Search

Your search keyword '"Constantine Vardavas"' showing total 91 results
Start Over Author "Constantine Vardavas"
91 results on '"Constantine Vardavas"'

1. On the extension of the use of a standard operating procedure for nicotine, glycerol and propylene glycol analysis in e-liquids using mass spectrometry

Author

Alessia Turina, Alice Passoni, Silvano Gallus, Alessandra Lugo, Walther Klerx, Reinskje Talhout, Ranti Fayokun, Constantine Vardavas, and Enrico Davoli

Subjects
nicotine, mass spectrometry, standard operating procedure, e-liquids, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction Standard operating procedures (SOP), accessible to several laboratories, are essential for product verification. EU-JATC (European-Joint Action on Tobacco Control) SOP and the WHO TobLabNet (World Health Organization Tobacco Laboratories Network) SOP (SOP11) are available standard methodologies to measure nicotine, glycerol, and propylene glycol, and propose mass spectrometer (MS) as an alternative method to flame ionization detector (FID). This study conducted a comparison between FID and MS concentration results, following the MS method described in SOP11. Methods In May 2020, five test e-liquids in replicates (A-E) were prepared at the Istituto di Ricerche Farmacologiche Mario Negri and sent, with SOP 11, validation document and results datasheet to 32 different laboratories all over the world from WHO TobLabNet and EU-JATC (18 from JATC, ten from WHO TobLabNet and four academic laboratories). Among thirty-two independent laboratories that participated in the study, results were received from 30 laboratories. Results The e-liquids analyses, using the two approaches, were compared. Of the 30 laboratories surveyed, 21 utilized the FID approach exclusively, 7 opted for MS detection, and 2 employed both methods. The findings demonstrated that the gas chromatography-mass spectrometry (GC-MS) method offers comparable analytical capabilities regarding accuracy and precision for nicotine, glycerol, and propylene glycol to the FID approach. Through Pearson’s correlation test with r≃1 showing a positive correlation between GC-FID and GC-MS data, and the Student’s t-test, no significant differences between the two approaches were revealed, showing p>0.005 for almost all three analytes in all samples. Conclusions This study indicates that it is possible to apply the available EU-JATC SOP and the WHO TobLabNet SOP11 even in laboratories that do not have access to an FID, for example, to analyze flavors, trace compounds or carcinogenic, mutagenic, or toxic for reproduction (CMR) in electronic cigarette liquids.

Published
2024
Full Text
View/download PDF

2. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review

Author

Esteve Fernández, Frank Sandmann, Anastasia Pharris, Katerina Nikitara, Constantine Vardavas, Jo Leonardi-Bee, Konstantinos Zisis, Konstantinos Athanasakis, Revati Phalkey, Jonathan E Suk, Charlotte Deogan, Ioanna Lagou, Valia Marou, Katerina Aslanoglou, Orla Condell, and Favelle Lamb

Subjects
Medicine
Abstract

Objectives The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role.Design A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null.Data sources Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021.Eligibility criteria Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible.Data extraction and synthesis Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist.Results We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.Conclusions COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

Published
2023
Full Text
View/download PDF

3. Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review

Author

Constantine Vardavas, Katerina Nikitara, Katerina Aslanoglou, Ioanna Lagou, Valia Marou, Revati Phalkey, Jo Leonardi-Bee, Esteve Fernandez, Victoria Vivilaki, Apostolos Kamekis, Emmanouil Symvoulakis, Teymur Noori, Andrea Wuerz, Jonathan E. Suk, and Charlotte Deogan

Subjects
COVID-19, Health determinants, Disparities, Vaccination, Pandemic, Public health, Medicine
Abstract

Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.

Published
2023
Full Text
View/download PDF

4. The EU Single-Use Plastics Directive and its impact on tobacco products: A policy analysis

Author

Katerina Nikitara, Ioanna Lagou, Zinovia Plyta, Karina Mocanu, and Constantine Vardavas

Subjects
tobacco, single-use plastics, eu, directive, marine, litter, Toxicology. Poisons, RA1190-1270
Abstract

Single-use plastics (SUPs), which are used only once or briefly, have become a significant source of litter on European beaches and seas. The European Union (EU), approved the SUP Directive after acknowledging the significant harm that SUPs cause to the environment, human health, and the economy. The SUP Directive requires all relevant parties, including plastics manufacturers, recyclers, retailers, and consumers, to take the appropriate actions and make the necessary investments to protect the environment. The primary objective of the SUP Directive is to prevent and minimize the negative effects that some plastic products have on the environment, particularly the marine environment, as well as on human health. In an effort to combat marine litter, the Directive imposes restrictions and criteria on SUPs that fall under the purview of specific categories and items made from oxo-degradable plastic. This includes, among other things, the phase-out of unnecessary SUPs and oxodegradable plastic, the reduction of SUP consumption and the use of reusable substitutes, the adoption of marking and labelling standards, and the development of extended producer responsibility programs (EPR). Tobacco products with filters and filters marketed for use in conjunction with tobacco products are among the categories covered by the SUP Directive, owing to the fact that tobacco product filters containing plastic are the second most littered single-use plastic items on EU beaches. The implementation of the SUP Directive presents a unique opportunity to educate consumers about the plastic found in tobacco filters and filters marketed for use in conjunction with tobacco products.

Published
2022
Full Text
View/download PDF

5. Examining the level of preparedness of the nursing profession in the US to combat COVID-19 and lessons learned for public health programs, practice, and policy

Author

Israel Agaku, Lungile Nkosi, Grace K. Azua, Tina N. Tsafa, Queen D. Agaku, and Constantine Vardavas

Subjects
covid-19, nursing, workforce, hospitalization, burnout, Medicine
Abstract

Introduction COVID-19 has placed substantial strain on the US nursing workforce. We measured the correlation between the number of state-specific COVID-19 hospitalizations per nurse and COVID-19 deaths, and assessed factors associated with nurses reporting an intention to leave their current job from stressors like those associated with COVID-19, including stress and burnout. Methods This study was of a cross-sectional design. Data came from the 2018 National Sample Survey of Registered Nurses (i.e. baseline) and the CDC COVID Data Tracker. Descriptive and multivariable analyses were performed at p

Published
2022
Full Text
View/download PDF

6. Use and Awareness of Heated Tobacco Products in Europe

Author

Silvano Gallus, Alessandra Lugo, Xiaoqiu Liu, Elisa Borroni, Luke Clancy, Giuseppe Gorini, Maria José Lopez, Anna Odone, Krzysztof Przewozniak, Olena Tigova, Piet A. van den Brandt, Constantine Vardavas, Esteve Fernandez, and the TackSHS Project Investigators

Subjects
heated tobacco products, heat-not-burn tobacco products, iqos, survey, europe, Medicine (General), R5-920
Abstract

Background: Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective was to analyze the prevalence and associations of use of HTP across 11 countries in Europe. Methods: Within the TackSHS Project, in 2017–2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects. Results: Overall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio [aOR] 1.47; 95% confidence interval [CI], 1.11–1.95). Ever HTP use was inversely related to age (P for trend

Published
2022
Full Text
View/download PDF

7. The predictors and association between knowledge of vaccines and vaccination among adults and children in 28 European Countries, 2019

Author

Constantine Vardavas, Katerina Nikitara, Satomi Odani, and Emmanouil Symvoulakis

Subjects
vaccination, vaccine, knowledge, εurobarometer, vaccine uptake, Medicine
Abstract

Introduction Confidence in vaccine safety and effectiveness is an important predictor of vaccine uptake. This study assessed the level of knowledge of vaccination and factors associated with vaccination uptake in 28 EU countries. Methods A secondary dataset analysis was performed on data from the Eurobarometer on Europeans’ Attitudes Towards Vaccination (March 2019 across 28 EU countries). Knowledge about vaccination was assessed with the Eurobarometer with four true/false questions (range 0–4 correct answers), with high knowledge reported as a score of 3/4 or 4/4. Adjusted regression analyses were performed on all respondents (n=27524) and those who lived with a child aged 0–14 years (n=6005). Results Significant inter-country variability in the knowledge of vaccination was noted across the 28 European Countries, with little intra-country variation by gender and age. Adults who trusted health authorities as a source of information were more likely to have high knowledge about vaccination (AOR=1.29). In contrast, those who reported the internet as a source of information were less likely to have high knowledge (AOR=0.71). Previous vaccination in the past five years increased with a higher knowledge score among adults. Similarly, the odds of previous vaccination for their children were significantly higher among those who scored 3/4 (AOR=2.17; 95% CI: 1.41–3.34) and those who scored 4/4 (AOR=3.15; 95% CI: 2.01–4.91) than those who answered incorrectly to all questions. Conclusions Higher socioeconomic status, higher educational level, previous vaccination and higher perceived effectiveness of vaccination were significantly associated with higher knowledge of vaccinations. Improving awareness of the benefits of vaccines is warranted, especially in light of COVID-19 booster vaccinations in Europe.

Published
2022
Full Text
View/download PDF

8. Who Smokes in Europe? Data From 12 European Countries in the TackSHS Survey (2017–2018)

Author

Silvano Gallus, Alessandra Lugo, Xiaoqiu Liu, Panagiotis Behrakis, Roberto Boffi, Cristina Bosetti, Giulia Carreras, Liliane Chatenoud, Luke Clancy, Xavier Continente, Ruaraidh Dobson, Tobias Effertz, Filippos T. Filippidis, Marcela Fu, Gergana Geshanova, Giuseppe Gorini, Sheila Keogan, Hristo Ivanov, María J. Lopez, Angel Lopez-Nicolas, José Precioso, Krzysztof Przewozniak, Cornel Radu-Loghin, Ario Ruprecht, Sean Semple, Joan B. Soriano, Polina Starchenko, Marta Trapero-Bertran, Olena Tigova, Anna S. Tzortzi, Constantine Vardavas, Vergina K. Vyzikidou, Paolo Colombo, Esteve Fernandez, and the TackSHS Project Investigators

Subjects
tobacco, cigarette smoking, smoking prevalence, cross-sectional study, survey, europe, tackshs, Medicine (General), R5-920
Abstract

Background: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. Methods: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017–2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. Results: Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P < 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to

Published
2021
Full Text
View/download PDF

9. Transmission of SARS-CoV-2 in educational settings in 2020: a review

Author

Anastasia Pharris, Katerina Nikitara, Constantine Vardavas, Alexander G Mathioudakis, Jo Leonardi-Bee, Revati Phalkey, Jonathan E Suk, Charlotte Deogan, and Michele Hilton Boon

Subjects
Medicine
Abstract

Objectives School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.Methods This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1–17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission.Results Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020–2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low—when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents.Conclusions Transmission in educational settings in 2020 was minimal—when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.

Published
2022
Full Text
View/download PDF

10. Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol

Author

Esteve Fernández, María José López, Silvano Gallus, Sean Semple, Luke Clancy, Panagiotis Behrakis, Ario Ruprecht, Giuseppe Gorini, Ángel López-Nicolás, Cornel Radu-Loghin, Joan B. Soriano, Yolanda Castellano, Marcela Fu, Montse Ballbè, Beladenta Amalia, Olena Tigova, Xavier Continente, Teresa Arechávala, Elisabet Henderson, Alessandra Lugo, Xiaoqiu Liu, Cristina Bosetti, Enrico Davoli, Paolo Colombo, Rachel O’Donnell, Ruaraidh Dobson, Sheila Keogan, Shashsa Li, Elizabeth Breslin, Hannah Byrne, Anna Tzortzi, Constantine Vardavas, Vergina Konstantina Vyzikidou, Stephanie Teloniatis, Gerasimos Bakelas, George Mattiampa, Roberto Boffi, Cinzia De Marco, Alessandro Borgini, Chiara Veronese, Martina Bertoldi, Andrea Tittarelli, Giulia Carreras, Barbara Cortini, Simona Verdi, Alessio Lachi, Elisabetta Chellini, Ángel López Nicolás, Marta Trapero-Bertran, Daniel Celdrán Guerrero, Dominick Nguyen, Polina Starchenko, Julio Ancochea, Tamara Alonso, María Teresa Pastor, Marta Erro, Ana Roca, and Patricia Pérez

Subjects
Public aspects of medicine, RA1-1270
Abstract

Objective: The TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. Method: The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. Conclusion: The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure. Resumen: Objetivo: El proyecto TackSHS pretende caracterizar el impacto global de la exposición al humo ambiental de tabaco (HAT) y al aerosol de los cigarrillos electrónicos (ACE) en la salud respiratoria de la población europea según variables socioeconómicas y otros determinantes. Método: El proyecto TackSHS consiste en una serie de estudios coordinados y gestionados por 11 organizaciones académicas y de salud pública de seis países europeos. El proyecto estudiará: a) los determinantes de la exposición al HAT y al ACE a nivel individual (encuestas en muestras representativas de la población general) y en espacios comunes (muestras ambientales en lugares específicos); b) su carga general de enfermedad y la morbimortalidad atribuible a tal exposición; y c) su impacto económico en términos de costes sanitarios directos e indirectos. Además, el proyecto investigará cambios específicos a corto plazo en la salud respiratoria en personas sanas y en pacientes con enfermedades respiratorias expuestos al HAT y al ACE. También examinará la efectividad de una intervención novedosa para reducir la exposición al HAT en hogares donde se permite fumar. Todos estos estudios están interrelacionados y conllevan una coordinación colaborativa entre las instituciones participantes. Conclusión: El enfoque integral del proyecto TackSHS permitirá un avance significativo en la evidencia sobre la comprensión del impacto de la exposición al HAT y al ACE en la salud, y proporcionará una base para desarrollar recomendaciones políticas sanitarias para ayudar a los países europeos a reducir los daños causados por la exposición al HAT y al ACE. Keywords: Second-hand smoke, Passive smoking, Electronic cigarette, Electronic nicotine delivery systems, Aerosols, Second-hand aerosols, Respiratory health, Burden of disease, Economic impact, Palabras clave: Humo ambiental del tabaco, Tabaquismo pasivo, Cigarrillos electrónicos, Sistemas electrónicos de administración de nicotina, Exposición al aerosol, Salud respiratoria, Carga de enfermedad, Impacto económico

Published
2020
Full Text
View/download PDF

11. Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis

Author

Helen Johnson, Katerina Nikitara, Constantine Vardavas, Jo Leonardi-Bee, Konstantinos Zisis, Konstantinos Athanasakis, Revati Phalkey, Svetla Tsolova, Massimo Ciotti, and Jonathan E Suk

Subjects
Medicine
Abstract

Objectives Respiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019.Setting Respiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies.Primary and secondary outcome measures Direct and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured.Results Overall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention.Conclusions Our cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.

Published
2021
Full Text
View/download PDF

12. Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries

Author

Constantine Vardavas, Satomi Odani, Katerina Nikitara, Hania El Banhawi, Christina Kyriakos, Luke Taylor, and Nicholas Becuwe

Subjects
COVID-19, Infection control, Public health, Public attitudes, Sars-CoV-2, Government, Medicine
Abstract

The COVID-19 pandemic poses a threat to global health and security inciting governments with the responsibility to respond with measures that ensure the health and safety of their communities. We assessed public attitudes towards governmental actions to combat the COVID-19 pandemic in the G7 countries. Data were collected during 19th–21st March 2020, from 7005 Kantar's online panelists aged >16 years across the G7 countries: Canada, France, Great Britain, Germany, Italy, Japan, and the United States. Data were post-stratified and weighted to match population distributions of the respective countries. Descriptive and multivariable analyses were conducted. Amongst the G7, Japan had the lowest level of approval of governmental response to the pandemic, rating governmental communication as good, and trusting governmental decisions (35.0%, 33.6%, and 38.0%, respectively), followed by the U.S. (52.9%, 64.6%, and 59.9%, respectively). Understanding of which measures one can personally take to help limit the spread of the coronavirus was significantly associated with approving governmental response (aOR = 2.88), rating government communication as good (aOR = 2.70) and trust in future governmental decisions (aOR = 2.73). Those who reported government/politicians and friends/family as their most trusted information source were more likely to report approval, higher rating, and/or trust toward governmental actions. Public attitudes towards governmental actions against COVID-19 varied substantially across the G7 countries and were associated with the understanding of measures and source of information that respondents most trusted. Timely and accurate communication is essential to enhance public engagement to control the COVID-19 pandemic.

Published
2021
Full Text
View/download PDF

13. Depression, periodontitis, caries and missing teeth in the USA, NHANES 2009–2014

Author

Israel Agaku, Satomi Odani, Constantine Vardavas, Muath Aldosari, Mohammad Helmi, Erinne N Kennedy, and Riddhi Badamia

Subjects
Medicine (General), R5-920
Abstract

Purpose This study aimed to investigate the association between self-reported depressive symptoms and oral diseases in US adults, including periodontitis, caries, missing teeth and untreated dental caries.Design This study was designed as a secondary data analysis of a cross-sectional survey. We conducted descriptive, multivariable logistic and Poisson regression analyses on weighted data.Setting US National Health and Nutrition Examination Survey 2009–2014 data.Participants Individuals aged ≥30 years who completed a periodontal examination and depression screening (n=9799).Results 21.6% (28.9 million) of adults aged ≥30 years reported depressive symptoms, with a higher prevalence among females, current smokers and participants with lower income and education status. More than half of the adults with moderate depressive symptoms had periodontal diseases, and more than one-third had teeth with untreated dental caries. After adjusting for sociodemographics, behavioural factors, having diabetes and psychotherapeutic medication use, depressive symptoms were associated with poorer oral health. Severe depressive symptoms were associated with higher odds of mild periodontitis (2.20; 99% CI 1.03 to 4.66). For those with mild depressive symptoms, the mean number of missing teeth was 1.20 (99% CI 1.06 to 1.37) times the average of non-symptomatic individuals; and 1.38 times (99% CI 1.15 to 1.66) among individuals with moderate depressive symptoms.Conclusions Depressive symptoms were associated with mild periodontitis and a greater number of missing teeth, while having teeth with untreated dental caries was attributed to sociodemographic factors. Awareness of oral health status among patients with depressive symptoms can inform both dental and mental health providers to develop tailored treatment and help patients achieve overall wellness.

Published
2020
Full Text
View/download PDF

14. Measuring for change: A multi-centre pre-post trial of an air quality feedback intervention to promote smoke-free homes

Author

Ruaraidh Dobson, Rachel O'Donnell, Olena Tigova, Marcela Fu, Marta Enríquez, Esteve Fernandez, Giulia Carreras, Giuseppe Gorini, Simona Verdi, Alessandro Borgini, Andrea Tittarelli, Chiara Veronese, Ario Ruprecht, Vergina Vyzikidou, Anna Tzortzi, Constantine Vardavas, and Sean Semple

Subjects
Second-hand smoke, Particulate matter, Indoor air quality, Environmental tobacco smoke, Environmental sciences, GE1-350
Abstract

Introduction: Second-hand smoke exposure in the home is a serious cause of ill-health for children. Behaviour change interventions have been developed to encourage parents to keep homes smoke-free. This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas. Methods: This paper presents a pre-post study of this intervention. Using internet connected monitors developed with the Dylos DC1700, daily SMS and weekly email feedback provided for 16 days to participants recruited in four European countries. Participants were recruited based on their stage of change, in order to target those most able to achieve smoke-free homes. The primary outcome measure was median change in mean fine particulate matter (PM2.5) concentration between baseline and follow-up periods, while secondary outcome measures included change in time over the World Health Organisation (WHO) guideline limit for PM2.5 exposure over 24 h (25 µg/m3) in those periods and the number of homes where PM2.5 concentrations reduced. Telephone interviews were conducted with participants in Scotland post-intervention to explore intervention experience and perceived effectiveness. Results: Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM2.5. The median reduction experienced was 4.1 µg/m3 (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback. Discussion: Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

Published
2020
Full Text
View/download PDF

15. The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma.

Author

Meena Daivadanam, Maia Ingram, Kristi Sidney Annerstedt, Gary Parker, Kirsty Bobrow, Lisa Dolovich, Gillian Gould, Michaela Riddell, Rajesh Vedanthan, Jacqui Webster, Pilvikki Absetz, Helle Mölsted Alvesson, Odysseas Androutsos, Niels Chavannes, Briana Cortez, Praveen Devarasetty, Edward Fottrell, Francisco Gonzalez-Salazar, Jane Goudge, Omarys Herasme, Hannah Jennings, Deksha Kapoor, Jemima Kamano, Marise J Kasteleyn, Christina Kyriakos, Yannis Manios, Kishor Mogulluru, Mayowa Owolabi, Maria Lazo-Porras, Wnurinham Silva, Amanda Thrift, Ezinne Uvere, Ruth Webster, Rianne van der Kleij, Josefien van Olmen, Constantine Vardavas, Puhong Zhang, and GACD Concepts and Contexts working group

Subjects
Medicine, Science
Abstract

IntroductionUnderstanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process.MethodsUsing a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level.ResultsProject teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process.ConclusionsContext is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.

Published
2019
Full Text
View/download PDF

16. Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention?

Author

Sophia Papadakis, Charis Girvalaki, Constantine Vardavas, Andrew L. Pipe, Adam Cole, Ioanna Tsiligianni, Eleni Petridou, and Christos Lionis

Subjects
tobacco treatment delivery, factors, primary health care, Crete, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction This study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece. Methods We conducted a secondary analysis of data derived from a quasiexperimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery. Results Our analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination. Conclusions Providers are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.

Published
2018
Full Text
View/download PDF

17. Tobacco Treatment Guideline for High Risk Groups: A pilot study in patients with Chronic Obstructive Pulmonary Disease

Author

Antigona C. Trofor, Sophia Papadakis, Lucia Lotrean, Ioana Buculei- Porosnicu, Vergina K. Vyzikidou, Vaso Evangelopoulou, Constantine Vardavas, and Panagiotis Behrakis

Subjects
tobacco treatment, guidelines, Chronic Obstructive Pulmonary Disease, cessation, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients. Methods A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months. Results Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up. Conclusions This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.

Published
2018
Full Text
View/download PDF

18. Passive exposure to e-cigarette emissions: irritation symptoms, severity and duration

Author

Anna Tzortzi, Stephanie Teloniatis, George Mattiampa, Gerasimos Bakellas, Vergina Vyzikidou, Chara Tzavara, Constantine Vardavas, Esteve Fernandez Munoz, and Panagiotis Behrakis

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background The current study, part of the EU H2020 funded TackSHS project, aimed to test the hypothesis that passive exposure to e-cigarette emissions provokes systemic symptoms and to determine their severity and timing. Methods 30 nonsmokers, 18-35 years old, BMI< 30, with no significant medical history, no medications, normal physical examination and spirometry, were passively exposed in a 35m 3 room, during a 30-minute Control (no passive smoking) and Experimental (standardized e-cigarette smoking by a human smoker) session. PM 2.5 concentrations were 0.027 mg/m 3 and 3.3 mg/m 3 during the Control and Experimental sessions, respectively. Participants completed an irritation questionnaire, grading symptom severity at T 0 (pre-exposure), T 15 (midway), T 30 (exposure endpoint) and T 60 (30-minute post-exposure) in both sessions. The questionnaire showed internal consistency (Cronbach's α>0.70). Scores 1-5 were generated for the environmental, ocular, nasal, airway and general complaints by adding symptoms per system. Analysis was performed using Wilcoxon-signed rank sum test and Spearman correlation (p< 0.05). Results The most frequent and intense symptoms reported were mild eye burning, nasal and airway dryness. Ocular irritation score gradually increased from T 0 reaching a significant increase by T 30 (p=0.034). Nasal score increased significantly from T 0 to T 15 (p=0.008) and remained significantly higher at T 30 . Airway irritation score increased significantly from T 0 to T 15 (p=0.004) and furthermore from T 15 to T 30 (p=0.018). All symptoms returned to T 0 scores by T 60 (p>0.05). The increased scores for ocular, nasal and airway complaints were positively correlated with increased environmental scores at T 15 and T 30 . General complaint scores showed a tendency to increase at T 30 that was positively correlated with increased environmental scores at T 30 . Conclusions Short-term exposure of nonsmokers to e-cigarette emissions resulted in mild ocular, nasal and airway symptoms that persisted up to 30 minutes and were positively correlated with environmental indices. Further research is needed to investigate long-term health implications.

Published
2018
Full Text
View/download PDF

19. The association between the awareness of the effects of smoking/secondhand smoke and the desire to quit

Author

Ioanna Petroulia, Constantine Vardavas, Filippos Filippidis, Theodosia Peleki, Panagiotis Behrakis, Anne C.K. Quah, Geoffrey T. Fong, and Yannis Tountas

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background The harmful effects of smoking are well documented. Moreover, public knowledge and beliefs about the health risks of smoking and secondhand smoke exposure have increased substantially over the past several decades. Methods The aim of this study is to examine the association between the awareness of the health risks of smoking and secondhand smoke exposure with the desire to quit smoking. The Wave 1 (2016) ITC 6 European Country (6E) Survey within the framework of EUREST-PLUS Project covered both urban and rural areas of the country's 13 geographical regions. The survey sample consisted of 1,000 individuals smokers aged 18 and older in Greece, one of the six ITC 6E countries. Results The majority of Greek smokers agreed that smoking causes lung cancer (95.4%), heart diseases (94.4%), throat cancer (87.9%), bronchitis (87.7%) and mouth cancer (84.8%), however, 51.7% smokers disagreed that smoking could cause blindness, tuberculosis (37.8%), impotence (33.8%), stroke (24%) and heart attacks to non-smokers (27.3%). Chi-square and spearman correlation coefficient were fitted to investigate the association between the awareness of the effects of smoking and the desire to quit. The percentages of the awareness regarding blindness and stroke were less among smokers who reported moderate difficulty to completely quit (p

Published
2018
Full Text
View/download PDF

20. Do European smokers opt for partial or total bans on smoking in homes and cars? Findings from the ITC 6 European Country Survey (EUREST-PLUS Project)

Author

Olena Tigova, Yolanda Castellano, Marcela Fu, Geoffrey T. Fong, Anne C.K. Quah, Constantine Vardavas, and Esteve Fernández

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background While smoke-free policies in most European countries are established for public places, private areas are mainly not regulated and may represent an important source of second-hand smoke exposure. We aimed to describe and characterise smoking rules in homes and cars of smokers from 6 European countries. Methods We used data from the first wave (2016) of the International Tobacco Control (ITC) 6 European Country Survey, part of the EUREST-PLUS Project, in representative national samples of adult (18+ years) smokers in Germany, Greece, Hungary, Poland, Romania and Spain (1000 in each country). We analysed questions about smoking rules in smokers' homes and cars with children and differentiated among: no rules, partial (allowed in some rooms or under special circumstances) and total ban (smoke-free homes and cars). We computed the prevalence (%) of homes and cars according to the rules, and used Poisson regression models to identify factors associated with total smoking ban. We incorporated weights from the complex sample design. Results In homes, more smokers opted for partial ban rather than for a total ban. The highest and lowest proportions of smoke-free homes were found in Hungary (35.5%) and Spain (13.1%), respectively, while partial ban prevalence ranged from 41.3% (Spain) to 49.9% (Greece). The proportion of smoke-free cars with children was overall higher compared to homes, ranging from 51.8% (Greece) to 67.7% (Germany). Having moderate or high level of education, presence of children, smoking less than 10 cigarettes per day and having previous attempts to quit smoking were positively associated with total smoking ban in homes and cars. Conclusions European smokers tend to opt for partial smoking ban at homes and for total ban in cars with children. Prevalence of smoke-free homes is relatively low and further legal and educational enforcement is needed to promote smoke-free environments. Funding: EC Horizon2020 HCO-6-2015 (EUREST-PLUS No. 681109).

Published
2018
Full Text
View/download PDF

21. Tobacco prevention in Greek school community

Author

Marina Demi, Vaso Evangelopoulou, Vergina Konstantina Vyzikidou, Dora Vogiatzi, Athina Lyroni, Anna Tzortzi, Constantine Vardavas, and Panagiotis Behrakis

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background and challenges to implementation Tobacco prevention and cessation are two key approaches of tackling the tobacco epidemic. Nearly all first use of tobacco occurs before secondary school graduation; hence if adolescents can be kept away from smoking, most of them will never start it. The school community, though, consists of a range of age groups with different needs and approach requirements. Intervention or response Substantial public health efforts in Greece have begun since 2009 to prevent tobacco use focusing especially on youth. An educational campaign, called “SmokeFreeGreece” which emphasizes the importance of following a healthy lifestyle linked to non- smoking one has been developed and implemented in Greece. This campaign includes intervention seminars about tobacco use for school students between 10-17 years old, “train the trainer” workshops for teachers, annual school student conferences called "Education for A Smoke Free World", the production of educational material addressed to both students and teachers and collaboration with Symplefsi, an NGO, that improves the living conditions of the inhabitants of the remote Greek islands. More specifically, three individual interventions were created to address tobacco use in ages 10-12, 13-15 and 16-17 years old. This methodological framework indicates the importance of creating a “tailor fitted programme”. Results and lessons learnt The educational seminars offered in specially designed centers have served over 26,000 students and 1,750 teachers. The material has been distributed to date more than 285,000 Greek school students, throughout Greece including visits to 13 remote islands of the Aegean. Conclusions and key recommendations The educational campaign has reached a substantial percentage of the Greek school population. As a motivational buffer to continue our efforts, during the years of the campaign, smoking prevalence among 16- 24 year olds has decreased by 33.3 % (Hellenic Statistical Authority, 2016) and we do believe that our activities are related with this reduction.

Published
2018
Full Text
View/download PDF

22. Classification, labelling and packaging of the most popular e-cigarette refill liquids across 9 European countries

Author

Charis Girvalaki, Alexander Vardavas, Manolis Tzatzarakis, Polychronis Stivaktakis, Aristidis Tsatsakis, Panagiotis Behrakis, and Constantine Vardavas

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background Classification, Labelling and Packaging (CLP) of the e-cigarette refill liquids adopts the UN Globally Harmonised System of Classification and Labelling of Chemicals (GHS) into the EU. Regarding article 17 where a substance and mixture classified as hazardous must bear a label and article 35, where substances and mixtures must acquire packaging requirements, our study aimed to evaluate the level of compliance of these products within the European market. Methods Through cross referencing of two data sources, we identified examples of the most popular websites and their marketed brands, as also the most popular point of sale e-cigarettes, in nine European Member States (Greece, France, Poland, Germany, Holland, the United Kingdom, Spain, Romania and Hungary). An optical evaluation from two independent researchers followed for all the e-liquids (n=122). Evaluation was conducted on the vial, on the external package and leaflet if included. Results Results showed that almost all products evaluated were in near compliance with the two articles based on CLP regulations. The 89.3% (109) of the samples contained hazard pictograms while 80.3% (98) contained hazard statements. Additionally, the use of child-resistant fastening (CRF) systems and tactile warnings of danger (TWD) were frequently found on the vials and external packages (90.2% vs. 80.3%, respectively). Conclusions This is the first study to evaluate the labelling/packaging practices and the technical design/safety features of e-cigarettes in 9 EU MS before the implementation of Tobacco Products Directive. Funding: This work was supported by a grant from the European Commission (Horizon2020 HCO-6-2015; EUREST-PLUS: 681109).

Published
2018
Full Text
View/download PDF

23. Transition from experimentation with tobacco and nicotine products to regular smoking in Europe

Author

Filippos Filippidis, Israel Agaku, and Constantine Vardavas

Subjects
WCTOH, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background Most of the tobacco-attributable deaths are from combustible tobacco products. We explored transitions from experimentation of different tobacco/nicotine products to regular use of combustible products in a European population. Methods We analysed a representative sample of persons aged ≥15 years from 28 European Union member states (Eurobarometer wave 87.1; March 2017; n=27,901). Respondents who indicated ever trying tobacco/nicotine products, including combustible products (boxed and hand-rolled cigarettes; cigars/cigarillos; pipe; waterpipe); e-cigarettes; and smokeless products (oral/nasal/chewing tobacco), were asked which product they first tried. Questions on history of regular tobacco use (≥1-time weekly) were further asked to determine whether ever tobacco users became established users at a point in their lifetime, regardless of their current use status. We used multilevel logistic regression to measure the association between first product tried and ever becoming an established smoker of combustible tobacco (ESCT), adjusting for age, sex, area of residence and financial difficulties We restricted analysis to those aged < 40 years (n=8,125) to reduce differential smoking-attributable mortality from different age cohorts. Results Overall, 58.7% of persons aged < 40 years had ever tried a tobacco/nicotine product. Among these 79.7% first tried boxed cigarettes, 7.0% hand-rolled cigarettes, 6.2% waterpipe and 1.9% e-cigarettes. Compared to those who first tried e-cigarettes, the odds of ever becoming an ESCT were higher among those who first tried boxed (aOR=3.50; 95%CI: 2.26-5.44) or hand-rolled cigarettes (aOR=4.70; 95%CI: 2.74-8.04), but lower among those who first tried waterpipe (aOR=0.30; 95%CI: 0.18-0.51). Adjusted odds did not differ significantly among those who first tried pipe or smokeless tobacco compared to first trial with e-cigarettes. Conclusions About 4 in 5 EU smokers first tried cigarettes, and these had increased likelihood of becoming established combustible tobacco smokers in their lifetime. Exploring reasons for experimenting with emerging products (e.g., e-cigarettes, hookahs) can inform public policy.

Published
2018
Full Text
View/download PDF

26. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

Author

Christos Lionis, Emmanouil K Symvoulakis, Adelais Markaki, Constantine Vardavas, Maria Papadakaki, Natasa Daniilidou, Kyriakos Souliotis, and Ioannis Kyriopoulos

Subjects
integrated care, continuity, primary health care, policy, Greece, Medicine (General), R5-920
Abstract

Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

Published
2009

27. Understanding perceived addiction to and addictiveness of electronic cigarettes among electronic cigarette users: a cross-sectional analysis of the International Tobacco Control Smoking and Vaping (ITC 4CV) England Survey

Author

Valerie Lohner, Ann McNeill, Sven Schneider, Sabine Vollstädt‐Klein, Marike Andreas, Daria Szafran, Nadja Grundinger, Tibor Demjén, Esteve Fernandez, Krzysztof Przewozniak, Yannis Tountas, Antigona Trofor, Witold Zatonski, Marc C. Willemsen, Constantine Vardavas, Geoffrey T. Fong, Ute Mons, Health promotion, and RS: CAPHRI - R6 - Promoting Health & Personalised Care

Subjects
reinforcement, Psychiatry and Mental health, E-cigarettes, relative addictiveness, electronic cigarettes, DEPENDENCE, POPULATION ASSESSMENT, perceived addiction, 1ST CIGARETTE, Medicine (miscellaneous), vaping, HEALTH, TIME
Abstract

Background and AimsThe addictive potential of electronic cigarettes (e-cigarettes) remains to be fully understood. We identified patterns and correlates of perceived addiction to e-cigarettes and perceived addictiveness of e-cigarettes relative to tobacco cigarettes (relative addictiveness) in dual users as well as exclusive e-cigarette users. Design, Setting and ParticipantsObservational study using cross-sectional survey data from England (2016) from the International Tobacco Control Project (ITC) Four Country Smoking and Vaping (4CV) survey. The study comprised 832 current e-cigarette users who had been vaping for at least 4 months. MeasurementsPerceived addiction to e-cigarettes and relative addictiveness of e-cigarettes were examined. Socio-demographic factors were age, gender and education; markers of addiction included urge to vape, time to first vape after waking and nicotine strength used; vaping and smoking characteristics included frequency and duration of e-cigarette use, intention to quit, adjustable power or temperature, enjoyment, satisfaction relative to tobacco cigarettes and tobacco cigarette smoking status. FindingsA total of 17% of participants reported feeling very addicted to e-cigarettes, while 40% considered e-cigarettes equally/more addictive than tobacco cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive than tobacco cigarettes (odds ratio 3.4, 95% confidence interval 2.3-5.1). All markers of addiction, daily use and enjoyment were associated with higher perceived addiction, whereas time to first vape after waking, daily vaping and perceiving vaping as less satisfying than smoking were associated with relative addictiveness. ConclusionsMarkers of addiction to e-cigarettes appear to correspond with perceived addiction to e-cigarettes, suggesting that self-reported perceived addiction might serve as an indicator of addiction. Prevalence both of markers of addiction and perceived addiction were comparatively low overall, suggesting a limited but relevant addictive potential of e-cigarettes. Additionally, positive and negative reinforcement, reflected here by enjoyment and relative satisfaction, might play a role in e-cigarette addiction.

Published
2023

28. Tobacco dependence treatment for special populations: challenges and opportunities

Author

João M. Castaldelli-Maia, Arusyak Harutyunyan, Aleksandra Herbec, Tzvia Kessel, Oluwakemi Odukoya, Katherine E. Kemper, J.T. Hays, and Constantine Vardavas

Subjects
nicotine, smoking, hiv, tuberculosis, pregnancy, Psychiatry, RC435-571
Abstract

Although smoking rates have declined in most of the countries in the world, there are population groups within these countries whose smoking rates remain significantly higher than the general population. These “forgotten groups” who have not been receiving the needed attention in tobacco control policies and tobacco cessation efforts include people with serious mental illness, substance use disorders, tuberculosis, people living with human immunodeficiency virus (HIV), lesbian-gay-bisexual-transgender-queer people, and pregnant women. A number of steps are needed at the national level in countries where these disparities exist, including modifications to national smoking cessation treatment guidelines that address the special needs of these populations, as well as targeted smoking cessation research, since these populations are often not included in clinical trials. Because of the higher smoking prevalence in these populations, as well as their lower smoking cessation treatment success rates than the general population, more resources are needed if we are to reduce health disparities in these vulnerable populations. Additionally, we believe that more effort should be focused on integrating smoking cessation treatment in the specialized care settings frequented by these subpopulations.

Full Text
View/download PDF

29. Review of industry reports on EU priority tobacco additives part B: Methodological limitations

Author

Anette Bolling, Nadja Mallock, Efthimios Zervas, Stéphanie Caillé-Garnier, Thibault Mansuy, Cécile Michel, Jeroen Pennings, Thomas Schulz, Per Schwarze, Renata Solimini, Jean-Pol Tassin, Constantine Vardavas, Miguel Merino, Charlotte Pauwels, Lotte van Nierop, Claude Lambré, and Anne Havermans

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

The Tobacco Products Directive (TPD) defines enhanced reporting obligations applying to 15 priority additives added to cigarettes and roll-your-own tobacco. A consortium of 12 international tobacco companies submitted 14 reports that were reviewed by an independent scientific body within the Joint Action on Tobacco Control (JATC). The reports were evaluated in accordance with the TPD with regard to their comprehensiveness, methodology and conclusions. Here we present their significant identified methodological limitations. The toxicological and chemical evaluation in the industry reports was mainly based on comparative testing, which lacks discriminative power for products with high toxicity and variability, like cigarettes. The literature reviews were biased, the comparative chemical studies did not assess previously identified pyrolysis products, the toxicological evaluation did not include the assessment of inhalation toxicity, and pyrolysis products were not assessed in terms of toxicity, including their genotoxic and carcinogenic potential. For both chemistry and toxicity testing, the statistical approach applied to test the difference between test and additive-free control cigarettes resulted in a high chance of false negatives. The clinical study for inhalation facilitation and nicotine uptake had limitations concerning study design and statistical analysis, while addictiveness was not assessed. Finally, the methodology used to assess characterizing flavors was flawed. In conclusion, there are significant limitations in the methodology applied by the industry. Therefore, the provided reports are of insufficient quality and are clearly not suitable to decide whether a priority additive should be banned in tobacco products according to the TPD.

Published
2022

32. EUREST-RISE: European Regulatory Science on Tobacco – Research and Innovation Staff Exchange

Author

Cornel Radu-Loghin, Karina Mocanu, Hani Al Gouhmani, Constantine Vardavas, Ioanna Lagou, Zinovia Plyta, Aikaterini Papathanasaki, Stella Vogiatzidaki, Alexander Vardavas, Manolis Tzatzarakis, Aristidis Tsatsakis, Filippos Filippidis, Christina Kyriakos, Esteve Fernández, Olena Tigova, Christina Martínez, Anna Mar Lopez Luque, Marius Eremia, Lucia Maria Lotrean, Antigona Trofor, Thomas Wenzl, Bill Simpson, Pipa Powell, Polina Starchenko, Angeliki Bakou, Eleni Asimaki, and Victoria Vivilaki

Subjects
Health (social science), Epidemiology, Public Health, Environmental and Occupational Health, Health Professions (miscellaneous)
Published
2023

35. Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries

Author

Beladenta Amalia, Marcela Fu, Olena Tigova, Montse Ballbè, Blanca Paniello-Castillo, Yolanda Castellano, Vergina K. Vyzikidou, Rachel O'Donnell, Ruaraidh Dobson, Alessandra Lugo, Chiara Veronese, Raúl Pérez-Ortuño, José A. Pascual, Nuria Cortés, Fernando Gil, Pablo Olmedo, Joan B. Soriano, Roberto Boffi, Ario Ruprecht, Julio Ancochea, Maria J. López, Silvano Gallus, Constantine Vardavas, Sean Semple, and Esteve Fernández

Subjects
Qualitat de l'aire, Environmental Engineering, Electronic nicotine delivery systems, Electronic cigarettes, Air quality, Airborne markers, Environmental Chemistry, Cigarretes electròniques, Pollution, Waste Management and Disposal, Indoor pollution, Biomarkers, Secondhand aerosol
Abstract

Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the concentrations of seven-day airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 μg/m3; 95 % CI: 0.01-0.02 μg/m3) and were all below the limit of quantification in control homes. Concentrations of seven-day PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 681040. BA received the support of a fellowship from “La Caixa” Foundation (ID 100010434; Fellowship code: LCF/BQ/IN17/11620013). The Tobacco Control Research Group at ICO-IDIBELL (BA, EF, MF, OT, MB, YC) is partly supported by the Ministry of Universities and Research, Government of Catalonia (2017SGR319) and thanks CERCA Programme Generalitat de Catalunya for the institutional support to IDIBELL. The work of SG is partially supported by an Investigation Grant from the Foundation AIRC for the Research on Cancer (AIRC IG 2021, ID 25987). The Laboratory of Toxicology University of Granada (FG, PO) is funded by the Spanish National Research Agency and the European Regional Development Fund (FEDER; Project UNGR15-CE-3380). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Published
2023

36. National scale-up of the TITAN Greece and Cyprus Primary Care Tobacco Treatment Training Network: Efficacy, assets, and lessons learned

Author

Sophia Papadakis, Constantine Vardavas, Pareskevi Katsaounou, Emmanouil Smyrnakis, George Samoutis, Eleftheria Lintovoi, Athina Tatsioni, Ioanna Tsiligianni, Lefteris Thireos, Sotiria Makaroni, Marilena Anastasaki, Irene Vasilaki, Stavros Stafylidis, Pareskevi Pataka, Andrew Pipe, and Christos Lionis

Subjects
Health (social science), Epidemiology, Public Health, Environmental and Occupational Health, Health Professions (miscellaneous)
Published
2022

38. The cost of the COVID-19 pandemic vs the cost-effectiveness of mitigation strategies in the EU/UK/EEA and OECD countries: a systematic review

Author

Constantine Vardavas, Konstantinos Zisis, Katerina Nikitara, Ioanna Lagou, Katerina Aslanoglou, Kostas Athanasakis, Revati Phalkey, Jo Leonardi-Bee, Esteve Fernandez, Orla Condell, Favelle Lamb, Frank Sandmann, Anastasia Pharris, Charlotte Deogan, and Jonathan E. Suk

Abstract

ObjectivesCOVID-19 poses a threat of loss of life, economic instability, and social disruption. We conducted a systematic review of published economic analyses to assess the direct and indirect costs of the SARS-CoV-2 pandemic, and to contrast these with the costs and the cost-benefit of public health surveillance, preparedness, and response measures in averting and/or responding to SARS-CoV-2 pandemic.SettingA systematic literature review was conducted to identify peer-reviewed articles estimating the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions in EU/EEA/UK and OECD countries, published from the 1st of January 2020 through 22nd April 2021 in Ovid Medline and EMBASE. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2021 Euro, with interventions compared with the null.Primary and secondary outcome measuresDirect and indirect costs for SARS-CoV-2 and preparedness and/or response or cost-benefit and cost-effectiveness were measured.ResultsWe included data from 41 economic studies. Ten studies evaluated the cost of COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness, and response measures. Overall, the economic burden of SARS-CoV-2 was found to be substantial for both the general population and within specific population subgroups. Community screening, bed provision policies, investing in personal protective equipment and vaccination strategies were cost-effective, in most cases due to the representative economic value of below acceptable cost-effectiveness thresholds. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.ConclusionsSARS-CoV-2 is associated with substantial economic costs to healthcare systems, payers, and societies, both short term and long term, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

Published
2022

39. Smoking is associated with altered serum and hair essential metal and metalloid levels in women

Author

Anatoly V. Skalny, Eugeny P. Serebryansky, Tatiana V. Korobeinikova, Aristidis Tsatsakis, Constantine Vardavas, Monica M.B. Paoliello, Tatiana I. Sotnikova, Michael Aschner, and Alexey A. Tinkov

Subjects
Adult, Spectrum Analysis, General Medicine, Middle Aged, Toxicology, Trace Elements, Young Adult, Cross-Sectional Studies, Metals, Humans, Female, Food Science, Aged, Hair, Metalloids
Abstract

The objective of the study was to evaluate the association between smoking and essential metal (Co, Cr, Cu, Fe, Mn, V, Zn) and metalloid (Se) levels in hair and serum of adult women using inductively coupled plasma-mass spectrometry (ICP-MS). In this cross-sectional study, a total of 344 women 20-70 years old including 199 smokers and 145 non-smoking women were enrolled. Serum Cu, Fe, and Zn levels in smoking women were found to be 6%, 8%, and 3% lower of levels in non-smokers, respectively. In contrast, circulating Mn, V, and especially Cr concentrations in smoking women exceeded the respective values in non-smoking women by 5%, 14%, and 54%. Hair Fe and Se levels in smoking women were 17% and 23% lower as compared to non-smoking controls, respectively. In multiple regression models, smoking severity was inversely associated with serum and hair Se concentrations, whereas the relationship to serum and hair Cr was positive. In addition, serum Zn and hair Fe levels were found to be inversely associated with the number of cigarettes per day. These findings hypothesize that health hazards of smoking may be at least in part be mediated by alteration in essential metal and metalloid metabolism.

Published
2022

40. Transmission of SARS-CoV-2 in educational settings in 2020: a review

Author

Constantine Vardavas, Katerina Nikitara, Alexander G Mathioudakis, Michele Hilton Boon, Revati Phalkey, Jo Leonardi-Bee, Anastasia Pharris, Charlotte Deogan, and Jonathan E Suk

Subjects
Adult, Schools, Adolescent, SARS-CoV-2, Infant, Newborn, COVID-19, Infant, General Medicine, SARS-CoV-2, COVID-19, pandemic, children, schools, household, Child, Preschool, Humans, Child, Students, Pandemics
Abstract

ObjectivesSchool closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.MethodsThis literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The studyPopulationwas restricted to people 1–17 years old (excluding neonatal transmission), theConceptwas to assess child-to-child and child-to-adult transmission, while theContextwas to assess specifically educational setting transmission.ResultsFifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020–2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low—when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents.ConclusionsTransmission in educational settings in 2020 was minimal—when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.

Published
2022

41. Tobacco products in the European Union Common Entry Gate (EU-CEG): A tool for monitoring the EU tobacco products directive

Author

Dolors Carnicer-Pont, Olena Tigova, Anne Havermans, Eline Remue, Matus Ferech, Katharina Vejdovszky, Renata Solimini, Silvano Gallus, Emilia Nunes, Carl Lange, Cristina Gomez-Chacon, Francisco Ruiz-Dominguez, Panagiotis Behrakis, Constantine Vardavas, Esteve Fernandez, [Carnicer-Pont,D, Tigova,O, Fernandez,E] Cancer Prevention and Control Programme, Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology, Barcelona, Spain. [Carnicer-Pont,D, Fernandez,E] Tobacco Control Research Group, Epidemiology and Public Health Programme, Bellvitge Biomedical Research Institute, Barcelona, Spain. [Carnicer-Pont,D, Fernandez,E] School of Medicine and Clinical Sciences, University of Barcelona, Barcelona, Spain. [Carnicer-Pont,D, Fernandez,E] Centre for Biomedical Research Network, CIBERES, Madrid, Spain. [Havermans,A] Centre for Health Protection, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands. [Remue,E] Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium. [Ferech,M] Tobacco Control Team, DG SANTE B2, Crossborder Healthcare and Tobacco Control, Brussels, Belgium. [Vejdovszky,K] Austrian Agency for Health and Food Safety, Vienna, Austria. [Solimini,R] National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy. [Gallus,S] Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy. [Nunes,E] Department of Health, Ministry of Health, Lisbon, Portugal. [Lange,CC] The Danish Safety Technology Authority, Copenhagen, Denmark. [Gomez-Chacon,C] Tobacco Prevention and Control Unit, Deputy Direction of Promotion, Prevention and Quality, General Direction of Public Health, Ministry of Health, Madrid, Spain. [Ruiz-Dominguez,F] General Directorate of Public Health and Pharmaceutical Management, Regional Ministry of Health and Families of Andalusia, Sevilla, Spain. [Behrakis.P, and Vardavas,CI] George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece.

Subjects
Health Care::Health Services Administration::Patient Care Management::Delivery of Health Care::Health Care Reform [Medical Subject Headings], Health (social science), Ingredients, Epidemiology, Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional Studies [Medical Subject Headings], EU-CEG, Països de la Unió Europea, ingredients, Legislación como asunto, Health Professions (miscellaneous), Tobacco Products Directive, Tabac, Tobacco, Fumar, Geographical Locations::Geographic Locations::Historical Geographic Locations::European Union [Medical Subject Headings], Tobacco products directive, Priority additives, Technology and Food and Beverages::Technology, Industry, and Agriculture::Manufactured Materials::Tobacco Products::Tobacco, Smokeless [Medical Subject Headings], Productos de tabaco, European Union countries, Public Health, Environmental and Occupational Health, Monitoreo, Health Care::Health Services Administration::Organization and Administration::Public Health Administration [Medical Subject Headings], Diseases::Chemically-Induced Disorders::Substance-Related Disorders::Tobacco Use Disorder [Medical Subject Headings], CAS number, priority additives, Tabaco, Health Care::Health Care Economics and Organizations::Social Control, Formal::Legislation as Topic [Medical Subject Headings], Cigarette characterizing flavor, Technology and Food and Beverages::Technology, Industry, and Agriculture::Manufactured Materials::Tobacco Products [Medical Subject Headings], Información, cigarette characterizing flavor
Abstract

Introduction: Under the European Union (EU) Tobacco Products Directive (2014/40/EU) (TPD), manufacturers and importers of tobacco products are required to report information to the European Commission (EC) and Member States (MS) on products intended to be placed on the market. We describe the distribution of notifications to the EU Common Entry Gate (EU-CEG) and identify key fields for improvement on reporting cigarettes or roll-your-own (RYO) tobacco. Methods: A cross-sectional analysis of secondary data reported in the EU-CEG was conducted for tobacco products notified within EU-CEG between June 2016 and October 2019 for 12 EU MS. Analysis of compliance to specific regulations for priority additives that refer to cigarettes and RYO was conducted for 10 EU countries. Results: Overall, 39170 tobacco products were notified. This included 16762 (42.8%) notifications of cigars, followed by cigarettes 11242 (28.7 %), waterpipes 3291 (8.4%), cigarillos (n=1783), pipe (n=1715), RYO (n=1635), chewing tobacco (n=1021), novel tobacco products (n=839), herbal products for smoking (n=535), other (n=258), nasal (n=74) and oral tobacco (n=15). In cigarettes and RYO tobacco products, the proportion of ingredients notified in all countries that contained an unknown Chemical Abstract Services (CAS) number was 3.8% and 2.1%, respectively. The proportion of underreporting flagging of priority additives ranged from 15.9% in Malta to 41.3% in Lithuania, the mean proportion of underreporting of the variable ‘priority additive’ for the 10 countries together was 24.7%. Conclusions: In the EU-CEG data base, for the period of analysis, a significant number of product notifications took place while large variations in the number of types of tobacco products notified across EU countries was noted. The timely monitoring of these data is needed so that products non-compliant within the EU-CEG system are assessed. This study is derived from the Joint Action on Tobacco Control funded by the European Union's Health Program (2014-2020) under the grant agreement - 761297. The Tobacco Control Research Group at ICO-IDIBELL (DCP, OT, EF) is partly supported by the Ministry of Universities and Research, Government of Catalonia (2017SGR319). DCP, OT and EF also thank CERCA Programme Generalitat de Catalunya for the institutional support to IDIBELL. Yes

Published
2022

42. Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients

Author

Georgios Georgiopoulos, Georgios Mavraganis, Dimitrios Delialis, Stelios Georgiou, Evmorfia Aivalioti, Raphael Patras, Ioannis Petropoulos, Maria-Angeliki Dimopoulou, Lasthenis Angelidakis, Alexandros Sianis, Dimitrios Bampatsias, Anna Dimoula, Eleni Maneta, Marinos Kosmopoulos, Constantine Vardavas, Konstantinos Stellos, and Kimon Stamatelopoulos

Subjects
Carotid Artery Diseases, Epidemiology, Cardiovascular Diseases, Risk Factors, Heart Disease Risk Factors, Humans, Cardiology and Cardiovascular Medicine, Atherosclerosis, Carotid Intima-Media Thickness, Risk Assessment, Plaque, Atherosclerotic, Ultrasonography
Abstract

Aims The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients. Methods and results We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology guidelines (clinical ESCrisk). Intima-media thickness excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort. Results MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (P < 0.05 for net reclassification index, integrated discrimination index and Delta Harrell’s C index). MaxWT < 0.9 mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort. Conclusion Integration of carotid ultrasonography in guidelines-defined risk stratification may identify patients at very high-risk in need for further residual risk reduction or at very low probability for events.

Published
2022

43. The global burden of cancer attributable to risk factors, 2010–19 : A systematic analysis for the Global Burden of Disease Study 2019

Author

Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Ayele Mamo Argaw, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Raphael Taiwo Aruleba, Armin Aryannejad, Malke Asaad, Mulusew A Asemahagn, Zatollah Asemi, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Reza Assadi, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Mamaru Ayenew Awoke, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Solomon Shitu Ayen, Davood Azadi, Sina Azadnajafabad, Saber Azami-Aghdash, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Hosein Azizi, Ahmed Y Y Azzam, Amirhesam Babajani, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Jennifer L Baker, Ahad Bakhtiari, Ravleen Kaur Bakshi, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Fabio Barra, Amadou Barrow, Nasir Z Bashir, Azadeh Bashiri, Saurav Basu, Abdul-Monim Mohammad Batiha, Aeysha Begum, Alehegn Bekele Bekele, Alemayehu Sayih Belay, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Luis Belo, Habib Benzian, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Eduardo Bernabe, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Bharti Bhandari Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Soumitra S Bhuyan, Sadia Bibi, Awraris Hailu Bilchut, Bagas Suryo Bintoro, Antonio Biondi, Mesfin Geremaw Birega Birega, Habitu Eshetu Birhan, Tone Bjørge, Oleg Blyuss, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Michael Brauer, Hermann Brenner, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Christina Maree Buchanan, Norma B Bulamu, Maria Teresa Bustamante-Teixeira, Muhammad Hammad Butt, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Chao Cao, Yin Cao, Giulia Carreras, Márcia Carvalho, Francieli Cembranel, Ester Cerin, Promit Ananyo Chakraborty, Periklis Charalampous, Vijay Kumar Chattu, Odgerel Chimed-Ochir, Jesus Lorenzo Chirinos-Caceres, Daniel Youngwhan Cho, William C S Cho, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Aaron J Cohen, Joao Conde, Sandra Cortés, Vera Marisa Costa, Natália Cruz-Martins, Garland T Culbreth, Omid Dadras, Fentaw Teshome Dagnaw, Saad M A Dahlawi, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Anna Danielewicz, An Thi Minh Dao, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Saswati Das, Dragos Virgil Davitoiu, Elham Davtalab Esmaeili, Fernando Pio De la Hoz, Sisay Abebe Debela, Azizallah Dehghan, Biniyam Demisse, Fitsum Wolde Demisse, Edgar Denova-Gutiérrez, Afshin Derakhshani, Meseret Derbew Molla, Diriba Dereje, Kalkidan Solomon Deribe, Rupak Desai, Markos Desalegn Desalegn, Fikadu Nugusu Dessalegn, Samuel Abebe A Dessalegni, Gashaw Dessie, Abebaw Alemayehu Desta, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mostafa Dianatinasab, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Shilpi Gupta Dixit, Saeid Doaei, Linh Phuong Doan, Paul Narh Doku, Deepa Dongarwar, Wendel Mombaque dos Santos, Tim Robert Driscoll, Haneil Larson Dsouza, Oyewole Christopher Durojaiye, Sareh Edalati, Fatemeh Eghbalian, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Donatus U Ekwueme, Maha El Tantawi, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hesham Elghazaly, Muhammed Elhadi, Waseem El-Huneidi, Mohammad Hassan Emamian, Luchuo Engelbert Bain, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Tegegne Eshetu, Babak Eshrati, Sharareh Eskandarieh, Juan Espinosa-Montero, Farshid Etaee, Azin Etemadimanesh, Tahir Eyayu, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Adeniyi Francis Fagbamigbe, Saman Fahimi, Ildar Ravisovich Fakhradiyev, Emerito Jose A Faraon, Jawad Fares, Abbas Farmany, Umar Farooque, Hossein Farrokhpour, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Wafa Fatima, Hamed Fattahi, Ginenus Fekadu, Berhanu Elfu Feleke, Allegra Allegra Ferrari, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Roham Foroumadi, Masoud Foroutan, Takeshi Fukumoto, Peter Andras Gaal, Mohamed M Gad, Muktar A Gadanya, Abduzhappar Gaipov, Nasrin Galehdar, Silvano Gallus, Tushar Garg, Mariana Gaspar Fonseca, Yosef Haile Gebremariam, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Yohannes Fikadu Geda, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Melaku Getachew, Motuma Erena Getachew, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Fariba Ghassemi, Ajnish Ghimire, Nermin Ghith, Maryam Gholamalizadeh, Jamshid Gholizadeh Navashenaq, Sherief Ghozy, Syed Amir Gilani, Paramjit Singh Gill, Themba G Ginindza, Abraham Tamirat T Gizaw, James C Glasbey, Justyna Godos, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Mohamad Golitaleb, Giuseppe Gorini, Bárbara Niegia Garcia Goulart, Giuseppe Grosso, Habtamu Alganeh Guadie, Mohammed Ibrahim Mohialdeen Gubari, Temesgen Worku Gudayu, Maximiliano Ribeiro Guerra, Damitha Asanga Gunawardane, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Mekdes Kondale Gurara, Alemu Guta, Parham Habibzadeh, Atlas Haddadi Avval, Nima Hafezi-Nejad, Adel Hajj Ali, Arvin Haj-Mirzaian, Esam S Halboub, Aram Halimi, Rabih Halwani, Randah R Hamadeh, Sajid Hameed, Samer Hamidi, Asif Hanif, Sanam Hariri, Netanja I Harlianto, Josep Maria Haro, Risky Kusuma Hartono, Ahmed I Hasaballah, S M Mahmudul Hasan, Hamidreza Hasani, Seyedeh Melika Hashemi, Abbas M Hassan, Soheil Hassanipour, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Zahra Heidarymeybodi, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamal Hezam, Yuta Hiraike, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Marianne Holm, Nobuyuki Horita, Mohammad Hoseini, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Mohammad-Salar Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Fernando N Hugo, Ayesha Humayun, Salman Hussain, Nawfal R Hussein, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Kaire Innos, Pooya Iranpour, Lalu Muhammad Irham, Md Shariful Islam, Rakibul M Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Linda Merin J, Abhishek Jaiswal, Mihajlo Jakovljevic, Mahsa Jalili, Shahram Jalilian, Elham Jamshidi, Sung-In Jang, Chinmay T Jani, Tahereh Javaheri, Umesh Umesh Jayarajah, Shubha Jayaram, Seyed Behzad Jazayeri, Rime Jebai, Bedru Jemal, Wonjeong Jeong, Ravi Prakash Jha, Har Ashish Jindal, Yetunde O John-Akinola, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Farima Kahe, Pradnya Vishal Kakodkar, Laleh R Kalankesh, Leila R Kalankesh, Rohollah Kalhor, Vineet Kumar Kamal, Farin Kamangar, Ashwin Kamath, Tanuj Kanchan, Eswar Kandaswamy, Himal Kandel, HyeJung Kang, Girum Gebremeskel Kanno, Neeti Kapoor, Sitanshu Sekhar Kar, Shama D Karanth, Ibraheem M Karaye, André Karch, Amirali Karimi, Bekalu Getnet Kassa, Patrick DMC Katoto, Joonas H Kauppila, Harkiran Kaur, Abinet Gebremickael Kebede, Leila Keikavoosi-Arani, Gemechu Gemechu Kejela, Phillip M Kemp Bohan, Maryam Keramati, Mohammad Keykhaei, Himanshu Khajuria, Abbas Khan, Abdul Aziz Khan Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Khaled Khatab, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Hamid Reza Khayat Kashani, Mohammad Amin Khazeei Tabari, Mehdi Khezeli, Mahmoud Khodadost, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Miloslav Klugar, Jitka Klugarová, Ali-Asghar Kolahi, Pavel Kolkhir, Farzad Kompani, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, Burcu Kucuk Bicer, Nuworza Kugbey, Mukhtar Kulimbet, Akshay Kumar, G Anil Kumar, Narinder Kumar, Om P Kurmi, Ambily Kuttikkattu, Carlo La Vecchia, Arista Lahiri, Dharmesh Kumar Lal, Judit Lám, Qing Lan, Iván Landires, Bagher Larijani, Savita Lasrado, Jerrald Lau, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Shaun Wen Huey Lee, Wei-Chen Lee, Yeong Yeh Lee, Yo Han Lee, Samson Mideksa Legesse, James Leigh, Elvynna Leong, Ming-Chieh Li, Stephen S Lim, Gang Liu, Jue Liu, Chun-Han Lo, Ayush Lohiya, Platon D Lopukhov, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Raimundas Lunevicius, Farzan Madadizadeh, Ahmad R Mafi, Sameh Magdeldin, Soleiman Mahjoub, Ata Mahmoodpoor, Morteza Mahmoudi, Marzieh Mahmoudimanesh, Rashidul Alam Mahumud, Azeem Majeed, Jamal Majidpoor, Alaa Makki, Konstantinos Christos Makris, Elaheh Malakan Rad, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Sneha Deepak Mallya, Mohammed A Mamun, Ana Laura Manda, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Santi Martini, Miquel Martorell, Sahar Masoudi, Seyedeh Zahra Masoumi, Clara N Matei, Elezebeth Mathews, Manu Raj Mathur, Vasundhara Mathur, Martin McKee, Jitendra Kumar Meena, Khalid Mehmood, Entezar Mehrabi Nasab, Ravi Mehrotra, Addisu Melese, Walter Mendoza, Ritesh G Menezes, SIsay Derso Mengesha, Laverne G Mensah, Alexios-Fotios A Mentis, Andry Yasmid Mera Mera-Mamián, Tuomo J Meretoja, Mehari Woldemariam Merid, Amanual Getnet Mersha, Belsity Temesgen Meselu, Mahboobeh Meshkat, Tomislav Mestrovic, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Gelana Fekadu Worku Mijena, Ted R Miller, Shabir Ahmad Mir, Seyed Kazem Mirinezhad, Seyyedmohammadsadeq Mirmoeeni, Mohammad Mirza-Aghazadeh-Attari, Hamed Mirzaei, Hamid Reza Mirzaei, Abay Sisay Misganaw, Sanjeev Misra, Karzan Abdulmuhsin Mohammad, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Alex Molassiotis, Mariam Molokhia, Kaveh Momenzadeh, Sara Momtazmanesh, Lorenzo Monasta, Ute Mons, Ahmed Al Montasir, Fateme Montazeri, Arnulfo Montero, Mohammad Amin Moosavi, Abdolvahab Moradi, Yousef Moradi, Mostafa Moradi Sarabi, Paula Moraga, Lidia Morawska, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Ebrahim Mostafavi, Seyyed Meysam Mousavi, Haleh Mousavi Isfahani, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Francesk Mulita, Daniel Munblit, Sandra B Munro, Efrén Murillo-Zamora, Jonah Musa, Ashraf F Nabhan, Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Gabriele Nagel, Mohammadreza Naghipour, Mukhammad David Naimzada, Tapas Sadasivan Nair, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Hasan Nassereldine, Zuhair S Natto, Biswa Prakash Nayak, Rawlance Ndejjo, Sabina Onyinye Nduaguba, Wogene Wogene Negash, Seyed Aria Nejadghaderi, Kazem Nejati, Sandhya Neupane Kandel, Huy Van Nguyen Nguyen, Robina Khan Niazi, Nurulamin M Noor, Maryam Noori, Nafise Noroozi, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Oluwakemi Ololade Odukoya, Onome Bright Oghenetega, Ropo Ebenezer Ogunsakin, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Andrew T Olagunju, Tinuke O Olagunju, Babayemi Oluwaseun Olakunde, Isaac Iyinoluwa Olufadewa, Emad Omer, Abidemi E Emmanuel Omonisi, Sokking Ong, Obinna E Onwujekwe, Hans Orru, Stanislav S Otstavnov, Abderrahim Oulhaj, Bilcha Oumer, Oluwatomi Funbi Owopetu, Babatunji Emmanuel Oyinloye, Mahesh P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Babak Pakbin, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Adrian Pana, Anamika Pandey, Ashok Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Seoyeon Park, Jay Patel, Siddhartha Pati, Rajan Paudel, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Minjin Peng, Jeevan Pereira, Renato B Pereira, Simone Perna, Navaraj Perumalsamy, Richard G Pestell, Raffaele Pezzani, Cristiano Piccinelli, Julian David Pillay, Zahra Zahid Piracha, Tobias Pischon, Maarten J Postma, Ashkan Pourabhari Langroudi, Akram Pourshams, Naeimeh Pourtaheri, Akila Prashant, Mirza Muhammad Fahd Qadir, Zahiruddin Quazi Syed, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Raghu Anekal Radhakrishnan, Venkatraman Radhakrishnan, Mojtaba Raeisi, Ata Rafiee, Alireza Rafiei, Nasiru Raheem, Fakher Rahim, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Shayan Rahmani, Vahid Rahmanian, Nazanin Rajai, Aashish Rajesh, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Sina Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Ashfaq Ur Rehman, Inayat ur Rehman, Marissa B Reitsma, Andre M N Renzaho, Maryam Rezaei, Nazila Rezaei, Negar Rezaei, Nima Rezaei, Saeid Rezaei, Mohsen Rezaeian, Aziz Rezapour, Abanoub Riad, Reza Rikhtegar, Maria Rios-Blancas, Thomas J Roberts, Peter Rohloff, Esperanza Romero-Rodríguez, Gholamreza Roshandel, Godfrey M Rwegerera, Manjula S, Maha Mohamed Saber-Ayad, Bahar Saberzadeh-Ardestani, Siamak Sabour, Basema Saddik, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Mohsen Safaei, Azam Safary, Maryam Sahebazzamani, Amirhossein Sahebkar, Harihar Sahoo, Mirza Rizwan Sajid, Hedayat Salari, Sana Salehi, Marwa Rashad Salem, Hamideh Salimzadeh, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Senthilkumar Sankararaman, Francesco Sanmarchi, Milena M Santric-Milicevic, Muhammad Arif Nadeem Saqib, Arash Sarveazad, Fatemeh Sarvi, Brijesh Sathian, Maheswar Satpathy, Nicolas Sayegh, Ione Jayce Ceola Schneider, Michaël Schwarzinger, Mario Šekerija, Subramanian Senthilkumaran, Sadaf G Sepanlou, Allen Seylani, Kenbon Seyoum, Feng Sha, Omid Shafaat, Pritik A Shah, Saeed Shahabi, Izza Shahid, Mohammad Amin Shahrbaf, Hamid R Shahsavari, Masood Ali Shaikh, Mohammed Feyisso Shaka, Elaheh Shaker, Mohammed Shannawaz, Mequannent Melaku Sharew Sharew, Azam Sharifi, Javad Sharifi-Rad, Purva Sharma, Bereket Beyene Shashamo, Aziz Sheikh, Mahdi Sheikh, Sara Sheikhbahaei, Rahim Ali Sheikhi, Ali Sheikhy, Peter Robin Shepherd, Adithi Shetty, Jeevan K Shetty, Ranjitha S Shetty, Kenji Shibuya, Reza Shirkoohi, Hesamaddin Shirzad-Aski, K M Shivakumar, Siddharudha Shivalli, Velizar Shivarov, Parnian Shobeiri, Zahra Shokri Varniab, Seyed Afshin Shorofi, Sunil Shrestha, Migbar Mekonnen Sibhat, Sudeep K Siddappa Malleshappa, Negussie Boti Sidemo, Diego Augusto Santos Silva, Luís Manuel Lopes Rodrigues Silva, Guilherme Silva Julian, Nicola Silvestris, Wudneh Simegn, Achintya Dinesh Singh, Ambrish Singh, Garima Singh, Harpreet Singh, Jasvinder A Singh, Jitendra Kumar Singh, Paramdeep Singh, Surjit Singh, Dhirendra Narain Sinha, Abiy H Sinke, Md Shahjahan Siraj, Freddy Sitas, Samarjeet Singh Siwal, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Bogdan Socea, Matthew J Soeberg, Ahmad Sofi-Mahmudi, Yonatan Solomon, Mohammad Sadegh Soltani-Zangbar, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Houman Sotoudeh, Alieu Sowe, Mu'awiyyah Babale Sufiyan, Ryan Suk, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Saima Sultana, Daniel Sur, Miklós Szócska, Seidamir Pasha Tabaeian, Rafael Tabarés-Seisdedos, Seyyed Mohammad Tabatabaei, Takahiro Tabuchi, Hooman Tadbiri, Ensiyeh Taheri, Majid Taheri, Moslem Taheri Soodejani, Ken Takahashi, Iman M Talaat, Mircea Tampa, Ker-Kan Tan, Nathan Y Tat, Vivian Y Tat, Ahmad Tavakoli, Arash Tavakoli, Arash Tehrani-Banihashemi, Yohannes Tekalegn, Fisaha Haile Tesfay, Rekha Thapar, Aravind Thavamani, Viveksandeep Thoguluva Chandrasekar, Nihal Thomas, Nikhil Kenny Thomas, Jansje Henny Vera Ticoalu, Amir Tiyuri, Daniel Nigusse Tollosa, Roman Topor-Madry, Mathilde Touvier, Marcos Roberto Tovani-Palone, Eugenio Traini, Mai Thi Ngoc Tran, Jaya Prasad Tripathy, Gebresilasea Gendisha Ukke, Irfan Ullah, Saif Ullah, Sana Ullah, Bhaskaran Unnikrishnan, Marco Vacante, Maryam Vaezi, Sahel Valadan Tahbaz, Pascual R Valdez, Constantine Vardavas, Shoban Babu Varthya, Siavash Vaziri, Diana Zuleika Velazquez, Massimiliano Veroux, Paul J Villeneuve, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Linh Gia Vu, Abdul Wadood Wadood, Yasir Waheed, Mandaras Tariku Walde, Richard G Wamai, Cong Wang, Fang Wang, Ning Wang, Yu Wang, Paul Ward, Abdul Waris, Ronny Westerman, Nuwan Darshana Wickramasinghe, Melat Woldemariam, Berhanu Woldu, Hong Xiao, Suowen Xu, Xiaoyue Xu, Lalit Yadav, Seyed Hossein Yahyazadeh Jabbari, Lin Yang, Fereshteh Yazdanpanah, Yigizie Yeshaw, Yazachew Yismaw, Naohiro Yonemoto, Mustafa Z Younis, Zabihollah Yousefi, Fatemeh Yousefian, Chuanhua Yu, Yong Yu, Ismaeel Yunusa, Mazyar Zahir, Nazar Zaki, Burhan Abdullah Zaman, Moein Zangiabadian, Fariba Zare, Iman Zare, Zahra Zareshahrabadi, Armin Zarrintan, Mikhail Sergeevich Zastrozhin, Mohammad A Zeineddine, Dongyu Zhang, Jianrong Zhang, Yunquan Zhang, Zhi-Jiang Zhang, Linghui Zhou, Sanjay Zodpey, Mohammad Zoladl, Theo Vos, Simon I Hay, Lisa M Force, Christopher J L Murray, Helsinki University Hospital Area, HUS Comprehensive Cancer Center, Tran, K, Lang, J, Compton, K, Xu, R, Acheson, A, Henrikson, H, Kocarnik, J, Penberthy, L, Aali, A, Abbas, Q, Abbasi, B, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abbastabar, H, Abdelmasseh, M, Abd-Elsalam, S, Abdelwahab, A, Abdoli, G, Abdulkadir, H, Abedi, A, Abegaz, K, Abidi, H, Aboagye, R, Abolhassani, H, Absalan, A, Abtew, Y, Abubaker Ali, H, Abu-Gharbieh, E, Achappa, B, Acuna, J, Addison, D, Addo, I, Adegboye, O, Adesina, M, Adnan, M, Adnani, Q, Advani, S, Afrin, S, Afzal, M, Aggarwal, M, Ahinkorah, B, Ahmad, A, Ahmad, R, Ahmad, S, Ahmadi, S, Ahmed, H, Ahmed, L, Ahmed, M, Ahmed Rashid, T, Aiman, W, Ajami, M, Akalu, G, Akbarzadeh-Khiavi, M, Aklilu, A, Akonde, M, Akunna, C, Al Hamad, H, Alahdab, F, Alanezi, F, Alanzi, T, Alessy, S, Algammal, A, Al-Hanawi, M, Alhassan, R, Ali, B, Ali, L, Ali, S, Alimohamadi, Y, Alipour, V, Aljunid, S, Alkhayyat, M, Al-Maweri, S, Almustanyir, S, Alonso, N, Alqalyoobi, S, Al-Raddadi, R, Al-Rifai, R, Al-Sabah, S, Al-Tammemi, A, Altawalah, H, Alvis-Guzman, N, Amare, F, Ameyaw, E, Aminian Dehkordi, J, Amirzade-Iranaq, M, Amu, H, Amusa, G, Ancuceanu, R, Anderson, J, Animut, Y, Anoushiravani, A, Anoushirvani, A, Ansari-Moghaddam, A, Ansha, M, Antony, B, Antwi, M, Anwar, S, Anwer, R, Anyasodor, A, Arabloo, J, Arab-Zozani, M, Aremu, O, Argaw, A, Ariffin, H, Aripov, T, Arshad, M, Artaman, A, Arulappan, J, Aruleba, R, Aryannejad, A, Asaad, M, Asemahagn, M, Asemi, Z, Asghari-Jafarabadi, M, Ashraf, T, Assadi, R, Athar, M, Athari, S, Atout, M, Attia, S, Aujayeb, A, Ausloos, M, Avila-Burgos, L, Awedew, A, Awoke, M, Awoke, T, Ayala Quintanilla, B, Ayana, T, Ayen, S, Azadi, D, Azadnajafabad, S, Azami-Aghdash, S, Azanaw, M, Azangou-Khyavy, M, Azari Jafari, A, Azizi, H, Azzam, A, Babajani, A, Badar, M, Badiye, A, Baghcheghi, N, Bagheri, N, Bagherieh, S, Bahadory, S, Baig, A, Baker, J, Bakhtiari, A, Bakshi, R, Banach, M, Banerjee, I, Bardhan, M, Barone-Adesi, F, Barra, F, Barrow, A, Bashir, N, Bashiri, A, Basu, S, Batiha, A, Begum, A, Bekele, A, Belay, A, Belete, M, Belgaumi, U, Bell, A, Belo, L, Benzian, H, Berhie, A, Bermudez, A, Bernabe, E, Bhagavathula, A, Bhala, N, Bhandari, B, Bhardwaj, N, Bhardwaj, P, Bhattacharyya, K, Bhojaraja, V, Bhuyan, S, Bibi, S, Bilchut, A, Bintoro, B, Biondi, A, Birega, M, Birhan, H, Bjorge, T, Blyuss, O, Bodicha, B, Bolla, S, Boloor, A, Bosetti, C, Braithwaite, D, Brauer, M, Brenner, H, Briko, A, Briko, N, Buchanan, C, Bulamu, N, Bustamante-Teixeira, M, Butt, M, Butt, N, Butt, Z, Caetano dos Santos, F, Camera, L, Cao, C, Cao, Y, Carreras, G, Carvalho, M, Cembranel, F, Cerin, E, Chakraborty, P, Charalampous, P, Chattu, V, Chimed-Ochir, O, Chirinos-Caceres, J, Cho, D, Cho, W, Christopher, D, Chu, D, Chukwu, I, Cohen, A, Conde, J, Cortes, S, Costa, V, Cruz-Martins, N, Culbreth, G, Dadras, O, Dagnaw, F, Dahlawi, S, Dai, X, Dandona, L, Dandona, R, Daneshpajouhnejad, P, Danielewicz, A, Dao, A, Darvishi Cheshmeh Soltani, R, Darwesh, A, Das, S, Davitoiu, D, Davtalab Esmaeili, E, De la Hoz, F, Debela, S, Dehghan, A, Demisse, B, Demisse, F, Denova-Gutierrez, E, Derakhshani, A, Derbew Molla, M, Dereje, D, Deribe, K, Desai, R, Desalegn, M, Dessalegn, F, Dessalegni, S, Dessie, G, Desta, A, Dewan, S, Dharmaratne, S, Dhimal, M, Dianatinasab, M, Diao, N, Diaz, D, Digesa, L, Dixit, S, Doaei, S, Doan, L, Doku, P, Dongarwar, D, dos Santos, W, Driscoll, T, Dsouza, H, Durojaiye, O, Edalati, S, Eghbalian, F, Ehsani-Chimeh, E, Eini, E, Ekholuenetale, M, Ekundayo, T, Ekwueme, D, El Tantawi, M, Elbahnasawy, M, Elbarazi, I, Elghazaly, H, Elhadi, M, El-Huneidi, W, Emamian, M, Engelbert Bain, L, Enyew, D, Erkhembayar, R, Eshetu, T, Eshrati, B, Eskandarieh, S, Espinosa-Montero, J, Etaee, F, Etemadimanesh, A, Eyayu, T, Ezeonwumelu, I, Ezzikouri, S, Fagbamigbe, A, Fahimi, S, Fakhradiyev, I, Faraon, E, Fares, J, Farmany, A, Farooque, U, Farrokhpour, H, Fasanmi, A, Fatehizadeh, A, Fatima, W, Fattahi, H, Fekadu, G, Feleke, B, Ferrari, A, Ferrero, S, Ferro Desideri, L, Filip, I, Fischer, F, Foroumadi, R, Foroutan, M, Fukumoto, T, Gaal, P, Gad, M, Gadanya, M, Gaipov, A, Galehdar, N, Gallus, S, Garg, T, Gaspar Fonseca, M, Gebremariam, Y, Gebremeskel, T, Gebremichael, M, Geda, Y, Gela, Y, Gemeda, B, Getachew, M, Ghaffari, K, Ghafourifard, M, Ghamari, S, Ghasemi Nour, M, Ghassemi, F, Ghimire, A, Ghith, N, Gholamalizadeh, M, Gholizadeh Navashenaq, J, Ghozy, S, Gilani, S, Gill, P, Ginindza, T, Gizaw, A, Glasbey, J, Godos, J, Goel, A, Golechha, M, Goleij, P, Golinelli, D, Golitaleb, M, Gorini, G, Goulart, B, Grosso, G, Guadie, H, Gubari, M, Gudayu, T, Guerra, M, Gunawardane, D, Gupta, B, Gupta, S, Gupta, V, Gurara, M, Guta, A, Habibzadeh, P, Haddadi Avval, A, Hafezi-Nejad, N, Hajj Ali, A, Haj-Mirzaian, A, Halboub, E, Halimi, A, Halwani, R, Hamadeh, R, Hameed, S, Hamidi, S, Hanif, A, Hariri, S, Harlianto, N, Haro, J, Hartono, R, Hasaballah, A, Hasan, S, Hasani, H, Hashemi, S, Hassan, A, Hassanipour, S, Hayat, K, Heidari, G, Heidari, M, Heidarymeybodi, Z, Herrera-Serna, B, Herteliu, C, Hezam, K, Hiraike, Y, Hlongwa, M, Holla, R, Holm, M, Horita, N, Hoseini, M, Hossain, M, Hosseini, M, Hosseinzadeh, A, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Huang, J, Hugo, F, Humayun, A, Hussain, S, Hussein, N, Hwang, B, Ibitoye, S, Iftikhar, P, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Immurana, M, Innos, K, Iranpour, P, Irham, L, Islam, M, Islam, R, Islami, F, Ismail, N, Isola, G, Iwagami, M, J, L, Jaiswal, A, Jakovljevic, M, Jalili, M, Jalilian, S, Jamshidi, E, Jang, S, Jani, C, Javaheri, T, Jayarajah, U, Jayaram, S, Jazayeri, S, Jebai, R, Jemal, B, Jeong, W, Jha, R, Jindal, H, John-Akinola, Y, Jonas, J, Joo, T, Joseph, N, Joukar, F, Jozwiak, J, Jurisson, M, Kabir, A, Kacimi, S, Kadashetti, V, Kahe, F, Kakodkar, P, Kalankesh, L, Kalhor, R, Kamal, V, Kamangar, F, Kamath, A, Kanchan, T, Kandaswamy, E, Kandel, H, Kang, H, Kanno, G, Kapoor, N, Kar, S, Karanth, S, Karaye, I, Karch, A, Karimi, A, Kassa, B, Katoto, P, Kauppila, J, Kaur, H, Kebede, A, Keikavoosi-Arani, L, Kejela, G, Kemp Bohan, P, Keramati, M, Keykhaei, M, Khajuria, H, Khan, A, Khan, E, Khan, G, Khan, M, Khanali, J, Khatab, K, Khatatbeh, M, Khatib, M, Khayamzadeh, M, Khayat Kashani, H, Khazeei Tabari, M, Khezeli, M, Khodadost, M, Kim, M, Kim, Y, Kisa, A, Kisa, S, Klugar, M, Klugarova, J, Kolahi, A, Kolkhir, P, Kompani, F, Koul, P, Koulmane Laxminarayana, S, Koyanagi, A, Krishan, K, Krishnamoorthy, Y, Kucuk Bicer, B, Kugbey, N, Kulimbet, M, Kumar, A, Kumar, G, Kumar, N, Kurmi, O, Kuttikkattu, A, La Vecchia, C, Lahiri, A, Lal, D, Lam, J, Lan, Q, Landires, I, Larijani, B, Lasrado, S, Lau, J, Lauriola, P, Ledda, C, Lee, S, Lee, W, Lee, Y, Legesse, S, Leigh, J, Leong, E, Li, M, Lim, S, Liu, G, Liu, J, Lo, C, Lohiya, A, Lopukhov, P, Lorenzovici, L, Lotfi, M, Loureiro, J, Lunevicius, R, Madadizadeh, F, Mafi, A, Magdeldin, S, Mahjoub, S, Mahmoodpoor, A, Mahmoudi, M, Mahmoudimanesh, M, Mahumud, R, Majeed, A, Majidpoor, J, Makki, A, Makris, K, Malakan Rad, E, Malekpour, M, Malekzadeh, R, Malik, A, Mallhi, T, Mallya, S, Mamun, M, Manda, A, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantovani, L, Martini, S, Martorell, M, Masoudi, S, Masoumi, S, Matei, C, Mathews, E, Mathur, M, Mathur, V, Mckee, M, Meena, J, Mehmood, K, Mehrabi Nasab, E, Mehrotra, R, Melese, A, Mendoza, W, Menezes, R, Mengesha, S, Mensah, L, Mentis, A, Mera-Mamian, A, Meretoja, T, Merid, M, Mersha, A, Meselu, B, Meshkat, M, Mestrovic, T, Miao Jonasson, J, Miazgowski, T, Michalek, I, Mijena, G, Miller, T, Mir, S, Mirinezhad, S, Mirmoeeni, S, Mirza-Aghazadeh-Attari, M, Mirzaei, H, Misganaw, A, Misra, S, Mohammad, K, Mohammadi, E, Mohammadi, M, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, A, Mohammed, S, Mohan, S, Mohseni, M, Moka, N, Mokdad, A, Molassiotis, A, Molokhia, M, Momenzadeh, K, Momtazmanesh, S, Monasta, L, Mons, U, Montasir, A, Montazeri, F, Montero, A, Moosavi, M, Moradi, A, Moradi, Y, Moradi Sarabi, M, Moraga, P, Morawska, L, Morrison, S, Morze, J, Mosapour, A, Mostafavi, E, Mousavi, S, Mousavi Isfahani, H, Mousavi Khaneghah, A, Mpundu-Kaambwa, C, Mubarik, S, Mulita, F, Munblit, D, Munro, S, Murillo-Zamora, E, Musa, J, Nabhan, A, Nagarajan, A, Nagaraju, S, Nagel, G, Naghipour, M, Naimzada, M, Nair, T, Naqvi, A, Narasimha Swamy, S, Narayana, A, Nassereldine, H, Natto, Z, Nayak, B, Ndejjo, R, Nduaguba, S, Negash, W, Nejadghaderi, S, Nejati, K, Neupane Kandel, S, Nguyen, H, Niazi, R, Noor, N, Noori, M, Noroozi, N, Nouraei, H, Nowroozi, A, Nunez-Samudio, V, Nzoputam, C, Nzoputam, O, Oancea, B, Odukoya, O, Oghenetega, O, Ogunsakin, R, Oguntade, A, Oh, I, Okati-Aliabad, H, Okekunle, A, Olagunju, A, Olagunju, T, Olakunde, B, Olufadewa, I, Omer, E, Omonisi, A, Ong, S, Onwujekwe, O, Orru, H, Otstavnov, S, Oulhaj, A, Oumer, B, Owopetu, O, Oyinloye, B, P A, M, Padron-Monedero, A, Padubidri, J, Pakbin, B, Pakshir, K, Pakzad, R, Palicz, T, Pana, A, Pandey, A, Pant, S, Pardhan, S, Park, E, Park, S, Patel, J, Pati, S, Paudel, R, Paudel, U, Paun, M, Pazoki Toroudi, H, Peng, M, Pereira, J, Pereira, R, Perna, S, Perumalsamy, N, Pestell, R, Pezzani, R, Piccinelli, C, Pillay, J, Piracha, Z, Pischon, T, Postma, M, Pourabhari Langroudi, A, Pourshams, A, Pourtaheri, N, Prashant, A, Qadir, M, Quazi Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Radhakrishnan, R, Radhakrishnan, V, Raeisi, M, Rafiee, A, Rafiei, A, Raheem, N, Rahim, F, Rahman, M, Rahmani, A, Rahmani, S, Rahmanian, V, Rajai, N, Rajesh, A, Ram, P, Ramezanzadeh, K, Rana, J, Ranabhat, K, Ranasinghe, P, Rao, C, Rao, S, Rashedi, S, Rashidi, A, Rashidi, M, Ratan, Z, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Razeghinia, M, Rehman, A, Rehman, I, Reitsma, M, Renzaho, A, Rezaei, M, Rezaei, N, Rezaei, S, Rezaeian, M, Rezapour, A, Riad, A, Rikhtegar, R, Rios-Blancas, M, Roberts, T, Rohloff, P, Romero-Rodriguez, E, Roshandel, G, Rwegerera, G, S, M, Saber-Ayad, M, Saberzadeh-Ardestani, B, Sabour, S, Saddik, B, Sadeghi, E, Saeb, M, Saeed, U, Safaei, M, Safary, A, Sahebazzamani, M, Sahebkar, A, Sahoo, H, Sajid, M, Salari, H, Salehi, S, Salem, M, Salimzadeh, H, Samodra, Y, Samy, A, Sanabria, J, Sankararaman, S, Sanmarchi, F, Santric-Milicevic, M, Saqib, M, Sarveazad, A, Sarvi, F, Sathian, B, Satpathy, M, Sayegh, N, Schneider, I, Schwarzinger, M, Sekerija, M, Senthilkumaran, S, Sepanlou, S, Seylani, A, Seyoum, K, Sha, F, Shafaat, O, Shah, P, Shahabi, S, Shahid, I, Shahrbaf, M, Shahsavari, H, Shaikh, M, Shaka, M, Shaker, E, Shannawaz, M, Sharew, M, Sharifi, A, Sharifi-Rad, J, Sharma, P, Shashamo, B, Sheikh, A, Sheikh, M, Sheikhbahaei, S, Sheikhi, R, Sheikhy, A, Shepherd, P, Shetty, A, Shetty, J, Shetty, R, Shibuya, K, Shirkoohi, R, Shirzad-Aski, H, Shivakumar, K, Shivalli, S, Shivarov, V, Shobeiri, P, Shokri Varniab, Z, Shorofi, S, Shrestha, S, Sibhat, M, Siddappa Malleshappa, S, Sidemo, N, Silva, D, Silva, L, Silva Julian, G, Silvestris, N, Simegn, W, Singh, A, Singh, G, Singh, H, Singh, J, Singh, P, Singh, S, Sinha, D, Sinke, A, Siraj, M, Sitas, F, Siwal, S, Skryabin, V, Skryabina, A, Socea, B, Soeberg, M, Sofi-Mahmudi, A, Solomon, Y, Soltani-Zangbar, M, Song, S, Song, Y, Sorensen, R, Soshnikov, S, Sotoudeh, H, Sowe, A, Sufiyan, M, Suk, R, Suleman, M, Suliankatchi Abdulkader, R, Sultana, S, Sur, D, Szocska, M, Tabaeian, S, Tabares-Seisdedos, R, Tabatabaei, S, Tabuchi, T, Tadbiri, H, Taheri, E, Taheri, M, Taheri Soodejani, M, Takahashi, K, Talaat, I, Tampa, M, Tan, K, Tat, N, Tat, V, Tavakoli, A, Tehrani-Banihashemi, A, Tekalegn, Y, Tesfay, F, Thapar, R, Thavamani, A, Thoguluva Chandrasekar, V, Thomas, N, Ticoalu, J, Tiyuri, A, Tollosa, D, Topor-Madry, R, Touvier, M, Tovani-Palone, M, Traini, E, Tran, M, Tripathy, J, Ukke, G, Ullah, I, Ullah, S, Unnikrishnan, B, Vacante, M, Vaezi, M, Valadan Tahbaz, S, Valdez, P, Vardavas, C, Varthya, S, Vaziri, S, Velazquez, D, Veroux, M, Villeneuve, P, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Vu, L, Wadood, A, Waheed, Y, Walde, M, Wamai, R, Wang, C, Wang, F, Wang, N, Wang, Y, Ward, P, Waris, A, Westerman, R, Wickramasinghe, N, Woldemariam, M, Woldu, B, Xiao, H, Xu, S, Xu, X, Yadav, L, Yahyazadeh Jabbari, S, Yang, L, Yazdanpanah, F, Yeshaw, Y, Yismaw, Y, Yonemoto, N, Younis, M, Yousefi, Z, Yousefian, F, Yu, C, Yu, Y, Yunusa, I, Zahir, M, Zaki, N, Zaman, B, Zangiabadian, M, Zare, F, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeineddine, M, Zhang, D, Zhang, J, Zhang, Y, Zhang, Z, Zhou, L, Zodpey, S, Zoladl, M, Vos, T, Hay, S, Force, L, Murray, C, Epidemiologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Bill & Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division

Subjects
Male, DEATHS, DALY, cancer, risk factors, Medizin, systematic analysis, Global Health, Risk Assessment, Cancer prevention, Global Burden of Disease, RC0254, Risk-attributable cancer deaths, SDG 3 - Good Health and Well-being, RA0421, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Quality-Adjusted Life Year, Neoplasms, cancer, Humans, Global Burden of Disease Study, UK, Medicine(all), MCC, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Risk Factor, Smoking, COVID-19, 3rd-DAS, General Medicine, Disability-adjusted life-years, SOCIAL DETERMINANTS, Risk assessments, risk factor, Cardiovascular and Metabolic Diseases, 3121 General medicine, internal medicine and other clinical medicine, OBESITY, Cancer burden, Neoplasm, Female, LIFE-STYLE, Quality-Adjusted Life Years, HEALTH, RA, Human, RC
Abstract

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí

Published
2022

44. Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Author

Hmwe Hmwe Kyu, Avina Vongpradith, Sarah Brooke Sirota, Amanda Novotney, Christopher E Troeger, Matthew C Doxey, Rose G Bender, Jorge R Ledesma, Molly H Biehl, Samuel B Albertson, Joseph Jon Frostad, Katrin Burkart, Fiona B Bennitt, Jeff T Zhao, William M Gardner, Hailey Hagins, Dana Bryazka, Regina-Mae Villanueva Dominguez, Semagn Mekonnen Abate, Michael Abdelmasseh, Amir Abdoli, Gholamreza Abdoli, Aidin Abedi, Vida Abedi, Tadesse M Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Ahmed Abu-Zaid, Kidist Adamu, Isaac Yeboah Addo, Oyelola A Adegboye, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Saira Afzal, Bright Opoku Ahinkorah, Aqeel Ahmad, Araz Ramazan Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Jivan Qasim Ahmed, Tarik Ahmed Rashid, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Luciana Albano, Mamoon A Aldeyab, Bezatu Mengistie Alemu, Kefyalew Addis Alene, Abdelazeem M Algammal, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Musa Mohammed Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Adel Al-Jumaily, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Saif Aldeen S AlRyalat, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, John H Amuasi, Dickson A Amugsi, Etsay Woldu Anbesu, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Demelash Areda, Ayele Mamo Argaw, Zeleke Gebru Argaw, Judie Arulappan, Raphael Taiwo Aruleba, Mulusew A Asemahagn, Seyyed Shamsadin Athari, Daniel Atlaw, Engi F Attia, Sameh Attia, Avinash Aujayeb, Tewachew Awoke, Tegegn Mulatu Ayana, Martin Amogre Ayanore, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Samad Azari, Amirhossein Azari Jafari, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Sara Bagherieh, Atif Amin Baig, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Azadeh Bashiri, Quique Bassat, Abdul-Monim Mohammad Batiha, Abate Bekele Belachew, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Parth Bhatt, Vijayalakshmi S Bhojaraja, Zulfiqar A Bhutta, Soumitra S Bhuyan, Ali Bijani, Saeid Bitaraf, Belay Boda Abule Bodicha, Nikolay Ivanovich Briko, Danilo Buonsenso, Muhammad Hammad Butt, Jiao Cai, Paulo Camargos, Luis Alberto Cámera, Promit Ananyo Chakraborty, Muluken Genetu Chanie, Jaykaran Charan, Vijay Kumar Chattu, Patrick R Ching, Sungchul Choi, Yuen Yu Chong, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Devasahayam J Christopher, Dinh-Toi Chu, Natalie L Cobb, Aaron J Cohen, Natália Cruz-Martins, Omid Dadras, Fentaw Teshome Dagnaw, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, An Thi Minh Dao, Sisay Abebe Debela, Biniyam Demisse, Fitsum Wolde Demisse, Solomon Demissie, Diriba Dereje, Hardik Dineshbhai Desai, Abebaw Alemayehu Desta, Belay Desye, Sameer Dhingra, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Linh Phuong Doan, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Wendel Mombaque dos Santos, Haneil Larson Dsouza, Eleonora Dubljanin, Oyewole Christopher Durojaiye, Hisham Atan Edinur, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Eman D El Desouky, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Ahmed Mahmoud Rabie Elkhapery, Amir Emami, Luchuo Engelbert Bain, Ryenchindorj Erkhembayar, Farshid Etaee, Mohamad Ezati Asar, Adeniyi Francis Fagbamigbe, Shahab Falahi, Aida Fallahzadeh, Anwar Faraj, Emerito Jose A Faraon, Ali Fatehizadeh, Pietro Ferrara, Allegra Allegra Ferrari, Getahun Fetensa, Florian Fischer, Joanne Flavel, Masoud Foroutan, Peter Andras Gaal, Abhay Motiramji Gaidhane, Santosh Gaihre, Nasrin Galehdar, Alberto L Garcia-Basteiro, Tushar Garg, Mesfin Damtew Gebrehiwot, Mathewos Alemu Gebremichael, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Bradford D Gessner, Melaku Getachew, Asmare Getie, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Ali Gholamrezanezhad, Abdolmajid Gholizadeh, Rakesh Ghosh, Sherief Ghozy, Pouya Goleij, Mohamad Golitaleb, Giuseppe Gorini, Alessandra C Goulart, Girma Garedew Goyomsa, Habtamu Alganeh Guadie, Zewdie Gudisa, Rashid Abdi Guled, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Alemu Guta, Parham Habibzadeh, Arvin Haj-Mirzaian, Rabih Halwani, Samer Hamidi, Md Abdul Hannan, Mehdi Harorani, Ahmed I Hasaballah, Hamidreza Hasani, Abbas M Hassan, Shokoufeh Hassani, Hossein Hassanian-Moghaddam, Hadi Hassankhani, Khezar Hayat, Behzad Heibati, Mohammad Heidari, Demisu Zenbaba Heyi, Kamal Hezam, Ramesh Holla, Sung Hwi Hong, Nobuyuki Horita, Mohammad-Salar Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Mowafa Househ, Soodabeh Hoveidamanesh, Junjie Huang, Nawfal R Hussein, Ivo Iavicoli, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Nahlah Elkudssiah Ismail, Masao Iwagami, Jalil Jaafari, Elham Jamshidi, Sung-In Jang, Amirreza Javadi Mamaghani, Tahereh Javaheri, Fatemeh Javanmardi, Javad Javidnia, Sathish Kumar Jayapal, Umesh Jayarajah, Shubha Jayaram, Alelign Tasew Jema, Wonjeong Jeong, Jost B Jonas, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Vaishali K, Zubair Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Laleh R Kalankesh, Rohollah Kalhor, Ashwin Kamath, Bhushan Dattatray Kamble, Himal Kandel, Tesfaye K Kanko, Ibraheem M Karaye, André Karch, Samad Karkhah, Bekalu Getnet Kassa, Patrick DMC Katoto, Harkiran Kaur, Rimple Jeet Kaur, Leila Keikavoosi-Arani, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Ejaz Ahmad Khan, Gulfaraz Khan, Imteyaz A Khan, Maseer Khan, Md Nuruzzaman Khan, Moien AB Khan, Yusra H Khan, Moawiah Mohammad Khatatbeh, Mina Khosravifar, Jagdish Khubchandani, Min Seo Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Luke D Knibbs, Sonali Kochhar, Farzad Kompani, Hamid Reza Koohestani, Vladimir Andreevich Korshunov, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Om P Kurmi, Ambily Kuttikkattu, Dharmesh Kumar Lal, Judit Lám, Iván Landires, Caterina Ledda, Sang-woong Lee, Miriam Levi, Sonia Lewycka, Gang Liu, Wei Liu, Rakesh Lodha, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Farzan Madadizadeh, Ata Mahmoodpoor, Razzagh Mahmoudi, Marzieh Mahmoudimanesh, Jamal Majidpoor, Alaa Makki, Elaheh Malakan Rad, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Clara N Matei, Alexander G Mathioudakis, Richard James Maude, Entezar Mehrabi Nasab, Addisu Melese, Ziad A Memish, Oliver Mendoza-Cano, Alexios-Fotios A Mentis, Tuomo J Meretoja, Mehari Woldemariam Merid, Tomislav Mestrovic, Ana Carolina Micheletti Gomide Nogueira de Sá, Gelana Fekadu Worku Mijena, Le Huu Nhat Minh, Shabir Ahmad Mir, Reza Mirfakhraie, Seyyedmohammadsadeq Mirmoeeni, Agha Zeeshan Mirza, Moonis Mirza, Mohammad Mirza-Aghazadeh-Attari, Abay Sisay Misganaw, Awoke Temesgen Misganaw, Esmaeil Mohammadi, Mokhtar Mohammadi, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Md Moniruzzaman, Fateme Montazeri, Catrin E Moore, Abdolvahab Moradi, Lidia Morawska, Jonathan F Mosser, Ebrahim Mostafavi, Majid Motaghinejad, Haleh Mousavi Isfahani, Seyed Ali Mousavi-Aghdas, Sumaira Mubarik, Efrén Murillo-Zamora, Ghulam Mustafa, Sanjeev Nair, Tapas Sadasivan Nair, Houshang Najafi, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Zuhair S Natto, Biswa Prakash Nayak, Seyed Aria Nejadghaderi, Huy Van Nguyen Nguyen, Robina Khan Niazi, Antonio Tolentino Nogueira de Sá, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Chimedsuren Ochir, Oluwakemi Ololade Odukoya, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Isaac Iyinoluwa Olufadewa, Ahmed Omar Bali, Emad Omer, Eyal Oren, Erika Ota, Nikita Otstavnov, Abderrahim Oulhaj, Mahesh P A, Jagadish Rao Padubidri, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Anamika Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Fatemeh Pashazadeh Kan, Rajan Paudel, Shrikant Pawar, Minjin Peng, Gavin Pereira, Simone Perna, Navaraj Perumalsamy, Ionela-Roxana Petcu, David M Pigott, Zahra Zahid Piracha, Vivek Podder, Roman V Polibin, Maarten J Postma, Hamid Pourasghari, Naeimeh Pourtaheri, Mirza Muhammad Fahd Qadir, Mathieu Raad, Mohammad Rabiee, Navid Rabiee, Saber Raeghi, Alireza Rafiei, Fakher Rahim, Mehran Rahimi, Vafa Rahimi-Movaghar, Azizur Rahman, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Vahid Rahmanian, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Priyanga Ranasinghe, Usha Rani, Sowmya J Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Elrashdy Moustafa Mohamed Redwan, Marissa B Reitsma, Andre M N Renzaho, Mohsen Rezaeian, Abanoub Riad, Reza Rikhtegar, Jefferson Antonio Buendia Rodriguez, Emma L B Rogowski, Luca Ronfani, Kristina E Rudd, Basema Saddik, Erfan Sadeghi, Umar Saeed, Azam Safary, Sher Zaman Safi, Maryam Sahebazzamani, Amirhossein Sahebkar, Sateesh Sakhamuri, Sana Salehi, Muhammad Salman, Hossein Samadi Kafil, Abdallah M Samy, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Maryam Sarkhosh, Brijesh Sathian, Monika Sawhney, Ganesh Kumar Saya, Abdul-Aziz Seidu, Allen Seylani, Amira A Shaheen, Masood Ali Shaikh, Elaheh Shaker, Hina Shamshad, Mequannent Melaku Sharew, Asaad Sharhani, Azam Sharifi, Purva Sharma, Ali Sheidaei, Suchitra M Shenoy, Jeevan K Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Jae Il Shin, Hesamaddin Shirzad-Aski, K M Shivakumar, Siddharudha Shivalli, Parnian Shobeiri, Wudneh Simegn, Colin R Simpson, Harpreet Singh, Jasvinder A Singh, Paramdeep Singh, Samarjeet Singh Siwal, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Mohammad Sadegh Soltani-Zangbar, Suhang Song, Yimeng Song, Prashant Sood, Chandrashekhar T Sreeramareddy, Paschalis Steiropoulos, Muhammad Suleman, Seyed-Amir Tabatabaeizadeh, Alireza Tahamtan, Majid Taheri, Moslem Taheri Soodejani, Elahe Taki, Iman M Talaat, Mircea Tampa, Sarmila Tandukar, Nathan Y Tat, Vivian Y Tat, Yibekal Manaye Tefera, Gebremaryam Temesgen, Mohamad-Hani Temsah, Azene Tesfaye, Degefa Gomora Tesfaye, Belay Tessema, Rekha Thapar, Jansje Henny Vera Ticoalu, Amir Tiyuri, Imad I Tleyjeh, Munkhsaikhan Togtmol, Marcos Roberto Tovani-Palone, Derara Girma Tufa, Irfan Ullah, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Rohollah Valizadeh, Constantine Vardavas, Tommi Juhani Vasankari, Bay Vo, Linh Gia Vu, Birhanu Wagaye, Yasir Waheed, Yu Wang, Abdul Waris, T Eoin West, Nuwan Darshana Wickramasinghe, Xiaoyue Xu, Sajad Yaghoubi, Gahin Abdulraheem Tayib Yahya, Seyed Hossein Yahyazadeh Jabbari, Dong Keon Yon, Naohiro Yonemoto, Burhan Abdullah Zaman, Alireza Zandifar, Moein Zangiabadian, Heather J Zar, Iman Zare, Zahra Zareshahrabadi, Armin Zarrintan, Mikhail Sergeevich Zastrozhin, Wu Zeng, Mengxi Zhang, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zoladl, Alimuddin Zumla, Stephen S Lim, Theo Vos, Mohsen Naghavi, Michael Brauer, Simon I Hay, Christopher J L Murray, Kyu, H. H., Vongpradith, A., Sirota, S. B., Novotney, A., Troeger, C. E., Doxey, M. C., Bender, R. G., Ledesma, J. R., Biehl, M. H., Albertson, S. B., Frostad, J. J., Burkart, K., Bennitt, F. B., Zhao, J. T., Gardner, W. M., Hagins, H., Bryazka, D., Dominguez, R. -M. V., Abate, S. M., Abdelmasseh, M., Abdoli, A., Abdoli, G., Abedi, A., Abedi, V., Abegaz, T. M., Abidi, H., Aboagye, R. G., Abolhassani, H., Abtew, Y. D., Abubaker Ali, H., Abu-Gharbieh, E., Abu-Zaid, A., Adamu, K., Addo, I. Y., Adegboye, O. A., Adnan, M., Adnani, Q. E. S., Afzal, M. S., Afzal, S., Ahinkorah, B. O., Ahmad, A., Ahmad, A. R., Ahmad, S., Ahmadi, A., Ahmadi, S., Ahmed, H., Ahmed, J. Q., Ahmed Rashid, T., Akbarzadeh-Khiavi, M., Al Hamad, H., Albano, L., Aldeyab, M. A., Alemu, B. M., Alene, K. A., Algammal, A. M., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, B. A., Ali, L., Ali, M. M., Ali, S. S., Alimohamadi, Y., Alipour, V., Al-Jumaily, A., Aljunid, S. M., Almustanyir, S., Al-Raddadi, R. M., Al-Rifai, R. H. H., Alryalat, S. A. S., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Ameyaw, E. K., Aminian Dehkordi, J. J., Amuasi, J. H., Amugsi, D. A., Anbesu, E. W., Ansar, A., Anyasodor, A. E., Arabloo, J., Areda, D., Argaw, A. M., Argaw, Z. G., Arulappan, J., Aruleba, R. T., Asemahagn, M. A., Athari, S. S., Atlaw, D., Attia, E. F., Attia, S., Aujayeb, A., Awoke, T., Ayana, T. M., Ayanore, M. A., Azadnajafabad, S., Azangou-Khyavy, M., Azari, S., Azari Jafari, A., Badar, M., Badiye, A. D., Baghcheghi, N., Bagherieh, S., Baig, A. A., Banach, M., Banerjee, I., Bardhan, M., Barone-Adesi, F., Barqawi, H. J., Barrow, A., Bashiri, A., Bassat, Q., Batiha, A. -M. M., Belachew, A. B., Belete, M. A., Belgaumi, U. I., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhatt, P., Bhojaraja, V. S., Bhutta, Z. A., Bhuyan, S. S., Bijani, A., Bitaraf, S., Bodicha, B. B. A., Briko, N. I., Buonsenso, D., Butt, M. H., Cai, J., Camargos, P., Camera, L. A., Chakraborty, P. A., Chanie, M. G., Charan, J., Chattu, V. K., Ching, P. R., Choi, S., Chong, Y. Y., Choudhari, S. G., Chowdhury, E. K., Christopher, D. J., Chu, D. -T., Cobb, N. L., Cohen, A. J., Cruz-Martins, N., Dadras, O., Dagnaw, F. T., Dai, X., Dandona, L., Dandona, R., Dao, A. T. M., Debela, S. A., Demisse, B., Demisse, F. W., Demissie, S., Dereje, D., Desai, H. D., Desta, A. A., Desye, B., Dhingra, S., Diao, N., Diaz, D., Digesa, L. E., Doan, L. P., Dodangeh, M., Dongarwar, D., Dorostkar, F., dos Santos, W. M., Dsouza, H. L., Dubljanin, E., Durojaiye, O. C., Edinur, H. A., Ehsani-Chimeh, E., Eini, E., Ekholuenetale, M., Ekundayo, T. C., El Desouky, E. D., El Sayed, I., El Sayed Zaki, M., Elhadi, M., Elkhapery, A. M. R., Emami, A., Engelbert Bain, L., Erkhembayar, R., Etaee, F., Ezati Asar, M., Fagbamigbe, A. F., Falahi, S., Fallahzadeh, A., Faraj, A., Faraon, E. J. A., Fatehizadeh, A., Ferrara, P., Ferrari, A. A., Fetensa, G., Fischer, F., Flavel, J., Foroutan, M., Gaal, P. A., Gaidhane, A. M., Gaihre, S., Galehdar, N., Garcia-Basteiro, A. L., Garg, T., Gebrehiwot, M. D., Gebremichael, M. A., Gela, Y. Y., Gemeda, B. N. B., Gessner, B. D., Getachew, M., Getie, A., Ghamari, S. -H., Ghasemi Nour, M., Ghashghaee, A., Gholamrezanezhad, A., Gholizadeh, A., Ghosh, R., Ghozy, S., Goleij, P., Golitaleb, M., Gorini, G., Goulart, A. C., Goyomsa, G. G., Guadie, H. A., Gudisa, Z., Guled, R. A., Gupta, S., Gupta, V. B., Gupta, V. K., Guta, A., Habibzadeh, P., Haj-Mirzaian, A., Halwani, R., Hamidi, S., Hannan, M. A., Harorani, M., Hasaballah, A. I., Hasani, H., Hassan, A. M., Hassani, S., Hassanian-Moghaddam, H., Hassankhani, H., Hayat, K., Heibati, B., Heidari, M., Heyi, D. Z., Hezam, K., Holla, R., Hong, S. H., Horita, N., Hosseini, M. -S., Hosseinzadeh, M., Hostiuc, M., Househ, M., Hoveidamanesh, S., Huang, J., Hussein, N. R., Iavicoli, I., Ibitoye, S. E., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Immurana, M., Ismail, N. E., Iwagami, M., Jaafari, J., Jamshidi, E., Jang, S. -I., Javadi Mamaghani, A., Javaheri, T., Javanmardi, F., Javidnia, J., Jayapal, S. K., Jayarajah, U., Jayaram, S., Jema, A. T., Jeong, W., Jonas, J. B., Joseph, N., Joukar, F., Jozwiak, J. J., K, V., Kabir, Z., Kacimi, S. E. O., Kadashetti, V., Kalankesh, L. R., Kalhor, R., Kamath, A., Kamble, B. D., Kandel, H., Kanko, T. K., Karaye, I. M., Karch, A., Karkhah, S., Kassa, B. G., Katoto, P. D., Kaur, H., Kaur, R. J., Keikavoosi-Arani, L., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, E. A., Khan, G., Khan, I. A., Khan, M., Khan, M. N., Khan, M. A., Khan, Y. H., Khatatbeh, M. M., Khosravifar, M., Khubchandani, J., Kim, M. S., Kimokoti, R. W., Kisa, A., Kisa, S., Kissoon, N., Knibbs, L. D., Kochhar, S., Kompani, F., Koohestani, H. R., Korshunov, V. A., Kosen, S., Koul, P. A., Koyanagi, A., Krishan, K., Kuate Defo, B., Kumar, G. A., Kurmi, O. P., Kuttikkattu, A., Lal, D. K., Lam, J., Landires, I., Ledda, C., Lee, S. -W., Levi, M., Lewycka, S., Liu, G., Liu, W., Lodha, R., Lorenzovici, L., Lotfi, M., Loureiro, J. A., Madadizadeh, F., Mahmoodpoor, A., Mahmoudi, R., Mahmoudimanesh, M., Majidpoor, J., Makki, A., Malakan Rad, E., Malik, A. A., Mallhi, T. H., Manla, Y., Matei, C. N., Mathioudakis, A. G., Maude, R. J., Mehrabi Nasab, E., Melese, A., Memish, Z. A., Mendoza-Cano, O., Mentis, A. -F. A., Meretoja, T. J., Merid, M. W., Mestrovic, T., Micheletti Gomide Nogueira de Sa, A. C., Mijena, G. F. W., Minh, L. H. N., Mir, S. A., Mirfakhraie, R., Mirmoeeni, S., Mirza, A. Z., Mirza, M., Mirza-Aghazadeh-Attari, M., Misganaw, A. S., Misganaw, A. T., Mohammadi, E., Mohammadi, M., Mohammed, A., Mohammed, S., Mohan, S., Mohseni, M., Moka, N., Mokdad, A. H., Momtazmanesh, S., Monasta, L., Moniruzzaman, M., Montazeri, F., Moore, C. E., Moradi, A., Morawska, L., Mosser, J. F., Mostafavi, E., Motaghinejad, M., Mousavi Isfahani, H., Mousavi-Aghdas, S. A., Mubarik, S., Murillo-Zamora, E., Mustafa, G., Nair, S., Nair, T. S., Najafi, H., Naqvi, A. A., Narasimha Swamy, S., Natto, Z. S., Nayak, B. P., Nejadghaderi, S. A., Nguyen, H. V. N., Niazi, R. K., Nogueira de Sa, A. T., Nouraei, H., Nowroozi, A., Nunez-Samudio, V., Nzoputam, C. I., Nzoputam, O. J., Oancea, B., Ochir, C., Odukoya, O. O., Okati-Aliabad, H., Okekunle, A. P., Okonji, O. C., Olagunju, A. T., Olufadewa, I. I., Omar Bali, A., Omer, E., Oren, E., Ota, E., Otstavnov, N., Oulhaj, A., P A, M., Padubidri, J. R., Pakshir, K., Pakzad, R., Palicz, T., Pandey, A., Pant, S., Pardhan, S., Park, E. -C., Park, E. -K., Pashazadeh Kan, F., Paudel, R., Pawar, S., Peng, M., Pereira, G., Perna, S., Perumalsamy, N., Petcu, I. -R., Pigott, D. M., Piracha, Z. Z., Podder, V., Polibin, R. V., Postma, M. J., Pourasghari, H., Pourtaheri, N., Qadir, M. M. F., Raad, M., Rabiee, M., Rabiee, N., Raeghi, S., Rafiei, A., Rahim, F., Rahimi, M., Rahimi-Movaghar, V., Rahman, A., Rahman, M. O., Rahman, M., Rahman, M. A., Rahmani, A. M., Rahmanian, V., Ram, P., Ramezanzadeh, K., Rana, J., Ranasinghe, P., Rani, U., Rao, S. J., Rashedi, S., Rashidi, M. -M., Rasul, A., Ratan, Z. A., Rawaf, D. L., Rawaf, S., Rawassizadeh, R., Razeghinia, M. S., Redwan, E. M. M., Reitsma, M. B., Renzaho, A. M. N., Rezaeian, M., Riad, A., Rikhtegar, R., Rodriguez, J. A. B., Rogowski, E. L. B., Ronfani, L., Rudd, K. E., Saddik, B., Sadeghi, E., Saeed, U., Safary, A., Safi, S. Z., Sahebazzamani, M., Sahebkar, A., Sakhamuri, S., Salehi, S., Salman, M., Samadi Kafil, H., Samy, A. M., Santric-Milicevic, M. M., Sao Jose, B. P., Sarkhosh, M., Sathian, B., Sawhney, M., Saya, G. K., Seidu, A. -A., Seylani, A., Shaheen, A. A., Shaikh, M. A., Shaker, E., Shamshad, H., Sharew, M. M., Sharhani, A., Sharifi, A., Sharma, P., Sheidaei, A., Shenoy, S. M., Shetty, J. K., Shiferaw, D. S., Shigematsu, M., Shin, J. I., Shirzad-Aski, H., Shivakumar, K. M., Shivalli, S., Shobeiri, P., Simegn, W., Simpson, C. R., Singh, H., Singh, J. A., Singh, P., Siwal, S. S., Skryabin, V. Y., Skryabina, A. A., Soltani-Zangbar, M. S., Song, S., Song, Y., Sood, P., Sreeramareddy, C. T., Steiropoulos, P., Suleman, M., Tabatabaeizadeh, S. -A., Tahamtan, A., Taheri, M., Taheri Soodejani, M., Taki, E., Talaat, I. M., Tampa, M., Tandukar, S., Tat, N. Y., Tat, V. Y., Tefera, Y. M., Temesgen, G., Temsah, M. -H., Tesfaye, A., Tesfaye, D. G., Tessema, B., Thapar, R., Ticoalu, J. H. V., Tiyuri, A., Tleyjeh, I. I., Togtmol, M., Tovani-Palone, M. R., Tufa, D. G., Ullah, I., Upadhyay, E., Valadan Tahbaz, S., Valdez, P. R., Valizadeh, R., Vardavas, C., Vasankari, T. J., Vo, B., Vu, L. G., Wagaye, B., Waheed, Y., Wang, Y., Waris, A., West, T. E., Wickramasinghe, N. D., Xu, X., Yaghoubi, S., Yahya, G. A. T., Yahyazadeh Jabbari, S. H., Yon, D. K., Yonemoto, N., Zaman, B. A., Zandifar, A., Zangiabadian, M., Zar, H. J., Zare, I., Zareshahrabadi, Z., Zarrintan, A., Zastrozhin, M. S., Zeng, W., Zhang, M., Zhang, Z. -J., Zhong, C., Zoladl, M., Zumla, A., Lim, S. S., Vos, T., Naghavi, M., Brauer, M., Hay, S. I., Murray, C. J. L., University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Tampere University, Health Sciences, Clinical Medicine, Kyu, H, Vongpradith, A, Sirota, S, Novotney, A, Troeger, C, Doxey, M, Bender, R, Ledesma, J, Biehl, M, Albertson, S, Frostad, J, Burkart, K, Bennitt, F, Zhao, J, Gardner, W, Hagins, H, Bryazka, D, Dominguez, R, Abate, S, Abdelmasseh, M, Abdoli, A, Abdoli, G, Abedi, A, Abedi, V, Abegaz, T, Abidi, H, Aboagye, R, Abolhassani, H, Abtew, Y, Abubaker Ali, H, Abu-Gharbieh, E, Abu-Zaid, A, Adamu, K, Addo, I, Adegboye, O, Adnan, M, Adnani, Q, Afzal, M, Afzal, S, Ahinkorah, B, Ahmad, A, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, H, Ahmed, J, Ahmed Rashid, T, Akbarzadeh-Khiavi, M, Al Hamad, H, Albano, L, Aldeyab, M, Alemu, B, Alene, K, Algammal, A, Alhalaiqa, F, Alhassan, R, Ali, B, Ali, L, Ali, M, Ali, S, Alimohamadi, Y, Alipour, V, Al-Jumaily, A, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Al-Rifai, R, Alryalat, S, Alvis-Guzman, N, Alvis-Zakzuk, N, Ameyaw, E, Aminian Dehkordi, J, Amuasi, J, Amugsi, D, Anbesu, E, Ansar, A, Anyasodor, A, Arabloo, J, Areda, D, Argaw, A, Argaw, Z, Arulappan, J, Aruleba, R, Asemahagn, M, Athari, S, Atlaw, D, Attia, E, Attia, S, Aujayeb, A, Awoke, T, Ayana, T, Ayanore, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari, S, Azari Jafari, A, Badar, M, Badiye, A, Baghcheghi, N, Bagherieh, S, Baig, A, Banach, M, Banerjee, I, Bardhan, M, Barone-Adesi, F, Barqawi, H, Barrow, A, Bashiri, A, Bassat, Q, Batiha, A, Belachew, A, Belete, M, Belgaumi, U, Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, Bhatt, P, Bhojaraja, V, Bhutta, Z, Bhuyan, S, Bijani, A, Bitaraf, S, Bodicha, B, Briko, N, Buonsenso, D, Butt, M, Cai, J, Camargos, P, Camera, L, Chakraborty, P, Chanie, M, Charan, J, Chattu, V, Ching, P, Choi, S, Chong, Y, Choudhari, S, Chowdhury, E, Christopher, D, Chu, D, Cobb, N, Cohen, A, Cruz-Martins, N, Dadras, O, Dagnaw, F, Dai, X, Dandona, L, Dandona, R, Dao, A, Debela, S, Demisse, B, Demisse, F, Demissie, S, Dereje, D, Desai, H, Desta, A, Desye, B, Dhingra, S, Diao, N, Diaz, D, Digesa, L, Doan, L, Dodangeh, M, Dongarwar, D, Dorostkar, F, dos Santos, W, Dsouza, H, Dubljanin, E, Durojaiye, O, Edinur, H, Ehsani-Chimeh, E, Eini, E, Ekholuenetale, M, Ekundayo, T, El Desouky, E, El Sayed, I, El Sayed Zaki, M, Elhadi, M, Elkhapery, A, Emami, A, Engelbert Bain, L, Erkhembayar, R, Etaee, F, Ezati Asar, M, Fagbamigbe, A, Falahi, S, Fallahzadeh, A, Faraj, A, Faraon, E, Fatehizadeh, A, Ferrara, P, Ferrari, A, Fetensa, G, Fischer, F, Flavel, J, Foroutan, M, Gaal, P, Gaidhane, A, Gaihre, S, Galehdar, N, Garcia-Basteiro, A, Garg, T, Gebrehiwot, M, Gebremichael, M, Gela, Y, Gemeda, B, Gessner, B, Getachew, M, Getie, A, Ghamari, S, Ghasemi Nour, M, Ghashghaee, A, Gholamrezanezhad, A, Gholizadeh, A, Ghosh, R, Ghozy, S, Goleij, P, Golitaleb, M, Gorini, G, Goulart, A, Goyomsa, G, Guadie, H, Gudisa, Z, Guled, R, Gupta, S, Gupta, V, Guta, A, Habibzadeh, P, Haj-Mirzaian, A, Halwani, R, Hamidi, S, Hannan, M, Harorani, M, Hasaballah, A, Hasani, H, Hassan, A, Hassani, S, Hassanian-Moghaddam, H, Hassankhani, H, Hayat, K, Heibati, B, Heidari, M, Heyi, D, Hezam, K, Holla, R, Hong, S, Horita, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Househ, M, Hoveidamanesh, S, Huang, J, Hussein, N, Iavicoli, I, Ibitoye, S, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Immurana, M, Ismail, N, Iwagami, M, Jaafari, J, Jamshidi, E, Jang, S, Javadi Mamaghani, A, Javaheri, T, Javanmardi, F, Javidnia, J, Jayapal, S, Jayarajah, U, Jayaram, S, Jema, A, Jeong, W, Jonas, J, Joseph, N, Joukar, F, Jozwiak, J, K, V, Kabir, Z, Kacimi, S, Kadashetti, V, Kalankesh, L, Kalhor, R, Kamath, A, Kamble, B, Kandel, H, Kanko, T, Karaye, I, Karch, A, Karkhah, S, Kassa, B, Katoto, P, Kaur, H, Kaur, R, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khan, E, Khan, G, Khan, I, Khan, M, Khan, Y, Khatatbeh, M, Khosravifar, M, Khubchandani, J, Kim, M, Kimokoti, R, Kisa, A, Kisa, S, Kissoon, N, Knibbs, L, Kochhar, S, Kompani, F, Koohestani, H, Korshunov, V, Kosen, S, Koul, P, Koyanagi, A, Krishan, K, Kuate Defo, B, Kumar, G, Kurmi, O, Kuttikkattu, A, Lal, D, Lam, J, Landires, I, Ledda, C, Lee, S, Levi, M, Lewycka, S, Liu, G, Liu, W, Lodha, R, Lorenzovici, L, Lotfi, M, Loureiro, J, Madadizadeh, F, Mahmoodpoor, A, Mahmoudi, R, Mahmoudimanesh, M, Majidpoor, J, Makki, A, Malakan Rad, E, Malik, A, Mallhi, T, Manla, Y, Matei, C, Mathioudakis, A, Maude, R, Mehrabi Nasab, E, Melese, A, Memish, Z, Mendoza-Cano, O, Mentis, A, Meretoja, T, Merid, M, Mestrovic, T, Micheletti Gomide Nogueira de Sa, A, Mijena, G, Minh, L, Mir, S, Mirfakhraie, R, Mirmoeeni, S, Mirza, A, Mirza, M, Mirza-Aghazadeh-Attari, M, Misganaw, A, Mohammadi, E, Mohammadi, M, Mohammed, A, Mohammed, S, Mohan, S, Mohseni, M, Moka, N, Mokdad, A, Momtazmanesh, S, Monasta, L, Moniruzzaman, M, Montazeri, F, Moore, C, Moradi, A, Morawska, L, Mosser, J, Mostafavi, E, Motaghinejad, M, Mousavi Isfahani, H, Mousavi-Aghdas, S, Mubarik, S, Murillo-Zamora, E, Mustafa, G, Nair, S, Nair, T, Najafi, H, Naqvi, A, Narasimha Swamy, S, Natto, Z, Nayak, B, Nejadghaderi, S, Nguyen, H, Niazi, R, Nogueira de Sa, A, Nouraei, H, Nowroozi, A, Nunez-Samudio, V, Nzoputam, C, Nzoputam, O, Oancea, B, Ochir, C, Odukoya, O, Okati-Aliabad, H, Okekunle, A, Okonji, O, Olagunju, A, Olufadewa, I, Omar Bali, A, Omer, E, Oren, E, Ota, E, Otstavnov, N, Oulhaj, A, P A, M, Padubidri, J, Pakshir, K, Pakzad, R, Palicz, T, Pandey, A, Pant, S, Pardhan, S, Park, E, Pashazadeh Kan, F, Paudel, R, Pawar, S, Peng, M, Pereira, G, Perna, S, Perumalsamy, N, Petcu, I, Pigott, D, Piracha, Z, Podder, V, Polibin, R, Postma, M, Pourasghari, H, Pourtaheri, N, Qadir, M, Raad, M, Rabiee, M, Rabiee, N, Raeghi, S, Rafiei, A, Rahim, F, Rahimi, M, Rahimi-Movaghar, V, Rahman, A, Rahman, M, Rahmani, A, Rahmanian, V, Ram, P, Ramezanzadeh, K, Rana, J, Ranasinghe, P, Rani, U, Rao, S, Rashedi, S, Rashidi, M, Rasul, A, Ratan, Z, Rawaf, D, Rawaf, S, Rawassizadeh, R, Razeghinia, M, Redwan, E, Reitsma, M, Renzaho, A, Rezaeian, M, Riad, A, Rikhtegar, R, Rodriguez, J, Rogowski, E, Ronfani, L, Rudd, K, Saddik, B, Sadeghi, E, Saeed, U, Safary, A, Safi, S, Sahebazzamani, M, Sahebkar, A, Sakhamuri, S, Salehi, S, Salman, M, Samadi Kafil, H, Samy, A, Santric-Milicevic, M, Sao Jose, B, Sarkhosh, M, Sathian, B, Sawhney, M, Saya, G, Seidu, A, Seylani, A, Shaheen, A, Shaikh, M, Shaker, E, Shamshad, H, Sharew, M, Sharhani, A, Sharifi, A, Sharma, P, Sheidaei, A, Shenoy, S, Shetty, J, Shiferaw, D, Shigematsu, M, Shin, J, Shirzad-Aski, H, Shivakumar, K, Shivalli, S, Shobeiri, P, Simegn, W, Simpson, C, Singh, H, Singh, J, Singh, P, Siwal, S, Skryabin, V, Skryabina, A, Soltani-Zangbar, M, Song, S, Song, Y, Sood, P, Sreeramareddy, C, Steiropoulos, P, Suleman, M, Tabatabaeizadeh, S, Tahamtan, A, Taheri, M, Taheri Soodejani, M, Taki, E, Talaat, I, Tampa, M, Tandukar, S, Tat, N, Tat, V, Tefera, Y, Temesgen, G, Temsah, M, Tesfaye, A, Tesfaye, D, Tessema, B, Thapar, R, Ticoalu, J, Tiyuri, A, Tleyjeh, I, Togtmol, M, Tovani-Palone, M, Tufa, D, Ullah, I, Upadhyay, E, Valadan Tahbaz, S, Valdez, P, Valizadeh, R, Vardavas, C, Vasankari, T, Vo, B, Vu, L, Wagaye, B, Waheed, Y, Wang, Y, Waris, A, West, T, Wickramasinghe, N, Xu, X, Yaghoubi, S, Yahya, G, Yahyazadeh Jabbari, S, Yon, D, Yonemoto, N, Zaman, B, Zandifar, A, Zangiabadian, M, Zar, H, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeng, W, Zhang, M, Zhang, Z, Zhong, C, Zoladl, M, Zumla, A, Lim, S, Vos, T, Naghavi, M, Brauer, M, Hay, S, Murray, C, HUS Comprehensive Cancer Center, and Department of Oncology

Subjects
Adult, Male, Global Health, Time, Global Burden of Disease, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Humans, Ambient air-quality, Child, Respiratory Tract Infections, Aged, Aged, 80 and over, MCC, Sex Characteristics, Malnutrition, Pyridinolcarbamate, Bayes Theorem, 3rd-DAS, 3142 Public health care science, environmental and occupational health, Infectious Diseases, 3121 General medicine, internal medicine and other clinical medicine, Child, Preschool, Female, Particulate Matter, Quality-Adjusted Life Years, Covid-19, LRI
Abstract

Funding: Bill & Melinda Gates Foundation. Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Publisher PDF

Published
2022

45. Review of industry reports on EU priority tobacco additives part A: Main outcomes and conclusions

Author

Anne Havermans, Nadja Mallock, Efthimios Zervas, Stéphanie Caillé-Garnier, Thibault Mansuy, Cécile Michel, Jeroen Pennings, Thomas Schulz, Per Schwarze, Renata Solimini, Jean-Pol Tassin, Constantine Vardavas, Miguel Merino, Charlotte Pauwels, Lotte van Nierop, Claude Lambré, Anette Bolling, National Institute for Public Health and the Environment [Bilthoven] (RIVM), German Federal Institute for Risk Assessment [Berlin] (BfR), Hellenic Open University [Patras], Hellenic Thoracic Society, Université de Bordeaux (UB), Direction de l'Evaluation des Risques (DER), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Norwegian Institute of Public Health [Oslo] (NIPH), Istituto Superiore di Sanità (ISS), Université Paris 1 Panthéon-Sorbonne (UP1), Neuroscience Paris Seine (NPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Hellenic Cancer Society, Andalusia Agency For Agriculture and Fisheries Development (AGAPA), Institut national de recherche et de sécurité (Paris) (INRS (Paris)), and European Project: 761297,JATC

Subjects
Inhalation facilitation, Attractiveness, Health (social science), Toxicity, Addictiveness, Epidemiology, [SDV]Life Sciences [q-bio], Public Health, Environmental and Occupational Health, MESH: Tobacco Control, Public Policy, Health Professions (miscellaneous), Tobacco additives, MESH: Tobacco Use Disorder, [SCCO]Cognitive science, Tobacco regulation, MESH: Tobacco
Abstract

International audience; The European Union Tobacco Products Directive (EU TPD) mandates enhanced reporting obligations for tobacco manufacturers regarding 15 priority additives. Within the Joint Action on Tobacco Control (JATC), a review panel of independent experts was appointed for the scientific evaluation of the additive reports submitted by a consortium of 12 tobacco manufacturers. As required by the TPD, the reports were evaluated based on their comprehensiveness, methodology and conclusions. In addition, we evaluated the chemical, toxicological, addictive, inhalation facilitating and flavoring properties of the priority additives based on the submitted reports, supplemented by the panel's expert knowledge and some independent literature. The industry concluded that none of the additives is associated with concern. Due to significant methodological limitations, we question the scientific validity of these conclusions and conclude that they are not warranted. Our review demonstrates that many issues regarding toxicity, addictiveness and attractiveness of the additives have not been sufficiently addressed, and therefore concerns remain. For example, menthol facilitates inhalation by activation of the cooling receptor TRPM8. The addition of sorbitol and guar gum leads to a significant increase of aldehydes that may contribute to toxicity and addictiveness. Titanium dioxide particles (aerodynamic diameter

Published
2022

46. Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries

Author

Elisabet Henderson, Luis A. Rodriguez Guerrero, Xavier Continente, Esteve Fernández, Olena Tigova, Nuria Cortés-Francisco, Sean Semple, Ruaraidh Dobson, Anna Tzortzi, Vergina K. Vyzikidou, Giuseppe Gorini, Gergana Geshanova, Ute Mons, Krzysztof Przewozniak, José Precioso, Ramona Brad, Maria J. López, Yolanda Castellano, Marcela Fu, Montse Ballbè, Beladenta Amalia, Maria José López, Teresa Arechavala, Silvano Gallus, Alessandra Lugo, Xiaoqiu Liu, Elisa Borroni, Paolo Colombo, Rachel O'Donnell, Luke Clancy, Sheila Keogan, Hannah Byrne, Panagiotis Behrakis, Constantine Vardavas, Vergina Konstantina Vyzikidou, Gerasimos Bakelas, George Mattiampa, Roberto Boffi, Ario Ruprecht, Cinzia De Marco, Alessandro Borgini, Chiara Veronese, Martina Bertoldi, Andrea Tittarelli, Giulia Carreras, Barbara Cortini, Simona Verdi, Alessio Lachi, Elisabetta Chellini, Ángel López Nicolás, Marta Trapero-Bertran, Daniel Celdrán Guerrero, Cornel Radu-Loghin, Dominick Nguyen, Polina Starchenko, Joan B. Soriano, Julio Ancochea, Tamara Alonso, María Teresa Pastor, Marta Erro, Ana Roca, Patricia Pérez, and Elena García Castillo

Subjects
Tobacco smoke pollution, Airborne nicotine, Questionnaire, National-level factors, Home, Biochemistry, Smoke-free policies, General Environmental Science
Abstract

Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households’ characteristics, tobacco consumption habits, and national contextual factors. Cross-sectional study (March 2017–September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 μg/m3. Overall, median nicotine concentration was 0.85 μg/m3 (interquartile range (IQR):0.15–4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 μg/m3 IQR: 0.32–6.34), where smoking was allowed (1.60 μg/m3 IQR: 0.68–7.63), with two or more residents who smoked (2.42 μg/m3 IQR: 0.58–11.0), with more than 40 cigarettes smoked (2.92 μg/m3 IQR: 0.97–10.61), and where two or more residents smoked inside (4.02 μg/m3 IQR: 1.58–11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures. This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 681040. The work of SG was partially supported by the Italian League Against Cancer (LILT, Milan). EF is partly supported by Ministry of Universities and Research, Government of Catalonia (2017SGR319) and by the Instituto Carlos III and co-funded by the European Regional Development Fund (FEDER) (INT16/00211 and INT17/00103), Government of Spain.

Published
2023

47. Smokers' support for the ban on sale of slim cigarettes

Author

Enkeleint Mechili, Krzysztof Przewoźniak, Pete Driezen, Christina Kyriakos, Charis Girvalaki, Ute Mons, Anne Quah, Esteve Fernández, Antigona Trofor, Tibor Demjén, Paraskevi Katsaounou, Witold Zatoński, Geoffrey Fong, Constantine Vardavas, and EUREST-PLUS Consortium

Subjects
Health (social science), Epidemiology, Public Health, Environmental and Occupational Health, Health Professions (miscellaneous)
Published
2021

49. Health beliefs, smoking behaviours and attitudes towards the tobacco flavor ban among smokers of menthol, other flavored and unflavored cigarettes: Findings from the EUREST-PLUS ITC Europe Surveys

Author

Krzysztof Przewoźniak, Mateusz Zatoński, Aleksandra Herbeć, Witold Zatoński, Kinga Janik-Koncewicz, Ute Mons, Geoffrey Fong, Anne Quah, Pete Driezen, Tibor Demjén, Yannis Tountas, Antigona Trofor, Esteve Fernández, Ann McNeill, Marc Willemsen, Karin Hummel, Christina Kyriakos, Constantine Vardavas, and EUREST-PLUS consortium

Subjects
Health (social science), Epidemiology, Public Health, Environmental and Occupational Health, Health Professions (miscellaneous)
Published
2021

50. Reporting system of suspected adverse effects from electronic cigarettes and refill liquids in Europe

Author

Renata Solimini, Caitriona Stack, Kathleen Clifford, Francisco Ruiz Dominguez, Laszlo Bencze, Constantine Vardavas, and Panagiotis Behrakis

Subjects
Health (social science), Epidemiology, electronic cigarettes, Public Health, Environmental and Occupational Health, adverse effects, Policy Case studies, Health Professions (miscellaneous), reporting system
Abstract

In line with Article 20 (9) of the Tobacco Products Directive (TPD) 2014/40/EU, a guidance document outlining a reporting system of suspected adverse effects from electronic cigarettes and their refill liquids was produced by Work Package 4 entitled 'Integration into national policies and sustainability' of the Joint Action on Tobacco Control (JATC). The JATC was a European project that lasted three years (2017-2020), with the general objective of providing support for the implementation of the TPD throughout the 27 European Union Member States (EU MS). The reporting system described in the guidance document includes a short reporting template for the reporting of adverse effects on human health from electronic cigarettes and refill liquids, both by Economic Operators (EO) and by National Competent Authorities (NCA). The present guidance document aims at providing the necessary steps and modalities that each MS should follow if involved in the development of a system for the reporting of suspected adverse effects on human health from electronic cigarettes and refill liquids.

Published
2021

Catalog

Books, media, physical & digital resources
See catalog results