AEHR
Subjects: hypertension, Ah receptor, Alabama, linear regression, body mass index, Anniston
Published: 2011

18. Time Series Analysis of Aplysia Total Motion Activity

Author: Zurbenko Ig, Carpenter Do, and A. G. DiRienzo
Subjects: Statistics and Probability, Nervous system, Chronobiology, General Immunology and Microbiology, biology, Applied Mathematics, General Medicine, biology.organism_classification, General Biochemistry, Genetics and Molecular Biology, Bacterial circadian rhythms, Electrophysiology, Rhythm, medicine.anatomical_structure, Light effects on circadian rhythm, Aplysia, medicine, Circadian rhythm, General Agricultural and Biological Sciences, Neuroscience
Abstract: SUMMARY We rely on various nonparametric time series techniques to quantify several autocorrelated Aplysia total motion activity series. The effect of light on total motion activity has been removed. A general model will be proposed for total motion activity, which is found to display a circadian rhythm, and the toxic effect of PCBs on total motion activity will be assessed. No underlying assumptions are made about the form of the circadian rhythm. Several types of circadian total motion activity patterns are discovered. We form the hypothesis that different data series may be separated into three distinct groups of common patterns of circadian total motion activity. We also investigate if in fact only a single innate oscillator regulates total motion activity. A fundamental property of living organisms is the phenomenon of the recurrence of various events at, for the most part, regular time intervals. Such biological rhythms have periods ranging from seconds (the firing of an isolated neuron) to 1 year (seasonal rhythms). In particular, rhythms with periods approximately equal to 24 hours (circadian rhythms) have especially drawn the attention of scientists (Aschoff, 1965). The most common types of circadian rhythms studied by scientists are total motion activity, body temperature, and urinary excretion (Wever, 1979). In this article, we investigate the structure of total motion activity in the mollusk Aplysia, which is a large marine snail that lives in shore environments. It is a herbivore that feeds on seaweed and moves by crawling, by which it can reach speeds of 80 meters per hour for limited periods of time. Aplysia are diurnal, being more active during the day than at night, and have a 1-year life cycle with death occurring soon after spawning. Aplysia are often selected by scientists for neurobiological studies of behavior because of the great analytic advantages of their central nervous system (in particular, unusually large nerve cells) and because considerable information exists on the electrophysiological properties of their neurons. Their selection for study is also based on two assumptions. First, their central nervous system mediates interesting behavior. Second, the principles of the neuronal organization of behavior are likely to be sufficiently general (Strumvasser, 1971), i.e., studies of their nervous system are likely to give us insights into the organization of behavior directly applicable to vertebrates, including humans. The discovery that certain rhythms persist in constant environmental conditions, e.g., constant darkness (DeCandolle, 1832), shows that they are generated and maintained within the organism. The strategy of studies that seek to identify the innate character of a rhythm is therefore to insulate the organism from environmental and social cues. Under such constant conditions, the effect of various factors (nutrition, temperature, light, toxins, etc.) on the innate rhythm may be tested. For instance, light-dark cycles have been shown to entrain organisms so that their rhythms are in phase with the environment (Roelfsema, 1987). In our present experiment, the effect of polychlorinated biphenyls (PCBs) on the innate Aplysia total motion activity was of interest.
Published: 1998

19. The role of residence near hazardous waste sites containing benzene in the development of hematologic cancers in upstate New York.

Author: Boberg E, Lessner L, and Carpenter DO
Published: 2011

20. Blood pressure and hypertension in relation to levels of serum polychlorinated biphenyls in residents of Anniston, Alabama.

Author: Goncharov A, Bloom M, Pavuk M, Birman I, and Carpenter DO
Published: 2010
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21. Benefits versus risks associated with consumption of fish and other seafood.

Author: Bushkin-Bedient S, Carpenter DO, Bushkin-Bedient, Sheila, and Carpenter, David O
Abstract: Fish provide nutrition for much of the world's population, and when not contaminated with chemicals, fish is a very good food. A major benefit of fish is that they are high in polyunsaturated fatty acids (PUFAs), low in saturated fat, and they contain other critical nutrients. Much of the benefit of fish consumption derives from their high levels of long chain omega-3 PUFAs, which are produced by aquatic microorganisms and bioconcentrate in the aquatic food supply. The PUFAs are essential, in that humans and other vertebrates are not able to synthesize them and therefore must obtain them from the diet. The PUFAs particularly concentrate in the nervous system, alter immune system function reduce serum triglyceride levels and have been reported to reduce the risk of sudden death after a myocardial infarction. But the problem is that most fish have at least some degree of chemical contamination with methylmercury, (which binds to muscle) and/or with persistent organic pollutants such as dioxins, polychlorinated biphenyls, polybrominated diphenyl ethers, chlorinated pesticides (which concentrate in fish fat). These chemicals have adverse effects on nervous system function, modulate the immune system, and are associated with elevations in risk of cardiovascular disease. Thus the question of benefits and risk from fish consumption is complex but very important. [ABSTRACT FROM AUTHOR]
Published: 2010
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22. Electromagnetic fields and cancer: the cost of doing nothing.

Author: Carpenter DO and Carpenter, David O
Abstract: Everyone is exposed to electromagnetic fields (EMFs) from electricity (extremely low frequency, ELF), communication frequencies, and wireless devices (radiofrequency, RF). Concern of health hazards from EMFs has increased as the use of cell phones and other wireless devices has grown in all segments of society, especially among children. While there has been strong evidence for an association between leukemia and residential or occupational exposure to ELF EMFs for many years, the standards in existence are not sufficiently stringent to protect from an increased risk of cancer. For RF EMFs, standards are set at levels designed to avoid tissue heating, in spite of convincing evidence of adverse biological effects at intensities too low to cause significant heating. Recent studies demonstrate elevations in rates of brain cancer and acoustic neuroma only on the side of the head where individuals used their cell phone. Individuals who begin exposure at younger ages are more vulnerable. These data indicate that the existing standards for radiofrequency exposure are not adequate. While there are many unanswered questions, the cost of doing nothing will result in an increasing number of people, many of them young, developing cancer. [ABSTRACT FROM AUTHOR]
Published: 2010
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23. Relationship of thyroid hormone levels to levels of polychlorinated biphenyls, lead, p,p'-DDE, and other toxicants in Akwesasne Mohawk youth.

Author: Schell LM, Gallo MV, Denham M, Ravenscroft J, DeCaprio AP, and Carpenter DO
Subjects: THYROID hormones, MULTIPLE regression analysis, PRENATAL exposure delayed effects, RESEARCH funding, ENVIRONMENTAL exposure, POLYCHLORINATED biphenyls, MOHAWK (North American people)
Abstract: BACKGROUND: It is well documented that acute exposure to high levels of persistent organic pollutants, such as polychlorinated biphenyls (PCBs), p,p'-dichlorophenyldichloroethylene (p,p'-DDE), and hexachlorobenzene (HCB), can affect human health including thyroid function. Chronic exposure to multiple toxicants is common but difficult to analyze, and most prior studies have focused on adults or newborns, creating a gap in our understanding of multitoxicant effects among adolescents. OBJECTIVE: We investigated whether levels of PCBs, p,p'-DDE, HCB, mirex, lead, and mercury reflecting past chronic exposure are associated with alterations in levels of thyroid-stimulating hormone (TSH), triiodothyronine (T(3)), total thyroxine (TT(4)), and free thyroxine (FT(4)) among older children and adolescents. METHODS: The sample consists of youth from the Akwesasne Mohawk Nation (n = 232) who reside in proximity to several industries that have contaminated the local environment. We used multiple regression analysis to examine the effect of PCB groupings, p,p'-DDE, HCB, lead, and mercury on thyroid hormones after adjusting for sociodemographic covariates and controlling for all other toxicants. RESULTS: Exposure to PCBs affects the thyroid hormone profile in adolescents. The group of persistent PCBs was positively associated with TSH but inversely related to FT(4). Nonpersistent PCBs were significantly and negatively related to FT(4) only. HCB was negatively associated with T(4), and lead was positively associated with T(3). Breast-fed adolescents had higher levels of persistent PCBs and p,p'-DDE but not of nonpersistent PCBs or any other toxicant when compared with non-breast-fed adolescents. Though having lower levels of persistent PCBs and p,p'-DDE, non-breast-fed adolescents exhibited significant relationships between persistent PCBs and TSH and FT(4), but breast-fed adolescents did not. It appears that PCBs from breast milk obscure the relationship between prenatal PCB exposure and thyroid function by adding random variation in PCB levels. CONCLUSION: Our results demonstrate a reduction in thyroid function in adolescents in relation to their current serum levels of PCBs. These observations are consistent with the hypothesis that pre-natal exposure to PCBs alters thyroid function in a long-lasting manner but does not exclude the possibility that postnatal exposure is influential also. [ABSTRACT FROM AUTHOR]
Published: 2008
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24. Diabetes in Relation to Serum Levels of Polychlorinated Biphenyls and Chlorinated Pesticides in Adult Native Americans.

Author: Codru N, Schymura MJ, Negoita S, Rej R, and Carpenter DO
Subjects: BENZENE derivatives, STATISTICS, ENVIRONMENTAL monitoring, CROSS-sectional method, DIABETES, HYDROCARBONS, BODY mass index, ODDS ratio, MOHAWK (North American people), POLYCHLORINATED biphenyls
Abstract: BACKGROUND: Recent research suggests that diabetes, a condition whose incidence is increasing, is associated with exposure to polychlorinated biphenyls (PCBs) and chlorinated pesticides. OBJECTIVES: We investigated the potential association between diabetes and serum levels of PCBs, dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB), and mirex in a cross-sectional study of an adult Native-American (Mohawk) population. METHODS: Through a standardized questionnaire we collected demographic, medical, and lifestyle information from 352 adults, > or =30 years of age. We collected fasting serum samples that were analyzed for 101 PCB congeners, DDE, HCB, and mirex along with fasting glucose, triglycerides, and cholesterol. Participants who had fasting-glucose values > 125 mg/dL and/or who were taking antidiabetic medication were defined as persons with diabetes. We conducted logistic regression to assess the potential association between organochlorine serum levels and diabetes, while controlling for the potential confounding variables of age, body mass index (BMI), smoking, sex, and serum lipid levels. Organochlorine serum levels were categorized in tertiles, and the lowest tertile was used as the reference category. RESULTS: The prevalence of diabetes was 20.2%. The odds ratio (OR) of having diabetes for participants in the highest tertile of total PCB concentration compared with the lowest tertile was 3.9 (95% confidence interval, 1.5-10.6). The corresponding ORs for DDE and HCB were even higher. Elevated serum mirex was not associated with diabetes. After adjustment for other analytes, the OR for HCB remained significant, whereas ORs for PCBs and DDE remained elevated but not statistically significant. In contrast, after adjustment for other analytes, the OR for mirex became statistically significant and indicated an inverse association. CONCLUSIONS: In this study of adult Native Americans, elevated serum PCBs, DDE, and HCB were positively associated with diabetes after controlling for potential confounders, whereas a negative association was observed for mirex. [ABSTRACT FROM AUTHOR]
Published: 2007
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25. The need for global environmental health policy.

Author: Carpenter DO
Abstract: The world economy has been growing by an average of 3.5% a year. Continued global development is sustainable if overall social assets remain constant or rise over time, including manufactured, human, and environmental capital. Sustainable development requires that society not decrease its overall assets. But unregulated global trade may result in long-term loss of environmental capital. Multilateral governance is needed. Classical business models tend to view environmental damage as an externality--an impact on a third party's welfare that is neither compensated nor appropriated. The Rio Declaration on Environment and Development clearly states that economic development must err on the side of environmental integrity. Whereas UN Environmental Program policy requires precaution in the face of scientific uncertainty, World Trade Organization policy requires scientific certainty before precaution can be used. The conflict is obvious. In fact, there is gross lack of policy coordination across institutions. This article looks at some environmental strains and concludes that trade policy must address all aspects of human welfare, not merely the economic. [ABSTRACT FROM AUTHOR]
Published: 2003
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26. Chronic disease surveillance of St. Regis Mohawk Health Service patients.

Author: Negoita S, Swamp L, Kelley B, and Carpenter DO
Abstract: A study of the distribution of some chronic diseases among the Akwesasne Mohawks was performed using computerized medical records of the St. Regis Mohawk Health Services Clinic. Prevalence proportions, annual incidence rates, and five-year incidence rates were computed for the period January 1, 1992 to January 1, 1997 for asthma, diabetes mellitus type II, hypothyroidism, and osteoarthritis. Hypothyroidism and diabetes showed higher age-specific prevalence than in the general U.S. population. Osteoarthritis was extremely frequent among people 60 years of age and older, and it may also be elevated in prevalence in relation to the U.S. general population. The incidence and prevalence trends of diabetes type II and osteoarthritis were stationary, but those for asthma and hypothyroidism showed increases over the study period. Morbidity from asthma and acquired hypothyroidism should be monitored in the future and investigated through analytic epidemiologic methods for a possible association with lifestyle and environmental factors. [ABSTRACT FROM AUTHOR]
Published: 2001
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27. Afferent new fiber activity responding to temperature changes of scrotal skin of the rat

Author: Carpenter Do, Pierau F-K, and Torrey P
Subjects: Male, Physiology, Pudendal nerve, Population, Action Potentials, Stimulation, Afferent, Oscillometry, Static electricity, Animals, Fiber, Neurons, Afferent, education, Skin, Neurons, education.field_of_study, Chemistry, General Neuroscience, Scrotal skin, Thermoreceptors, Rats, Biophysics, Scrotum, Mechanosensitive channels, Mechanoreceptors, Microelectrodes
Abstract: The discharge patterns of single afferent fibers from rat pudendal nerve were studied as a function in temperature of the scrotal skin, an area known to function in temperature regulation. In a number of respects the population of temperature-sensitive afferents here differ from most previously described; 75% of temperature-sensitive afferents were also sensitive to mechanical stimulation. Of the 25% nonmechanosensitive units, half showed dynamic and static responses to cooling, while most of the remaining fibers gave only static discharges to warming. The most frequent thermal reaction of the mechanosensitive units was a dynamic-static cold response or a pure static warm response. However, fibers were also present with only dynamic or only static cold responses. Of the bimodal units, 20% had a dynamic cold response, but showed a minimal static discharge at intermediate temperatures (about 35 degrees C) and an increased discharge on both warming and cooling from that temperature. One unit had static and dynamic warm responses. Whereas a bursting discharge in the cold has previously been considered to be a distinguishing characteristic of specific cold receptors, in the pudendal afferents a bursting discharge on cooling or at low temperatures is common both in mechanosensitive and specific cold fibers. This observation and the identical discharge patterns and mechanisms underlying the thermosensitivity argue for the view that the mechanosensitive afferents participate in thermal sensation and/or regulation along with the specific temperature receptors. Hellon and Misra (7) have concluded that there is processing of thermal information from the scrotal skin at the level of the first synapse in the cord. However, in this study, we have found peripheral afferents which have most of the discharge properties that led Hellon and Misra to conclude that processing had occurred. The unusual characteristics of thermosensitive afferents of the pudendal nerve suggest that there is probably organ specificity of neuronal discharge properties.
Published: 1975

28. Bring environmental health back into public health.

Author: Carpenter DO
Published: 1999
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29. Zip code and GIS studies: Kouznetsova et al. respond.

Author: Kouznetsova M, Huang X, Ma J, Lessner L, and Carpenter DO
Published: 2008
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30. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author: Vos, Theo, Allen, Christine, Arora, Megha, Barber, Ryan M, Bhutta, Zulfiqar A, Brown, Alexandria, Carter, Austin, Casey, Daniel C, Charlson, Fiona J, Chen, Alan Z, Coggeshall, Megan, Cornaby, Leslie, Dandona, Lalit, Dicker, Daniel J, Dilegge, Tina, Erskine, Holly E, Ferrari, Alize J, Fitzmaurice, Christina, Fleming, Tom, Forouzanfar, Mohammad H, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Graetz, Nicholas, Haagsma, Juanita A, Hay, Simon I, Johnson, Catherine O, Kassebaum, Nicholas J, Kawashima, Toana, Kemmer, Laura, Khalil, Ibrahim A, Kinfu, Yohannes, Kyu, Hmwe H, Leung, Janni, Liang, Xiaofeng, Lim, Stephen S, Lopez, Alan D, Lozano, Rafael, Marczak, Laurie, Mensah, George A, Mokdad, Ali H, Naghavi, Mohsen, Nguyen, Grant, Nsoesie, Elaine, Olsen, Helen, Pigott, David M, Pinho, Christine, Rankin, Zane, Reinig, Nikolas, Salomon, Joshua A, Sandar, Logan, Smith, Alison, Stanaway, Jeffrey, Steiner, Caitlyn, Teeple, Stephanie, Thomas, Bernadette A, Troeger, Christopher, Wagner, Joseph A, Wang, Haidong, Wanga, Valentine, Whiteford, Harvey A, Zoeckler, Leo, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Ackerman, Ilana N, Adebiyi, Akindele Olupelumi, Ademi, Zanfina, Adou, Arsène Kouablan, Afanvi, Kossivi Agbelenko, Agardh, Emilie Elisabet, Agarwal, Arnav, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ajala, Oluremi N, Akinyemi, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Aldhahri, Saleh Fahed, Alegretti, Miguel Angel, Alemu, Zewdie Aderaw, Alexander, Lily T, Alhabib, Samia, Ali, Raghib, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Gregory M, Anderson, Benjamin O, Antonio, Carl Abelardo T, Aregay, Atsede Fantahun, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barregard, Lars, Barrero, Lope H, Basu, Arindam, Bazargan-Hejazi, Shahrzad, Beghi, Ettore, Bell, Brent, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Boris, Biryukov, Stan, Bisanzio, Donal, Bjertness, Espen, Blore, Jed, Borschmann, Rohan, Boufous, Soufiane, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brown, Jonathan, Buchbinder, Rachelle, Buckle, Geoffrey Colin, Butt, Zahid A, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carabin, Hélène, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Coates, Matthew M, Colquhoun, Samantha M, Cooper, Cyrus, Cortinovis, Monica, Crump, John A, Damtew, Solomon Abrha, Dandona, Rakhi, Daoud, Farah, Dargan, Paul I, das Neves, José, Davey, Gail, Davis, Adrian C, Leo, Diego De, Degenhardt, Louisa, Gobbo, Liana C Del, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Derrett, Sarah, Jarlais, Don C Des, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Ding, Eric L, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ebrahimi, Hedyeh, Ellenbogen, Richard G, Elyazar, Iqbal, Endres, Matthias, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Estep, Kara, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Felson, David T, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Foreman, Kyle, Fowkes, F Gerry R, Fox, Jordan, Franklin, Richard C, Friedman, Joseph, Frostad, Joseph, Fürst, Thomas, Futran, Neal D, Gabbe, Belinda, Ganguly, Parthasarathi, Gankpé, Fortuné Gbètoho, Gebre, Teshome, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Glaser, Elizabeth, Godwin, William W, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Grainger, Rebecca, Greaves, Felix, Guillemin, Francis, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hammami, Mouhanad, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Havmoeller, Rasmus, Hay, Roderick J, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hoy, Damian G, Htet, Aung Soe, Huang, Hsiang, Huang, John J, Huynh, Chantal, Iannarone, Marissa, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jensen, Paul N, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Keiyoro, Peter Njenga, Kemp, Andrew Haddon, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Khubchandani, Jagdish, Kieling, Christian, Kim, Pauline, Kim, Cho-il, Kim, Daniel, Kim, Yun Jin, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kumar, G Anil, Kutz, Michael, Kwan, Gene F, Lal, Aparna, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Larsson, Anders, Lavados, Pablo M, Leasher, Janet L, Leigh, James, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Liang, Juan, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Lo, Warren D, Logroscino, Giancarlo, Looker, Katharine J, Lotufo, Paulo A, Lunevicius, Raimundas, Lyons, Ronan A, Mackay, Mark T, Magdy, Mohammed, Razek, Abd El, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Marcenes, Wagner, Margolis, David Joel, Martinez-Raga, Jose, Masiye, Felix, Massano, João, McGarvey, Stephen Theodore, McGrath, John J, McKee, Martin, McMahon, Brian J, Meaney, Peter A, Mehari, Alem, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Millear, Anoushka, Miller, Ted R, Mills, Edward J, Mirarefin, Mojde, Mitchell, Philip B, Mock, Charles N, Mohammadi, Alireza, Mohammed, Shafiu, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Mooney, Meghan D, Moradi-Lakeh, Maziar, Morawska, Lidia, Mueller, Ulrich O, Mullany, Erin, Mumford, John Everett, Murdoch, Michele E, Nachega, Jean B, Nagel, Gabriele, Naheed, Aliya, Naldi, Luigi, Nangia, Vinay, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nolla, Joan M, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nunes, Bruno P, Ogbo, Felix Akpojene, Oh, In-Hwan, Ohkubo, Takayoshi, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ortiz, Alberto, Osman, Majdi, Ota, Erika, PA, Mahesh, Park, Eun-Kee, Parsaeian, Mahboubeh, de Azeredo Passos, Valéria Maria, Caicedo, Angel J Paternina, Patten, Scott B, Patton, George C, Pereira, David M, Perez-Padilla, Rogelio, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Pishgar, Farhad, Plass, Dietrich, Platts-Mills, James A, Polinder, Suzanne, Pond, Constance D, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M, Qorbani, Mostafa, Rabiee, Rynaz H S, Radfar, Amir, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Rao, Puja, Refaat, Amany H, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Reynolds, Alex, Ribeiro, Antonio L, Blancas, Maria Jesus Rios, Roba, Hirbo Shore, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Ambuj, Sagar, Rajesh, Sahathevan, Ramesh, Sanabria, Juan R, Sanchez-Niño, Maria Dolores, Santos, Itamar S, Santos, João Vasco, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schaub, Michael P, Schmidt, Maria Inês, Schneider, Ione J C, Schöttker, Ben, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya A, Shaheen, Amira, Shaikh, Masood Ali, Sharma, Rajesh, Sharma, Upasana, Shen, Jiabin, Shepard, Donald S, Sheth, Kevin N, Shibuya, Kenji, Shin, Min-Jeong, Shiri, Rahman, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Silveira, Dayane Gabriele Alves, Singh, Abhishek, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Sivonda, Anna, Skirbekk, Vegard, Skogen, Jens Christoffer, Sligar, Amber, Sliwa, Karen, Soljak, Michael, Søreide, Kjetil, Sorensen, Reed J D, Soriano, Joan B, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steel, Nicholas, Stein, Dan J, Steiner, Timothy J, Steinke, Sabine, Stovner, Lars, Stroumpoulis, Konstantinos, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Takala, Jukka S, Tandon, Nikhil, Tanne, David, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Ao, Braden J Te, Tedla, Bemnet Amare, Terkawi, Abdullah Sulieman, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Fotis, Tran, Bach Xuan, Truelsen, Thomas, Dimbuene, Zacharie Tsala, Tsilimbaris, Miltiadis, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Gool, Coen H, Varakin, Yuri Y, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wagner, Gregory R, Waller, Stephen G, Wang, Linhong, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, White, Richard A, Williams, Hywel C, Wiysonge, Charles Shey, Wolfe, Charles D A, Won, Sungho, Woodbrook, Rachel, Wubshet, Mamo, Xavier, Denis, Xu, Gelin, Yadav, Ajit Kumar, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zeeb, Hajo, Zhou, Maigeng, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Murray, Christopher J L, Vos, T, Allen, 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Orjuela, Ca, Rivas, Jc, Catalá López, F, Chang, Jc, Chiang, Pp, Chibueze, Ce, Chisumpa, Vh, Choi, Jj, Chowdhury, R, Christensen, H, Christopher, Dj, Ciobanu, Lg, Cirillo, Massimo, Coates, Mm, Colquhoun, Sm, Cooper, C, Cortinovis, M, Crump, Ja, Gastroenterology & Hepatology, Health Services Management & Organisation (HSMO), Public Health, Psychiatry, Vos, Theo, Allen, Christine, Arora, Megha, Barber, Ryan M, Bhutta, Zulfiqar A, Brown, Alexandria, Carter, Austin, Casey, Daniel C, Charlson, Fiona J, Chen, Alan Z, Coggeshall, Megan, Cornaby, Leslie, Dandona, Lalit, Dicker, Daniel J, Dilegge, Tina, Erskine, Holly E, Ferrari, Alize J, Fitzmaurice, Christina, Fleming, Tom, Forouzanfar, Mohammad H, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Graetz, Nichola, Haagsma, Juanita A, Johnson, Catherine O, Kassebaum, Nicholas J, Kawashima, Toana, Kemmer, Laura, Khalil, Ibrahim A, Kinfu, Yohanne, Kyu, Hmwe H, Leung, Janni, Liang, Xiaofeng, Lim, Stephen S, Lopez, Alan D, Lozano, Rafael, Marczak, Laurie, Mensah, George A, Mokdad, Ali H, Naghavi, Mohsen, Nguyen, Grant, Nsoesie, Elaine, Olsen, Helen, Pigott, David M, Pinho, Christine, Rankin, Zane, Reinig, Nikola, Salomon, Joshua A, Sandar, Logan, Smith, Alison, Stanaway, Jeffrey, Steiner, Caitlyn, Teeple, Stephanie, Thomas, Bernadette A, Troeger, Christopher, Wagner, Joseph A, Wang, Haidong, Wanga, Valentine, Whiteford, Harvey A, Zoeckler, Leo, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Ackerman, Ilana N, Adebiyi, Akindele Olupelumi, Ademi, Zanfina, Adou, Arsène Kouablan, Afanvi, Kossivi Agbelenko, Agardh, Emilie Elisabet, Agarwal, Arnav, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ajala, Oluremi N, Akinyemi, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Aldhahri, Saleh Fahed, Alegretti, Miguel Angel, Alemu, Zewdie Aderaw, Alexander, Lily T, Alhabib, Samia, Ali, Raghib, Alkerwi, Ala'A, Alla, Françoi, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Gregory M, Anderson, Benjamin O, Antonio, Carl Abelardo T, Aregay, Atsede Fantahun, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barregard, Lar, Barrero, Lope H, Basu, Arindam, Bazargan-Hejazi, Shahrzad, Bell, Brent, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Bori, Biryukov, Stan, Bisanzio, Donal, Bjertness, Espen, Blore, Jed, Borschmann, Rohan, Boufous, Soufiane, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brown, Jonathan, Buchbinder, Rachelle, Buckle, Geoffrey Colin, Butt, Zahid A, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carabin, Hélène, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesu, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesuda, Ciobanu, Liliana G, Coates, Matthew M, Colquhoun, Samantha M, Cooper, Cyru, Cortinovis, Monica, Crump, John A, Damtew, Solomon Abrha, Dandona, Rakhi, Daoud, Farah, Dargan, Paul I, das Neves, José, Davey, Gail, Davis, Adrian C, Leo, Diego De, Degenhardt, Louisa, Gobbo, Liana C Del, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Derrett, Sarah, Jarlais, Don C De, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Ding, Eric L, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ebrahimi, Hedyeh, Ellenbogen, Richard G, Elyazar, Iqbal, Endres, Matthia, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Estep, Kara, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Felson, David T, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Foreman, Kyle, Fowkes, F Gerry R, Fox, Jordan, Franklin, Richard C, Friedman, Joseph, Frostad, Joseph, Fürst, Thoma, Futran, Neal D, Gabbe, Belinda, Ganguly, Parthasarathi, Gankpé, Fortuné Gbètoho, Gebre, Teshome, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Glaser, Elizabeth, Godwin, William W, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Grainger, Rebecca, Greaves, Felix, Guillemin, Franci, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hammami, Mouhanad, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Havmoeller, Rasmu, Hay, Roderick J, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hoy, Damian G, Htet, Aung Soe, Huang, Hsiang, Huang, John J, Huynh, Chantal, Iannarone, Marissa, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jensen, Paul N, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Keiyoro, Peter Njenga, Kemp, Andrew Haddon, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Khubchandani, Jagdish, Kieling, Christian, Kim, Pauline, Kim, Cho-il, Kim, Daniel, Kim, Yun Jin, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kumar, G Anil, Kutz, Michael, Kwan, Gene F, Lal, Aparna, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Larsson, Ander, Lavados, Pablo M, Leasher, Janet L, Leigh, Jame, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Liang, Juan, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Lo, Warren D, Logroscino, Giancarlo, Looker, Katharine J, Lotufo, Paulo A, Lunevicius, Raimunda, Lyons, Ronan A, Mackay, Mark T, Magdy, Mohammed, Razek, Abd El, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Marcenes, Wagner, Margolis, David Joel, Martinez-Raga, Jose, Masiye, Felix, Massano, João, Mcgarvey, Stephen Theodore, Mcgrath, John J, Mckee, Martin, Mcmahon, Brian J, Meaney, Peter A, Mehari, Alem, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Miller, Ted R, Mills, Edward J, Mirarefin, Mojde, Mitchell, Philip B, Mock, Charles N, Mohammadi, Alireza, Mohammed, Shafiu, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Mooney, Meghan D, Moradi-Lakeh, Maziar, Morawska, Lidia, Mueller, Ulrich O, Mullany, Erin, Mumford, John Everett, Murdoch, Michele E, Nachega, Jean B, Nagel, Gabriele, Naheed, Aliya, Naldi, Luigi, Nangia, Vinay, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nolla, Joan M, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nunes, Bruno P, Ogbo, Felix Akpojene, Oh, In-Hwan, Ohkubo, Takayoshi, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ortiz, Alberto, Osman, Majdi, Ota, Erika, Pa, Mahesh, Park, Eun-Kee, Parsaeian, Mahboubeh, de Azeredo Passos, Valéria Maria, Caicedo, Angel J Paternina, Patten, Scott B, Patton, George C, Pereira, David M, Perez-Padilla, Rogelio, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Pishgar, Farhad, Plass, Dietrich, Platts-Mills, James A, Polinder, Suzanne, Pond, Constance D, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M, Qorbani, Mostafa, Rabiee, Rynaz H S, Radfar, Amir, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Rao, Puja, Refaat, Amany H, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Reynolds, Alex, Ribeiro, Antonio L, Blancas, Maria Jesus Rio, Roba, Hirbo Shore, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Ambuj, Sagar, Rajesh, Sahathevan, Ramesh, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Santos, Itamar S, Santos, João Vasco, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schaub, Michael P, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya A, Shaheen, Amira, Shaikh, Masood Ali, Sharma, Rajesh, Sharma, Upasana, Shen, Jiabin, Shepard, Donald S, Sheth, Kevin N, Shibuya, Kenji, Shin, Min-Jeong, Shiri, Rahman, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Singh, Abhishek, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Sivonda, Anna, Skirbekk, Vegard, Skogen, Jens Christoffer, Sligar, Amber, Sliwa, Karen, Soljak, Michael, Søreide, Kjetil, Soriano, Joan B, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steel, Nichola, Stein, Dan J, Steiner, Timothy J, Steinke, Sabine, Stovner, Lar, Stroumpoulis, Konstantino, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Takala, Jukka S, Tandon, Nikhil, Tanne, David, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Ao, Braden J Te, Tedla, Bemnet Amare, Terkawi, Abdullah Sulieman, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tran, Bach Xuan, Dimbuene, Zacharie Tsala, Tsilimbaris, Miltiadi, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefano, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Gool, Coen H, Varakin, Yuri Y, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wagner, Gregory R, Waller, Stephen G, Wang, Linhong, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, White, Richard A, Williams, Hywel C, Wiysonge, Charles Shey, Wolfe, Charles D A, Won, Sungho, Woodbrook, Rachel, Wubshet, Mamo, Xavier, Deni, Xu, Gelin, Yadav, Ajit Kumar, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zeeb, Hajo, Zhou, Maigeng, Zodpey, Sanjay, Zuhlke, Liesl Joanna, and Murray, Christopher J L
Subjects: Medicine(all), VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Incidence, Medicine (all), Public Health, Global Health, Social Medicine and Epidemiology, Bayes Theorem, 11 Medical And Health Sciences, Articles, Department of Error, Global Health, Cost of Illne, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Cost of Illness, disability, General & Internal Medicine, Quality-Adjusted Life Year, Prevalence, Humans, Disabled Person, Disabled Persons, Quality-Adjusted Life Years, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, Human
Abstract: Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation. Open Access funded by Bill & Melinda Gates FoundationUnder a Creative Commons license Attribution 4.0 International (CC BY 4.0)
Published: 2016

31. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Author: Karen Sliwa, Xiaofeng Liang, Vivekanand Jha, Dorairaj Prabhakaran, Rakhi Dandona, Gonghuan Yang, Xuan Che, Soewarta Kosen, Sergei Petrovich Ermakov, Ted R. Miller, Samath D Dharmaratne, Philimon Gona, Sergey Soshnikov, Atsushi Goto, Costas A. Christophi, Zacharie Tsala Dimbuene, Elena Alvarez, Yanping Wang, Peggy Pei-Chia Chiang, Mohammad H. Forouzanfar, Giancarlo Logroscino, Massimo Cirillo, Knud Juel, Johanna M. Geleijnse, Stefan Ma, Samaya Ismayilova, Karen Fern Greenwell, Michelle L. Bell, Saad B. Omer, Ademola Lukman Adelekan, Joshua A. Salomon, Dhruv S. Kazi, Jed D. Blore, Walid Ammar, Carly E Levitz, Kovin Naidoo, Solveig A. Cunningham, Stephen G. Waller, Anand Dayama, James D. Wilkinson, Vasiliki Stathopoulou, Meghan D. Mooney, Mall Leinsalu, Jonathan R. Carapetis, Paul S. F. Yip, Anders Larsson, Abbas Ali Mahdi, Hideaki Toyoshima, Guohong Jiang, Xia Wan, Chuanhua Yu, Soufiane Boufous, Ivy Shiue, Bulat Idrisov, Qing Lan, Chelsea A. Liddell, Austin E Schumacher, Valeria Caso, Nigel Bruce, Paulo A. Lotufo, Ibrahim Abubakar, Roberto Tchio Talongwa, Luke Nyakarahuka, Edward J Mills, Iuri da Costa Leite, Semaw Ferede Abera, Ana C. Garcia, Ayse Abbasoglu Ozgoren, Matthew M Coates, Konstantinos Stroumpoulis, Bradford D. Gessner, Kebede Deribe, Tommi Vasankari, Logan Sandar, Kenji Shibuya, Karen M. Tabb, Troy Jacobs, Christopher J L Murray, Chakib Nejjari, Katherine T. Lofgren, Melvin Barrientos Marzan, Haidong Wang, Joanna Moschandreas, Raimundas Lunevicius, Nataliya Foigt, Rashmi Gupta, Ziad A. Memish, Victoria Pillay-van Wyk, Randah R. Hamadeh, Azmeraw T. Amare, Lalit Dandona, Uchechukwu K.A. Sampson, Monika Sawhney, Vasiliy Victorovich Vlassov, Farhad Islami, Palwasha Anwari, Mustafa Z. Younis, Amitava Banerjee, Ruben Castro, David O. Carpenter, Karzan Abdulmuhsin Mohammad, Taavi Lai, Yousef Khader, Sara Sheikhbahaei, Atte Meretoja, Zanfina Ademi, Ivo Rakovac, Yang Yang, Hilda L Harb, Daniel Pope, Jun She, Yichong Li, Andrew L. Thorne-Lyman, Adrian Davis, Stein Emil Vollset, Andre Pascal Kengne, Henry Apfel, Mark J. Nieuwenhuijsen, John J. McGrath, Yoshihiro Kokubo, Jonas Minet Kinge, Elisabete Weiderpass, Rajiv Chowdhury, Damian G Hoy, Jürgen C Schmidt, Seyed-Mohammad Fereshtehnejad, Harish Chander Gugnani, Hywel C Williams, Karen Edmond, Peter J. Allen, Marina Shakh-Nazarova, Tom Achoki, Edmond K. Kabagambe, Naohiro Yonemoto, Jun Zhu, Simon I. Hay, Karen J. Courville, Ketevan Goginashvili, Theo Vos, Kim Yun Jin, Kawkab Shishani, Lorenzo Monasta, H. Dean Hosgood, Uʇur Dilmen, Marcella Montico, Shankuan Zhu, Ami R. Moore, Marie Ng, Maigeng Zhou, Hebe N. Gouda, Linh N Bui, Sanjay Basu, Mouhanad Hammami, Mohammad T Mashal, Bryan K. Phillips, Marissa Iannarone, Ronan A Lyons, Young-Ho Khang, Robert G. Weintraub, Luca Ronfani, Daniel Kim, Alanur Çavlin, Ferrán Catalá-López, Ronny Westerman, Maia Kereselidze, Itamar S. Santos, Reza Assadi, Hwashin Hyun Shin, Carolina Maria Teixeira, Berrak Bora Basara, David Rojas-Rueda, Abdullah Sulieman Terkawi, Adansi A. Amankwaa, Nicholas J K Breitborde, Gokalp Kadri Yentur, Kaushalendra Kumar, Daniel Obadare Fijabi, Neeraj Bedi, Robert Quentin Reilly, Ana Maria Nogales Vasconcelos, Scott Weichenthal, Mark A. Green, Selen Begüm Uzun, Mukesh Dherani, Shams Eldin Ali Hassan Khalifa, Majed Asad, Jasvinder A. Singh, Angel J Paternina Caicedo, Eric L. Ding, Jost B. Jonas, Tolesa Bekele, Alan J Thomson, Steven E. Lipshultz, Rosario Cárdenas, Sajjad Ur Rahman, George A. Mensah, Jongmin Lee, Inga Dora Sigfusdottir, Mohammad Yahya Saeedi, Magdalena M. Muszyńska, Ulrich O Mueller, Stephen S Lim, Barthelemy Kuate Defo, Alan D. Lopez, Luciano A. Sposato, G Anil Kumar, Farshad Pourmalek, Zulfiqar A Bhutta, Maysaa El Sayed Zaki, Shiwei Liu, K.M. Venkat Narayan, William Msemburi, Ting Wu Chuang, Zewdie Aderaw Alemu, Saleem M Rana, Mohammad Taghi Hedayati, Mohsen Naghavi, Vegard Skirbekk, Walter Mendoza, Ali H. Mokdad, Yohannes Kinfu, Jean de Dieu Ngirabega, Takayoshi Ohkubo, Parfait Uwaliraye, Tasara T. Mazorodze, Farshad Farzadfar, Rob E. Dorrington, Mohammad A. AlMazroa, R. Kumar, Lesley Rushton, Wang, H, Liddell, Ca, Coates, Mm, Mooney, Md, Levitz, Ce, Schumacher, Ae, Apfel, H, Iannarone, M, Phillips, B, Lofgren, Kt, Sandar, L, Dorrington, Re, Rakovac, I, Jacobs, Ta, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, Aa, Abera, Sf, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, Za, Allen, Pj, Almazroa, Ma, Alvarez, E, Amankwaa, Aa, Amare, At, Ammar, W, Anwari, P, Cunningham, Sa, Asad, Mm, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, Ml, Bhutta, Z, Blore, J, Basara, Bb, Boufous, S, Breitborde, N, Bruce, Ng, Bui, Ln, Carapetis, Jr, Cárdenas, R, Carpenter, Do, Caso, V, Castro, Re, Catalá Lopéz, F, Cavlin, A, Che, X, Chiang, Pp, Chowdhury, R, Christophi, Ca, Chuang, Tw, Cirillo, Massimo, da Costa Leite, I, Courville, Kj, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, Sd, Dherani, Mk, Dilmen, U, Ding, El, Edmond, Km, Ermakov, Sp, Farzadfar, F, Fereshtehnejad, Sm, Fijabi, Do, Foigt, N, Forouzanfar, Mh, Garcia, Ac, Geleijnse, Jm, Gessner, Bd, Goginashvili, K, Gona, P, Goto, A, Gouda, Hn, Green, Ma, Greenwell, Kf, Gugnani, Hc, Gupta, R, Hamadeh, Rr, Hammami, M, Harb, Hl, Hay, S, Hedayati, Mt, Hosgood, Hd, Hoy, Dg, Idrisov, Bt, Islami, F, Ismayilova, S, Jha, V, Jiang, G, Jonas, Jb, Juel, K, Kabagambe, Ek, Kazi, D, Kengne, Ap, Kereselidze, M, Khader, Y, Khalifa, Se, Khang, Yh, Kim, D, Kinfu, Y, Kinge, Jm, Kokubo, Y, Kosen, S, Defo, Bk, Kumar, Ga, Kumar, K, Kumar, Rb, Lai, T, Lan, Q, Larsson, A, Lee, Jt, Leinsalu, M, Lim, S, Lipshultz, Se, Logroscino, G, Lotufo, Pa, Lunevicius, R, Lyons, Ra, Ma, S, Mahdi, Aa, Marzan, Mb, Mashal, Mt, Mazorodze, Tt, Mcgrath, Jj, Memish, Za, Mendoza, W, Mensah, Ga, Meretoja, A, Miller, Tr, Mills, Ej, Mohammad, Ka, Mokdad, Ah, Monasta, L, Montico, M, Moore, Ar, Moschandreas, J, Msemburi, Wt, Mueller, Uo, Muszynska, Mm, Naghavi, M, Naidoo, K, Narayan, Kv, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, Mj, Nyakarahuka, L, Ohkubo, T, Omer, Sb, Caicedo, Aj, Wyk, Vp, Pope, D, Prabhakaran, D, Rahman, Su, Rana, Sm, Reilly, Rq, Rojas Rueda, D, Ronfani, L, Rushton, L, Saeedi, My, Salomon, J, Sampson, U, Santos, I, Sawhney, M, Schmidt, Jc, Shakh Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, Hh, Shishani, K, Shiue, I, Sigfusdottir, Id, Singh, Ja, Skirbekk, V, Sliwa, K, Soshnikov, S, Sposato, La, Stathopoulou, Vk, Stroumpoulis, K, Tabb, Km, Talongwa, Rt, Teixeira, Cm, Terkawi, A, Thomson, Aj, Thorne Lyman, Al, Toyoshima, H, Dimbuene, Zt, Uwaliraye, P, Uzun, Sb, Vasankari, Tj, Vasconcelos, Am, Vlassov, Vv, Vollset, Se, Vos, T, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Westerman, R, Wilkinson, Jd, Williams, Hc, Yang, Yc, Yentur, Gk, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, Ky, El Sayed Zaki, M, Zhu, S, Lopez, Ad, and Murray, C. J.
Subjects: trends, Pediatrics, medicine.medical_specialty, Nutrition and Disease, democracy, Developing country, coverage, VDP::Medisinske fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803, millennium development goals, Global Health, survival, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Voeding en Ziekte, Infant Mortality, Global health, Humans, Organizational Objectives, Medicine, 030212 general & internal medicine, 10. No inequality, VLAG, business.industry, Mortality rate, Infant, Newborn, 1. No poverty, Infant, health, General Medicine, Millennium Development Goals, Infant mortality, maternal education, 3. Good health, Secular variation, Child mortality, Socioeconomic Factors, income countries, Child, Preschool, Child Mortality, developing-countries, VDP::Midical sciences: 700::Health sciences: 800::Epidemiology, medical and dental statistics: 803, International development, business, Demography, child-mortality
Abstract: Summary Background Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. Methods We generated updated estimates of child mortality in early neonatal (age 0–6 days), late neonatal (7–28 days), postneonatal (29–364 days), childhood (1–4 years), and under-5 (0–4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. Findings We estimated that 6·3 million (95% UI 6·0–6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1–18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6–177·4) in Guinea-Bissau to 2·3 (1·8–2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from −6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000–13 than during 1990–2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only −1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. Interpretation Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. Funding Bill & Melinda Gates Foundation, US Agency for International Development.
Published: 2014

32. PBDEs and dechlorane plus contamination in community e-waste recycling: Environmental and health implications in Northeastern Thailand.

Author: Walaska H, Dvorska A, Petrlik J, Boontongmai T, Bubphachat N, Strakova J, Thowsakul C, Teebthaisong A, Jelinek N, Grechko V, Saetang P, Jeungsmarn P, Phanphet P, Pulawun S, Sykorova A, Gramblicka T, Pulkrabova J, and Carpenter DO
Abstract: Electronic waste (e-waste) poses significant environmental and health risks in Thailand due to both domestic production and international imports. A notable portion of this waste is processed in small-scale, community-based workshops, often located in poorer regions, where safety regulations are improperly enforced or entirely ignored. This study focuses on the Kalasin province in Northern Thailand, a region with numerous such workshops, where no comprehensive analysis of exposure to polybrominated diphenyl ethers (PBDEs) and dechlorane plus (DP) has been conducted. The study's objective was to quantify these toxic substances in environmental and biological samples to assess its contamination and human health risks. Environmental samples, including soil, dust, sediment, ash, eggs, crabs, snails, fish, and rice, were collected from e-waste processing sites and compared with control areas. Blood samples from e-waste workers and a control group were also analysed. Gas chromatography coupled with mass spectrometry operated in negative ion chemical ionization (GC-NCI-MS) was used to quantify PBDEs and DP isomers. Results showed significantly higher concentrations of these toxic compounds in e-waste sites compared to control areas. E-waste workers also had elevated levels of these substances in their blood, suggesting exposure through contaminated dust and food. These findings underscore the severe environmental contamination and health risks associated with improper e-waste management, highlighting the urgent need for regulatory measures and improved recycling practices to safeguard both environmental and public health., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 Elsevier B.V. All rights reserved.)
Published: 2024
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33. Air pollution we breathe: Assessing the air quality and human health impact in a megacity of Southeast Asia.

Author: Sannoh F, Fatmi Z, Carpenter DO, Santoso M, Siddique A, Khan K, Zeb J, Hussain MM, and Khwaja HA
Subjects: Humans, Pakistan, Risk Assessment, Cities, Environmental Exposure statistics & numerical data, Air Pollution statistics & numerical data, Air Pollutants analysis, Particulate Matter analysis, Environmental Monitoring
Abstract: With 24 million inhabitants and 6.6 million vehicles on the roads, Karachi, Pakistan ranks among the world's most polluted cities due to high levels of fine particulate matter (PM 2.5 ). This study aims to investigate PM 2.5 mass, seasonal and temporal variability, chemical characterization, source apportionment, and health risk assessment at two urban sites in Karachi. Samples were analyzed using ion chromatography and dual-wavelength optical transmissometer for various inorganic components (anions, cations, and trace elements) and black carbon (BC). Several PM 2.5 pollution episodes were frequently observed, with annual mean concentrations at Kemari (140 ± 179 μg/m 3 ) and Malir (95 ± 40.9 μg/m 3 ) being significantly above the World Health Organization's guidelines of 5 μg/m 3 . Chemical composition at both sites exhibited seasonal variability, with higher pollution levels in winter and fall and lower concentrations in summer. The annual average BC concentrations were 4.86 ± 5.29 μg/m 3 and 4.52 ± 3.68 μg/m 3 , respectively. A Positive Matrix Factorization (PMF) analysis identified 5 factors, crustal, sea salt, vehicular exhaust, fossil-fuel combustion, and industrial emission. The health risk assessment indicated a higher number of deaths in colder seasons (fall and winter) at the Kemari (328,794 and 287,814) and Malir (228,406 and 165,737) sites and potential non-carcinogenic and carcinogenic risks to children from metals. The non-carcinogenic risk of PM 2.5 bound Pb, Fe, Zn, Mn, Cr, Cu and Ni via inhalation exposure were within the acceptable level (<1) for adults. However, potential non-carcinogenic and carcinogenic health risk posed by Pb and Cr through inhalation were observed for children. The findings exhibit critical levels of air pollution that exceed the safe limits in Karachi, posing significant health risks to children and sensitive groups. Our study underscores the urgent need for effective emission control strategies and policy interventions to mitigate these air pollution risks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)
Published: 2024
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34. Associations between urine glyphosate levels and metabolic health risks: insights from a large cross-sectional population-based study.

Author: Otaru S, Jones LE, and Carpenter DO
Subjects: Humans, Cross-Sectional Studies, Male, Female, Middle Aged, Adult, Aged, Metabolic Syndrome urine, Metabolic Syndrome epidemiology, Metabolic Syndrome chemically induced, United States epidemiology, Environmental Exposure analysis, Young Adult, Risk Factors, Environmental Pollutants urine, Glyphosate, Glycine analogs & derivatives, Glycine urine, Nutrition Surveys, Herbicides urine
Abstract: Background: The prevalence of metabolic syndrome (MetS) in American adults increased from 37.6% in the 2011-12 period to 41.8% in 2017-2018. Environmental exposure, particularly to common compounds such as glyphosate, has drawn increasing attention as a potential risk factor., Methods: We employed three cycles of data (2013-2018) from the National Health and Nutrition Examination Survey (NHANES) in a cross-sectional study to examine potential associations between urine glyphosate measurements and MetS incidence. We first created a MetS score using exploratory factor analysis (EFA) of the International Diabetes Federation (IDF) criteria for MetS, with data drawn from the 2013-2018 NHANES cycles, and validated this score independently on an additional associated metric, the albumin-to-creatinine (ACR) ratio. The score was validated via a machine learning approach in predicting the ACR score via binary classification and then used in multivariable regression to test the association between quartile-categorized glyphosate exposure and the MetS score., Results: In adjusted multivariable regressions, regressions between quartile-categorized glyphosate exposure and MetS score showed a significant inverted U-shaped or saturating dose‒response profile, often with the largest effect for exposures in quartile 3. Exploration of potential effect modification by sex, race, and age category revealed significant differences by race and age, with older people (aged > 65 years) and non-Hispanic African American participants showing larger effect sizes for all exposure quartiles., Conclusions: We found that urinary glyphosate concentration is significantly associated with a statistical score designed to predict MetS status and that dose-response coefficient is nonlinear, with advanced age and non-Hispanic African American, Mexican American and other Hispanic participants exhibiting greater effect sizes., (© 2024. The Author(s).)
Published: 2024
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35. Standards for levels of lead in soil and dust around the world.

Author: Moyebi OD, Lebbie T, and Carpenter DO
Abstract: Lead poisoning is a serious environmental health problem in every country in the world. Exposure to lead results in neurocognitive and behavioral changes, has adverse effects on the immune system, causes anemia, hypertension and perturbs other organ systems. The effects of lead poisoning are most critical for children because their bodies are growing and developing, and particularly because agents that reduce cognitive function and attention span as well as promote disruptive behavior will have life-long consequences. Lead exposure, especially to children, is a major health disparity issue. If the next generation starts with reduced cognitive ability, there will be significant barriers for development of skills and country-wide development. While there are many sources of exposure to lead, the commonest source is lead in soil and dust. Since lead is an element, it does not go away and past releases of lead into the environment remain as soil and dust contamination. This is an especially important route of exposure to children because children regularly play in soil and are exposed via hand-to-mouth activity. In addition to indoor sources of lead, contaminated soil is tracked on shoes or feet and blown by air currents into homes, accumulating in household dust which is a major source of exposure for both children and adults. The purpose of this review is to determine standards presumed to be health protective for lead and dust in different countries. We find that many countries have no standards for lead in soil and dust and rely on standards set by the World Health Organization or the US Environmental Protection Agency, and these standards may or may not be enforced. There is considerable variation in standards set by other countries., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)
Published: 2024
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36. Reply to P Ayotte and A Achouba.

Author: Sasaki N, Jones LE, and Carpenter DO
Published: 2024
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37. Reply to A Olluri.

Author: Sasaki N, Jones LE, and Carpenter DO
Published: 2024
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38. Fish consumption and omega-3 polyunsaturated fatty acids from diet are positively associated with cognitive function in older adults even in the presence of exposure to lead, cadmium, selenium, and methylmercury: a cross-sectional study using NHANES 2011-2014 data.

Author: Sasaki N, Jones LE, and Carpenter DO
Subjects: Animals, Humans, Cadmium, Cross-Sectional Studies, Lead, Nutrition Surveys, Diet, Cognition, Selenium, Methylmercury Compounds, Fatty Acids, Omega-3
Abstract: Background: Long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFAs) are reported to be beneficial for cognition, but limited consumption of some fish is recommended due to high concentrations of heavy metals and persistent organics., Objective: We aimed to determine whether dietary ω-3 PUFAs from fish consumption are associated with higher cognitive scores in older adults and explored the associations of mixtures of ω-3 PUFAs and blood concentrations of lead, cadmium, selenium, and methylmercury on cognitive performance., Methods: We conducted a cross-sectional study with data from the NHANES 2011-2014, assessing cognitive scores of immediate recall, delayed recall, and executive function in adults ≥60 y (n = 3123). We performed multivariate linear regressions and mixture models utilizing the quantile-based g-computation method to identify associations between monthly fish consumption or dietary ω-3 PUFAs with blood concentrations of lead, cadmium, methyl mercury, and selenium on cognitive scores., Results: Fish consumption had significant positive associations with all 3 cognitive scores, whereas dietary ω-3 PUFAs were only significantly associated with the Digit Symbol Substitution Test (DSST) scores. Mixture analysis showed significant positive associations with DSST scores for fish consumption (β: 0.88; 95% CI: 0.48, 1.29) and dietary ω-3 PUFAs (β: 0.41; 95% CI: 0.03, 0.78) with positive component weights for fish consumption, dietary ω-3 PUFAs, and blood selenium and negative component weight for blood cadmium concentrations., Conclusions: Our findings support dietary recommendations for older adults to consume fish to maintain cognitive function, likely due to biomolecular actions of ω-3 PUFAs that increase neuronal membrane fluidity, have antioxidation activity, and restore cell damage. The combination of selenium and fish consumption or ω-3 PUFAs was associated with reduced decline in cognitive scores and less negative associations from exposures to lead, cadmium, and mercury compounds., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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39. Nutritional epigenetics education improves diet and attitude of parents of children with autism or attention deficit/hyperactivity disorder.

Author: Dufault RJ, Adler KM, Carpenter DO, Gilbert SG, and Crider RA
Abstract: Background: Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations, creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder (ADHD). Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream, and the severity of their symptoms correlates with the heavy metal levels measured in their blood. Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education., Aim: To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake., Methods: The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD. Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test ( n = 11) or control ( n = 11) group. The test group participated in the six-week online nutritional epigenetics tutorial, while the control group did not. The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods. Diet intake scores were derived for both ultra-processed and whole/organic foods. Paired sample t -tests were conducted to determine any differences in mean diet scores within each group., Results: There was a significant difference in the diet scores of the test group between the pre- and post-intervention periods. The parents in the test group significantly reduced their intake of ultra-processed foods with a pre-intervention diet score of 70 (mean = 5.385, SD = 2.534) and a post-intervention diet score of 113 (mean = 8.692, SD = 1.750) and the paired t -test analysis showing a significance of P < 0.001. The test group also significantly increased their consumption of whole and/or organic foods with a pre-intervention diet score of 100 (mean = 5.882, SD = 2.472) and post-intervention diet score of 121 (mean = 7.118, SD = 2.390) and the paired t -test analysis showing a significance of P < 0.05., Conclusion: Here we show nutritional epigenetics education can be used to reduce ultra-processed food intake and improve attitude among parents having learning-disabled children with autism or ADHD., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)
Published: 2024
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40. Different volatile organic compounds in local point source air pollution pose distinctive elevated risks for respiratory disease-associated emergency room visits.

Author: Madani NA, Jones LE, and Carpenter DO
Subjects: Humans, Environmental Exposure analysis, Benzene, Particulate Matter analysis, Volatile Organic Compounds analysis, Air Pollution analysis, Air Pollutants analysis, Asthma, Respiration Disorders, Pulmonary Disease, Chronic Obstructive, Respiratory Tract Infections
Abstract: Air pollution increases risk of respiratory disease but prior research has focused on particulate matter and criteria air pollutants, and there are few studies on respiratory effects of volatile organic compounds (VOC). We examined zip code level relationships between emergency room (ER) visits for respiratory illness and VOC pollution in New York State from 2010 to 2018. Detailed information on VOC pollution was derived from the National Emissions Inventory, which provides point source information on VOC emissions at the zip code level. We considered four respiratory diseases: asthma, acute upper respiratory infections, chronic obstructive pulmonary disease (COPD), and lower respiratory disease, using mixed effects regression with a random intercept to account for county level variability in single pollutant models, and Random Forest Regression (RFR) to assess relative importance of VOC exposures when considered together in multipollutant models. Single pollutant models show associations between respiratory-related ER visits with all pollutants of interest across all study years, even after adjusting for poverty and smoking by zip code. The largest relative single pollutant effect sizes considered included benzene, ethylbenzene, and total (summed) VOCs. Results from RFR including all VOC exposures indicate that ethylbenzene has the greatest variable importance for asthma, acute upper respiratory infections, and COPD, with toluene and benzene most important for lower respiratory ailments. RFR results also demonstrate presence of pairwise interactive effects between VOC pollutants. Our findings show that local VOC pollution may offer a significant contribution to the risk of respiratory disease-related ER visits, and that effects vary by illness and by VOC compound. ER visit rates for respiratory illness were elevated in high poverty zip codes, although this may be attributable to the fact that the poor lack basic access to health care and use ERs more frequently for routine care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
Published: 2023
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41. Effects of mixtures of polychlorinated biphenyls (PCBs) and three organochlorine pesticides on cognitive function differ between older Mohawks at Akwesasne and older adults in NHANES.

Author: Sasaki N, Morse G, Jones L, and Carpenter DO
Abstract: Background: Akwesasne Mohawks has been exposed to high concentrations of polychlorinated biphenyls (PCBs) and background levels of organochlorine pesticides, hexachlorobenzene (HCB), dichlorodiphenyl dichloroethylene (DDE), and mirex. We have previously reported relative contributions to the mixture of low- and high-chlorinated PCBs, HCB, and DDE on cognitive decrements in Mohawks of various ages., Objective: This study examines differences in the mixture effects of PCB congener groups, HCB, DDE, and mirex on cognitive function in older Mohawks and less PCB-exposed older adults from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 cycles., Methods: We used Bayesian kernel machine regression (BKMR) to evaluate the mixture effects of different PCB congener groups, HCB, DDE, and mirex on cognitive function in both populations. Models were adjusted for age, sex, education levels, and race/ethnicity focusing on individuals 60 years and older., Results: Older Mohawks had 3-fold higher mean total PCB concentrations and 1.8-fold higher mirex, but slightly lower mean DDE and HCB levels than NHANES older adults. Higher mixture concentrations were significantly associated with greater cognitive decline. In older Mohawks, low- and high-chlorinated PCBs, HCB, and DDE contributed to the cognitive score decline. In contrast, score decline in older NHANES adults were primarily from high-chlorinated PCBs and DDE with a threshold dose of approximately 2.08-2.27 ng/g and 2.02-2.40 ng/g, respectively., Conclusion: Mixtures of PCBs and organochlorine pesticides increase the risk of cognitive decline in both older Mohawks and NHANES older adults. However, contributions to these mixture effects show significant differences. In older Mohawks, high- and low-chlorinated PCBs, DDE, and HCB are the primary contributors, while high-chlorinated PCBs and DDE are important contributors in NHANES older adults. Due to chronic heavy exposures to PCBs, older Mohawks had a significantly increased risk of cognitive decline compared to general older adults from NHANES., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
Published: 2023
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42. Fine particulate matter and its chemical constituents' levels: A troubling environmental and human health situation in Karachi, Pakistan.

Author: Moyebi OD, Fatmi Z, Carpenter DO, Santoso M, Siddique A, Khan K, Zeb J, Hussain MM, and Khwaja HA
Subjects: Humans, Particulate Matter analysis, Pakistan, Environmental Monitoring methods, Vehicle Emissions analysis, Seasons, Ions analysis, Air Pollutants analysis, Trace Elements analysis
Abstract: Like many urban centers in developing countries, the effect of air pollution in Karachi is understudied. The goal of this study was to determine the chemical characterization, temporal and seasonal variability, sources, and health impacts of fine particulate matter (PM 2.5 ) in Karachi, Pakistan. Daily samples of PM 2.5 were collected using a low-volume air sampler at two different sites (Makro and Karachi University) over the four seasons between October 2009 and August 2010. Samples were analyzed for black carbon (BC), trace metals, and water-soluble ions. Results showed that the annual average concentrations of PM 2.5 at Makro and Karachi University were 114 ± 115 and 71.7 ± 56.4 μg m -3 , respectively, about 22.8 and 14.3-fold higher than the World Health Organization annual guideline of 5 μg m -3 . BC concentrations were 3.39 ± 1.97 and 2.70 ± 2.06 μg m -3 , respectively. The concentrations of PM 2.5 , BC, trace metals, and ions at the two sites showed clear seasonal trends, with higher concentrations in winter and lower concentrations in summer. The trace metals and ionic species with the highest concentrations were Pb, S, Zn, Ca, Si, Cl, Fe, and SO 4 2- . The air quality index in the fall and winter at both sites was about 68 %, which is "unhealthy" for the general population. Positive Matrix Factorization revealed the overall contribution to PM 2.5 at the Makro site came from three major sources - industrial emissions (13.3 %), vehicular emissions (59.1 %), and oil combustion (23.3 %). The estimates of expected number of deaths due to short-term exposure to PM 2.5 were high in the fall and winter at both sites, with an annual mean estimate of 3592 expected number of deaths at the Makro site. Attention should be paid to the reduction of inorganic pollutants from industrial facilities, vehicular traffic, and fossil fuel combustion, due to their extremely high contribution to PM 2.5 mass and health risks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)
Published: 2023
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43. Patterns of Emergency Room Visits for Respiratory Diseases in New York State in Relation to Air Pollution, Poverty and Smoking.

Author: Madani NA and Carpenter DO
Subjects: Humans, Emergency Service, Hospital, Smoking, Poverty, New York City, Air Pollution, Asthma complications, Pulmonary Disease, Chronic Obstructive complications, Air Pollutants, Respiration Disorders, Respiratory Tract Diseases etiology
Abstract: We have explored differences in rates of emergency room (ER) visits for respiratory diseases in the counties of New York State (NYS) in relation to levels of air pollution, poverty, and smoking. Air pollution information was derived from the National Emissions Inventory, which provides information on road, non-road, point, and non-point sources of 12 different air pollutants. This information is only available at the county level. Four types of respiratory diseases were considered: asthma, chronic obstructive pulmonary disease (COPD), acute lower respiratory diseases, and acute upper respiratory diseases. Asthma ER visits were elevated in counties with greater total air pollution. All forms of respiratory diseases were elevated in counties with a greater rate of poverty, although this may reflect the fact that poor people often use ERs for routine care. There was a very strong association between rates of smoking for COPD and acute lower respiratory diseases. There was an apparent negative association between smoking and asthma ER visits, but this must reflect the fact that smoking was much more common in upstate counties while asthma was more common in the New York City area, where air pollution is high. Air pollution was much greater in urban than in rural areas. Our evidence indicates that air pollution is the greatest risk factor for asthma attacks, whereas smoking is the greatest risk factor for chronic obstructive pulmonary disease (COPD) and lower respiratory disease. Poor people are more vulnerable to all forms of respiratory diseases.
Published: 2023
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44. Mixture Effects of Polychlorinated Biphenyls (PCBs) and Three Organochlorine Pesticides on Cognitive Function in Mohawk Adults at Akwesasne.

Author: Sasaki N, Jones LE, Morse GS, Carpenter DO, and On Behalf Of The Akwesasne Task Force On The Environment
Subjects: Aged, Humans, Middle Aged, Cognition, Environmental Exposure analysis, Hexachlorobenzene, Indians, North American, Mirex, Environmental Pollutants toxicity, Hydrocarbons, Chlorinated toxicity, Pesticides toxicity, Polychlorinated Biphenyls toxicity
Abstract: The Mohawks at Akwesasne have been highly exposed to polychlorinated biphenyls (PCBs), via releases from three aluminum foundries located near the reserve. They are also exposed to organochlorine pesticides, namely hexachlorobenzene (HCB), dichlorodiphenyldichloroethylene (DDE), and mirex. Previous studies have demonstrated reduced cognition in relation to total PCBs, but the effects of the mixtures of different PCB congener groups, HCB, DDE, and mirex on cognitive function have not been studied. Therefore, cognitive performance for executive function, scored via the digit symbol substitution test (DSST), in Mohawk adults aged 17-79 years ( n = 301), was assessed in relation to serum concentrations of low-chlorinated PCBs, high-chlorinated PCBs, total PCBs, HCB, DDE, and mirex. We used mixture models employing the quantile-based g-computation method. The mixture effects of low-chlorinated PCBs, high-chlorinated PCBs, HCB, DDE, and mirex were significantly associated with 4.01 DSST scores decrements in the oldest age group, 47-79 years old. There were important contributions to mixture effects from low-chlorinated PCBs, high-chlorinated PCBs, and total PCBs, with smaller contributions of HCB and DDE. Our findings indicate that exposures to both low- and high-chlorinated PCBs increase the risk of cognitive decline in older adults, while DDE and HCB have less effect.
Published: 2023
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45. State of gaseous air pollutants and resulting health effects in Karachi, Pakistan.

Author: Moyebi OD, Sannoh F, Fatmi Z, Siddique A, Khan K, Zeb J, Hussain MM, Carpenter DO, and Khwaja HA
Subjects: Nitrogen Dioxide analysis, Pakistan, Environmental Monitoring methods, Sulfur Dioxide analysis, Seasons, Particulate Matter analysis, China, Air Pollutants analysis, Air Pollution analysis, Environmental Pollutants analysis
Abstract: Karachi, Pakistan, is a priority site for air pollution research due to high emissions of air pollutants from vehicular traffic, industrial activities, and biomass burning, as well as rapid growth in population. The objectives of this study were to investigate the levels of gaseous pollutants (NO, NO 2 , O 3 , HNO 3 , and SO 2 ) in Karachi, to determine temporal and seasonal variations, to compare Karachi's air quality with other urban centers, to identify relationships with meteorological conditions, to identify source characterization, and to perform a backward-in-time trajectory analysis and a health impact assessment. Daily samples of gaseous pollutants were collected for six consecutive weeks in each of the four seasons for a year. Daily maximum concentrations of NO (90 parts per billion by volume (ppbv)), NO 2 (28.1 ppbv), O 3 (57.8 ppbv), and SO 2 (331 ppbv) were recorded in fall, while HNO 3 (9129 parts per trillion by volume (pptv)) was recorded in spring. Seasonal average concentrations were high in winter for NO (9.47 ± 7.82 ppbv), NO 2 (4.84 ± 3.35 ppbv), and O 3 (8.92 ± 7.65 ppbv), while HNO 3 (629 ± 1316 pptv) and SO 2 (20.2 ± 39.4 ppbv) were high in spring and fall, respectively. The observed SO 2 seasonal average concentration in fall (20.2 ± 39.4) was 5 times higher than that in summer (3.97 ± 2.77) with the fall 24-h average (120 ppbv) exceeding the WHO daily guideline (7.64 ppbv) by a factor of about 15.7. A health impact assessment estimated an increase of 1200 and 569 deaths due to short-term exposure to SO 2 in fall and spring, respectively. Chronic daily intake estimated risk per 1000 was 0.99, 0.47, 0.45, and 0.26 for SO 2 in fall, NO in winter, O 3 in winter, and NO 2 in spring, respectively. This study confirms the effect of poor urban air quality on public health and demonstrated the influence of photochemical reactions as well as unfavorable meteorological conditions on the formation of secondary pollutants., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Published: 2023
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46. Effects of glyphosate and glyphosate-based herbicides like Roundup™ on the mammalian nervous system: A review.

Author: Madani NA and Carpenter DO
Subjects: Animals, Carcinogens, Glycine analogs & derivatives, Glycine toxicity, Humans, Mammals, Nervous System, Glyphosate, Herbicides toxicity
Abstract: Glyphosate is the active ingredient in glyphosate-based herbicides (GBHs), such as Roundup™, the most widely used herbicides in the world. Glyphosate targets an essential enzyme in plants that is not found in animals. However, both glyphosate and GBHs are rated as Group 2A, probable human carcinogens, and also have documented effects on reproduction, acting as endocrine disruptive chemicals. We have reviewed reports of the effects of glyphosate and GBHs on mammalian nervous system function. As with several other herbicides, GBHs exposure has been associated with an increased risk of Parkinson's Disease and death of neurons in the substantia nigra. There is also some evidence implicating Roundup™ in elevated risk of autism. Other studies have shown the effects of GBHs on synaptic transmission in animal and cellular studies. The major mechanism of action appears to be oxidative stress, accompanied by mitochondrial dysfunction. In addition, some gut bacteria utilize the enzyme used by plants, and glyphosate and GBHs use has been shown to alter the gut microbiome. There is a large and growing body of evidence that the gut microbiome alters susceptibility to great number of human diseases, including nervous system function. The weight of the evidence indicates that in addition to cancer and reproductive effects, glyphosate and GBHs have significant adverse effects on the brain and behavior and increase the risk of at least some serious neurological diseases., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Carpenter has served as an expert witness in Roundup cases with all reimbursement going to support students and staff., (Copyright © 2022 Elsevier Inc. All rights reserved.)
Published: 2022
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47. PFAS and PBDEs in traditional subsistence foods from Sivuqaq, Alaska.

Author: Byrne S, Seguinot-Medina S, Waghiyi V, Apatiki E, Immingan T, Miller P, von Hippel FA, Buck CL, and Carpenter DO
Subjects: Animals, Halogenated Diphenyl Ethers analysis, Alaska, Persistent Organic Pollutants, Walruses, Lipids, Fluorocarbons, Environmental Pollutants analysis, Caniformia, Phoca
Abstract: The Arctic is a hemispheric sink for both legacy and current use persistent organic pollutants (POPs). Once in the Arctic, POPs biomagnify in food webs, potentially reaching concentrations in high trophic level animals that pose a health concern for people who subsist on those animals. Indigenous Peoples of the Arctic may be highly exposed to POPs through their traditional diets. The objective of this study was to assess concentrations of polybrominated diphenyl ethers (PBDEs) and per- and polyfluoroalkyl substances (PFAS) in tissues of traditionally harvested foods from Sivuqaq (St. Lawrence Island), Alaska. Community health researchers identified volunteer households and local hunters to donate tissues from traditionally harvested animals. Target species included bowhead whale (Balaena mysticetus), Pacific walrus (Odobenus rosmarus), ringed seal (Pusa hispida), bearded seal (Erignathus barbatus), ribbon seal (Histriophoca fasciata), spotted seal (Phoca largha), and reindeer (Rangifer tarandus). PBDEs were frequently detected in all species and tissues. PBDE concentrations tended to be highest in lipid-rich tissues of seals. PFAS were infrequently detected and did not show obvious patterns among species or tissues. This and other studies demonstrate that POPs such as PBDEs are present in tissues of traditional food animals from Sivuqaq, as they are throughout the Arctic, and consumption of these animals likely contributes to exposure among Arctic Indigenous Peoples., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Published: 2022
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48. Arnold R. Eiser: Preserving brain health in a toxic age: new insights from neuroscience, integrative medicine and public health.

Author: Carpenter DO
Subjects: Public Health, Brain, Integrative Medicine, Neurosciences
Published: 2022
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49. Exocrine pancreatic cancer and living near to waste sites containing hazardous organic chemicals, New York State, USA - an 18-year population-based study.

Author: Weinstein B, da Silva A, and Carpenter DO
Subjects: Benzene, Hazardous Substances, Hazardous Waste, Humans, New York epidemiology, Environmental Pollutants, Pancreatic Neoplasms chemically induced, Pancreatic Neoplasms epidemiology, Pesticides, Polychlorinated Biphenyls, Tetrachloroethylene, Trichloroethylene
Abstract: Objectives: The etiology of exocrine pancreatic cancer (EPC) remains unknown except for family history and smoking. Despite recent medical advances, rates of pancreatic cancer incidence and mortality are increasing. Although existing evidence suggests a potentially causal relationship between environmental chemical exposures and pancreatic cancer, whether residential exposure impacts pancreatic cancer rates remains unknown., Material and Methods: The authors identified 28 941 patients diagnosed with exocrine pancreatic cancer in New York State exclusive of New York City for the years 1996-2013. Descriptive statistics and negative binomial regression were used in this ecological study to compare pancreatic cancer hospitalization rates among patients who lived in zip codes with hazardous waste sites (HWSs) containing persistent organic pollutants (POPs) and volatile organic pollutants (VOCs) compared with clean zip codes with no identified hazardous waste sites. The authors assessed the effect of selected known and suspected human carcinogens on the EPC hospitalization rates by subgroup analyses., Results: Compared with the clean sites, the pancreatic cancer hospital discharge rate in the "VOCs without POPs" and "VOCs and POPs" sites, after adjustment for potential confounders were 1.06 (95% CI: 1.03-1.09) and 1.05 (95% CI: 1.01-1.08), respectively. In the analysis by specific chemicals, rate ratios (RR) for the benzene (RR = 1.12) and ethylbenzene (RR = 1.34) in the non-chlorinated VOCs group, trichloroethylene (RR = 1.07) and tetrachloroethylene (RR = 1.11) in the chlorinated VOCs group, chlorinated pesticides (RR = 1.11) and PCBs (RR = 1.05) in the POPs groups were statistically significant (p-values <0.05) compared with clean sites., Conclusions: Compared with the clean sites, the pancreatic cancer hospital discharge rate in the "VOCs without POPs" and "VOCs and POPs" sites, after adjustment for potential confounders were 1.06 (95% CI: 1.03-1.09) and 1.05 (95% CI: 1.01-1.08), respectively. In the analysis by specific chemicals, rate ratios (RR) for the benzene (RR = 1.12) and ethylbenzene (RR = 1.34) in the non-chlorinated VOCs group, trichloroethylene (RR = 1.07) and tetrachloroethylene (RR = 1.11) in the chlorinated VOCs group, chlorinated pesticides (RR = 1.11) and PCBs (RR = 1.05) in the POPs groups were statistically significant (p-values <0.05) compared with clean sites. Int J Occup Med Environ Health. 2022;35(4):459-71., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)
Published: 2022
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50. Evidence Base on the Potential Carcinogenicity of Radiofrequency Radiation.

Author: Carpenter DO, Hardell L, and Sage C
Subjects: Humans, Radio Waves adverse effects
Published: 2022
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