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4. A Psychometric Comparison of Different Health Utility Measures in Patients Affected by Parkinson's Disease

Author

del Pozo-Cruz, B., Collado-Mateo, D., Adsuar, J.C., Garcia-Gordillo, M.A., Cordero-Ferrera, J.M., Sanchez-Martinez, F.I., and Abellan-Perpinan, J.M.

Subjects
Parkinson disease -- Research, Rehabilitation -- Usage, Quality of life -- Analysis, Health
Abstract

* Parkinson's disease is a chronic disease affecting quality of life and well-being. * Cost utility analyses is a method of determining the cost effectiveness of nursing interventions. These analyses are performed using data from preference-based questionnaires. * Several options are available but their psychometric properties should be compared to optimize choice. * The main purpose of this study was to evaluate the validity, sensitivity, and relative efficiency of 15D and SF-6D questionnaires in Spanish patients with Parkinson's to be used in cost-effectiveness analyses. * Findings indicated SF-6D and 15D are adequate instruments for monitoring of patient's health during the period of rehabilitation., IN RECENT YEARS THERE HAS been an increasing interest in using economic evaluation, particularly cost-effectiveness analysis, as a relevant argument to decide which new healthcare technologies should be publicly financed. [...]

Published
2018

7. Additional file 1 of Impact of replacing sedentary behaviour with other movement behaviours on depression and anxiety symptoms: a prospective cohort study in the UK Biobank

Author

Kandola, A. A., del Pozo Cruz, B., Osborn, D. P. J., Stubbs, B., Choi, K. W., and Hayes, J. F.

Abstract

Additional file 1: Contains a flowchart of participants in the study (Figure 1), additional details on the exposure (Methods 1), a graph of our causal assumptions (Figure 2), additional details on compositional data analysis (Methods 2), the outcome distributions (Figures 3 and 4), base model results (Table 1), and sensitivity analyses results (Results 1 and 2).

Published
2021
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9. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project

Author

Tremblay, Mark S., Aubert, S, Barnes, Joel, Saunders, T.J., Carson, Valerie, Latimer-Cheung, Amy, Chastin, S.F.M., Altenburg, T.M., Chinapaw, Mai J.M., Aminian, S., Arundell, L., Atkin, A.J., Barone Gibbs, B., Bassett-Gunter, R., Belanger, K., Biddle, S., Biswas, A., Chaput, J.P., Chau, J., Colley, R., Coppinger, T., Craven, C., Cristi-Montero, C., de Assis Teles Santos, D., del Pozo Cruz, B., del Pozo Cruz, J., Dempsey, P., do Carmo Santos Goncalves, R.F., Ekelund, U., Ezeugwu, V., Fitzsimons, C., Florez-Pregonero, A., Friel, C., Fröberg, A., Giangregorio, L., Godin, L., Gunnell, K., Halloway, S., Hinkley, T., Hnatiuk, J., Husu, P., Kadir, M., Karagounis, L.G., Koster, A., Lakerveld, J., Lamb, M., Larouche, R., LeBlanc, A., Lee, E.Y., Lee, P., Lopes, L., Manns, T., Manyanga, T., Martin Ginis, K., McVeigh, J., Meneguci, J., Moreira, C., Murtagh, E., Patterson, F., Pereira da Silva, D.R., Pesola, A.J., Peterson, N., Pettitt, C., Pilutti, L., Pinto Pereira, S., Poitras, V., Prince, S., Rathod, A., Rivière, F., Rosenkranz, S., Routhier, F., Santos, R., Smith, B., Theu, O., Tomasone, J., and Tucker, Patricia

Subjects
Medicine and Health Sciences
Abstract

Background: The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need.Method: First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey.Results: Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided.Conclusion: It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors.

Published
2017

10. Reallocating sedentary time to moderate-to-vigorous physical activity but not to light-intensity physical activity is effective to reduce adiposity among youths: a systematic review and meta-analysis

Author

García-Hermoso A., Saavedra J.M., Ramírez-Vélez R., Ekelund U., and del Pozo-Cruz B.

Subjects
Adolescent, Physiology, Sedentary lifestyle, Juvenile, Review, Body composition, Body Mass Index, Accelerometry, Humans, Obesity, Child, Exercise, Cross-sectional study, Body mass index, Adiposity, Light intensity, Physical activity, Isotemporal substitution models, Sedentary behaviour, body regions, Outcome assessment, Phenotype, Body mass, Body fat, Systematic review, Waist circumference, Sedentary Behavior, Waist Circumference, human activities, Meta analysis, Human
Abstract

The aim of the study was to summarize the evidence of the effects of reallocating time spent in sedentary behaviours in different activity intensities on youth's adiposity. Five databases were searched. Studies that reported the effects of replacing sedentary behaviour with light-intensity physical activity (LIPA) and/or moderate-to-vigorous physical activity (MVPA) on at least one adiposity parameter. The estimated regression coefficients (?) and 95% CIs were combined and meta-analysed. Data from 7,351 youths and five studies were analysed. Pooled analysis from cross-sectional studies shows that replacing sedentary time with LIPA showed no significant associations with any adiposity-related outcomes. Replacing sedentary time with MVPA was statistically associated with total body fat percentage (? = ?2.512; p = 0.003), but not with body mass index or waist circumference. In subgroup analysis, the greatest magnitude of association was observed from studies where 60 min of sedentary behaviour was reallocated to 60 min of MVPA (? = ?4.535; p less than 0.001). Our results highlight the importance of promoting MVPA, which may improve body composition phenotypes in young people. This information can be used to develop more effective lifestyle interventions. © 2017 World Obesity Federation

Published
2017

13. Whole body vibration improves the single-leg stance static balance in women with fibromyalgia: a randomized controlled trial

Author

Jc, Adsuar, Del Pozo-Cruz B, Ja, Parraca, Pedro Olivares, and Gusi N

Subjects
Fibromyalgia, Humans, Accidental Falls, Female, Middle Aged, Postural Balance, Vibration
Abstract

AIM:Fibromyalgia (FM) is a chronic disorder characterized by widespread pain. Fibromyalgia is associated with balance problems and increased fall frequency. Whole-body vibration therapy had been used for improve balance in special populations but not in fibromyalgia. The main objective of this study was to analyze the effects of 12 weeks of tilting whole-body vibration therapy on static balance in fibromyalgia patients. METHODS:Women with FM were randomly and sequentially assigned to either the vibration group (N.=21) or the control group (N.=20) based on a randomly generated number table, and a code number was assigned to each participant. All participants received standard care that included medical care through the public health system (hospital and outpatient clinic, including primary care) and social support through the local fibromyalgia association. Participants in the exercise group received whole-body vibration therapy (12 weeks, 12.5 Hz frequency and 3 mm amplitude). Outcome measure was determined using postural stability indices (overall, anterior-posterior and medial-lateral) assessed by the Biodex Balance System in a single dominant limb stance. RESULTS: Treatment effect after12-weeks of tilting whole body vibration therapy were 57.1% on overall stability and 66.6% on anterior-posterior stability. CONCLUSION:Tilting whole-body vibration therapy effectively improves static balance in patients with FM.

Published
2012

16. VALIDATION AND COMPARISON OF EQ-5D-3L AND SF-6D INSTRUMENTS IN A SPANISH PARKINSON´S DISEASE POPULATION SAMPLE.

Author

García-Gordillo, Miguel Ángel, del Pozo-Cruz, B., Adsuar, J. C., Cordero-Ferrera, J. M., Abellán-Perpiñán, J. M., Sánchez-Martínez, F. I., Garcia-Gordillo, Miguel Ángel, Abellan-Perpiñan, J M, and Sanchez-Martinez, F I

Subjects
*PARKINSON'S disease, *PSYCHOMETRICS, *QUALITY of life, *MEDICAL care, *MEDICAL decision making, *QUESTIONNAIRES, *PARKINSON'S disease diagnosis, *COMPARATIVE studies, *HEALTH status indicators, *RESEARCH methodology, *MEDICAL cooperation, *REFERENCE values, *RESEARCH, *EVALUATION research, *PSYCHOLOGY, RESEARCH evaluation
Abstract

Introduction: generic, preference-based Health- Related Quality of Life instruments are receiving growing attention in health-care decision-making process. In spite of this, to our knowledge, EQ-5D and SF-6D have never been compared in a Parkinson´s disease population sample.Objective: the aim of this paper was to assess the psychometric properties of both instruments in a Spanish PD population sample.Methods: a total sample of 133 patients were interviewed using EQ-5D-3L and SF-6D. The validity, level of agreement and sensitivity of both instruments were computed and then compared. The Spanish tariff has been used in both instruments.Results: utilities of EQ-5D-3L and SF-6D have shown a strong correlation (r >0.50 and p<0.001) with the summary score of the PDQ-8 and the EQ-VAS score. Significant differences were observed in the stages III-IV of the Hoehn & Yahr stage. SF-6D had 51% higher efficiency than EQ-5D at detecting differences in symptoms severity.Discussion: both EQ-5D-3L and SF-6D seem to be adequate generic Health-Related Quality of Life measures in terms of validity and sensitivity.Conclusion: EQ-5D-3L presents greater ceiling and floor effects than the SF-6D instrument in this sample. Besides, the instrument SF-6D was better at detecting changes in symptoms severity compared with EQ-5D-3L. [ABSTRACT FROM AUTHOR]

Published
2015
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20. FIABILIDAD TEST-RETEST DE DOS PRUEBAS DE MOVILIDAD EN CUIDADORAS INFORMALES.

Author

Vicente, M. Madruga, Del Pozo Cruz, B., Sánchez-Toledo, P. R. Olivares, Domínguez Muñoz, F. J., Prieto, J. Prieto, and Sala, J. C. Adsuar

Abstract

Copyright of Journal of Sport & Health Research is the property of Journal of Sport & Health Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2014

21. Influencia del Consumo de Información de Actividad Física sobre la CVRS, Motivación y Nivel de Actividad Física en pacientes afectados por DM2.

Author

Sicardo Pinilla, E., Borrero-González, J., Del Pozo-Cruz, J. T., Alfonso-Rosa, R. M., Del Pozo-Cruz, B., and Del Pozo-Cruz, J.

Subjects
PHYSICAL activity, QUALITY of life, MOTIVATION (Psychology), PSYCHOLOGY of physicians, SELF-esteem
Abstract

Copyright of Revista Kronos is the property of Revista Kronos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2013

22. Relación entre la capacidad funcional y el perfil psicosocial en personas mayores no institucionalizadas. Diferencias basadas en género.

Author

Del Pozo-Cruz, J., Rodríguez Bies, E., Alfonso-Rosa, R. M ª., Del Pozo-Cruz, B., Grimaldi Puyana, M., Navas, P., and López-Lluch, G.

Subjects
PSYCHOSOCIAL factors, GERIATRIC psychology, SOCIAL conditions of older people, HEALTH of older people, QUALITY of life
Abstract

Copyright of Revista Kronos is the property of Revista Kronos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2013

23. Capacitación del profesional sanitario y consejo sobre Actividad Física y su influencia sobre la calidad de vida en pacientes afectados por Síndrome Metabólico.

Author

Borrero-González, J., Sicardo Pinilla, E., Del Pozo-Cruz, J. T., Alfonso-Rosa, R. M., Del Pozo-Cruz, B., and Del Pozo-Cruz, J.

Subjects
MEDICAL personnel training, METABOLIC syndrome, PHYSICAL activity, QUALITY of life, PRIMARY care, PATIENTS
Abstract

Copyright of Revista Kronos is the property of Revista Kronos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2013

24. Efectos de un programa de ejercicio vibratorio de 12 semanas sobre la calidad de vida y la satisfacción con el tratamiento en pacientes adultos-mayores afectados por diabetes mellitus tipo 2.

Author

Alfonso Rosa, R.Mª, Del Pozo-Cruz, J., Sañudo-Corrales, B., Haro González, M., Fuentes Aragón, A., and Del Pozo-Cruz, B.

Subjects
QUALITY of life, TYPE 2 diabetes treatment, DIABETES in old age, RANDOMIZED controlled trials, TREATMENT effectiveness
Abstract

Copyright of Revista Kronos is the property of Revista Kronos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2013

29. Reliability of spirometric tests during the different menstrual cycle phases in healthy women

Author

Rafael Timon, Ramirez-Balas, A., Adsuar, J. C., Del Pozo-Cruz, B., and Maynar, M.

Subjects
lcsh:Public aspects of medicine, lcsh:RA1-1270, sense organs, skin and connective tissue diseases, Letter to the Editor
Abstract

Reliability and SRD are important prerequisites for the correct interpreta- tion of spirometric data, which indicate to the clinician whether or not a genuine and real change has occurred. [...]the aim of this study has been to check the reliability of spirometric tests during the menstrual cycle phases and to investi- gate if spirometric variables are modified across the menstrual cycle. On the basis of the percentage of smallest real difference observed in the present study, the size of the relative change (SRD%) should exceed 6.5 % for FEV1, FVC and PEF and 8.3 % for MVV, to indicate a real change for a single individual. [...]these measurements could be used to detect real changes for a single individual following an intervention program, re- gardless of the menstrual cycle phase.

30. Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Author

Carl Abelardo T. Antonio, Rob E. Dorrington, Belinda K Lloyd, Elisabete Weiderpass, Kovin Naidoo, Leslie T. Cooper, Sandra Nolte, Eduardo A. Undurraga, Mohammad A. AlMazroa, R. Kumar, Xiaofeng Liang, Amanda J. Mason-Jones, Kazem Rahimi, Sanjay Basu, Vasiliy Victorovich Vlassov, André Karch, Dipan Bose, Vivekanand Jha, Adansi A. Amankwaa, Kaire Innos, Ione Jayce Ceola Schneider, Itamar S. Santos, Anwar Rafay, Bolajoko O. Olusanya, Tommi Vasankari, Nana Kwaku Mainoo, Saleem M Rana, Wagner Marcenes, Fortuné Gbètoho Gankpé, Rana J. Asghar, Lela Sturua, Nicholas J K Breitborde, Corine Karema, Charles R. Newton, Uche S. Uchendu, Jongmin Lee, Inga Dora Sigfusdottir, Harish Chander Gugnani, Kaushalendra Kumar, Reza Assadi, Ibrahim Abubakar, Konstantinos Stroumpoulis, Megan Coggeshall, Timothy M. Wolock, Ronny Westerman, Samath D Dharmaratne, Katya Anne Shackelford, Anders Larsson, Jeffrey A. Towbin, Jixiang Ma, Lynne Gaffikin, Konstantin Kazanjan, Mohammad Ali Sahraian, Mohammad H. Forouzanfar, Yichong Li, Felix Sayinzoga, Daniel Dicker, Philimon Gona, Maurice Giroud, Maysaa El Sayed Zaki, Shiwei Liu, Lorenzo Monasta, Chantal Huynh, Abdullatif Husseini, Ted R. Miller, Solomon Meseret Woldeyohannes, D. Alex Quistberg, Justin Beardsley, Majed Asad, Uʇur Dilmen, Alaa Badawi, Hsien-Ho Lin, Haidong Kan, Vinod K. Paul, Mitsuru Mukaigawara, James Leigh, Xiao Nong Zou, Sajjad Ur Rahman, Valentina Arsić Arsenijević, Gokalp Kadri Yentur, Man Mohan Mehndiratta, Murugesan Raju, Stephanie J. London, Kingsley N. Ukwaja, Young-Ho Khang, Knud Juel, Mohsen Naghavi, Rasmus Havmoeller, Gelin Xu, Semaw Ferede Abera, Devina Nand, Norito Kawakami, Neil Pearce, Elisabeth Barboza França, Ferrán Catalá-López, Ketevan Goginashvili, Vegard Skirbekk, Neeraj Bedi, Barthelemy Kuate Defo, Andrew H. Kemp, H. Dean Hosgood, Vafa Rahimi-Movaghar, Konrad Pesudovs, Linhong Wang, Xiao Rong Wang, Alan D. Lopez, Ademola Lukman Adelekan, Joshua A. Salomon, Walter Mendoza, Aref A. Bin Abdulhak, Ivy Shiue, G Anil Kumar, Yuichiro Yano, Luke D. Knibbs, Jung-Chen Chang, Yousef Khader, Caitlyn Steiner, Selen Begüm Uzun, Luciano A. Sposato, Gabrielle deVeber, Raghib Ali, Andre Pascal Kengne, Chakib Nejjari, Rafael Alfonso-Cristancho, Tania Georgina Sánchez Pimienta, Roberto Tchio Talongwa, Hilda L Harb, Ali H. Mokdad, Edward J Mills, Angel J Paternina Caicedo, Xiaohong Li, Luke Nyakarahuka, Diego De Leo, Rashmi Gupta, Robert G. Weintraub, Tim Driscoll, Sun Ha Jee, Carolina Maria Teixeira, Ole Frithjof Norheim, Zulfiqar A Bhutta, Hwashin Hyun Shin, Palwasha Anwari, Daniel Pope, Hassan Amini, Jae-Hyun Park, Saad B. Omer, Eric L. Ding, Narayanaswamy Venketasubramanian, Juan Liang, Tara Templin, Arindam Basu, Farshad Farzadfar, Yang Yang, Xuan Che, Scott Weichenthal, Jeyaraj D Pandian, David L. Tirschwell, Adrian Davis, Hilton Lam, Feng Tan, Stephen S Lim, Soewarta Kosen, Atsushi Goto, Ratilal Lalloo, Yanping Wang, Glen Mola, Paulo A. Lotufo, Dhruv S. Kazi, Jose C. Adsuar, Amany H Refaat, Ruben Castro, Gene F. Kwan, Johanna M. Geleijnse, Emerito Jose A. Faraon, Costas A. Christophi, Theo Vos, Sara Sheikhbahaei, Guilherme V. Polanczyk, Jed D. Blore, Azmeraw T. Amare, Kyle R. Heuton, Walid Ammar, Louisa Degenhardt, Andrew Vallely, Guohong Jiang, Ricky Leung, Jasvinder A. Singh, Zewdie Aderaw Alemu, A Artaman, Steven E. Lipshultz, Carlos A Castañeda-Orjuela, Seyed-Mohammad Fereshtehnejad, Sadaf G. Sepanlou, Mark J. Nieuwenhuijsen, John Q. Wong, Manami Inoue, Coen H. Van Gool, James D. Wilkinson, Ejaz Ahmad Khan, Yoshihiro Kokubo, Manuela Mendonca Felicio, Farshad Pourmalek, Boris I. Pavlin, Karen Sliwa, Robert G. Nelson, Tom Achoki, Edmond K. Kabagambe, Orish Ebere Orisakwe, Christopher J L Murray, In-Hwan Oh, Uchechukwu K.A. Sampson, Ulrich O Mueller, Austin E Schumacher, Edson Serván-Mori, Berrak Bora Basara, Simon I. Hay, Anil Kaul, Foad Abd-Allah, Takayoshi Ohkubo, Kim Yun Jin, Abdullah Sulieman Terkawi, Mall Leinsalu, Sergei Petrovich Ermakov, Marek Majdan, Ileana B. Heredia Pi, Christina Papachristou, Scott B. Patten, Rajeev Gupta, Kalpana Balakrishnan, Mustafa Z. Younis, Kenji Shibuya, Graça Maria Ferreira De Lima, Andrea P. Silva, Maziar Moradi-Lakeh, Anand Dayama, Eiman Jahangir, Stefan Ma, Karen M. Tabb, Nicholas J Kassebaum, Shams Eldin Ali Hassan Khalifa, Mazin J. Al Kahbouri, Nadim E. Karam, Jun Zhu, Chandrashekhar T Sreeramareddy, Dinorah González-Castell, Diego Gonzalez-Medina, Aliya Naheed, Ryan M Barber, Salvador Villalpando, Yang Liu, Chanda Kulkarni, Vinay Nangia, Haidong Wang, Yongmei Li, Rosario Cárdenas, Randah R. Hamadeh, Suzanne Polinder, Van C. Lansingh, François Alla, Max Petzold, Bryan L. Sykes, Ubai Alsharif, Chuanhua Yu, Francesco Saverio Violante, Monika Sawhney, Ayse Abbasoglu Ozgoren, Graeme J. Hankey, Mouhanad Hammami, Iuri da Costa Leite, Dickens Akena, Rintaro Mori, Alanur Çavlin, Maia Kereselidze, Jonathan de la Cruz Monis, Deena Alasfoor, Taavi Lai, Eric Y. Tenkorang, Cyrus Cooper, Sudan Prasad Neupane, Dan Poenaru, Veena S. Kulkarni, Naohiro Yonemoto, Elizabeth Glaser, Sergey Soshnikov, Ziad A. Memish, Paul N. Jensen, Fabiola Mejía-Rodríguez, Ana C. Garcia, Rakhi Dandona, Emilie Agardh, Katherine B Gibney, Vasco Manuel Pedro Machado, Michelle L. Bell, David M. Pereira, Muluemebet Abera Wordofa, Samantha M. Colquhoun, Elena Alvarez, Stephen G. Waller, Ketevan Gambashidze, Eduardo Bernabé, Rafael Lozano, Damian G Hoy, Miltiadis K. Tsilimbaris, Hebe N. Gouda, Muhammad Imran Nisar, Zanfina Ademi, Andrew L. Thorne-Lyman, Denis Nash, Dima M. Qato, Luca Ronfani, Nobhojit Roy, Donald H. Silberberg, Monica S. Vavilala, Lydia S. Atkins, Hans W. Hoek, Muluken Dessalegn, David C. Schwebel, Christopher C. Mapoma, Jost B. Jonas, Tolesa Bekele, Lalit Dandona, Borja del Pozo-Cruz, Sumeet S. Chugh, Johan Ärnlöv, Tariku Jibat Beyene, Melvin Barrientos Marzan, Ami R. Moore, Marie Ng, Maigeng Zhou, Samia Alhabib, Massimo Cirillo, Soraya Seedat, Paul S. F. Yip, Nima Hafezi-Nejad, Amelia Bertozzi-Villa, Kebede Deribe, John Nelson Opio, Peter J. Allen, Marina Shakh-Nazarova, Bach Xuan Tran, Arsène Kouablan Adou, Yingfeng Zheng, Julio Cesar Montañez Hernandez, Yong Zhao, Nelson Alvis-Guzman, Bulat Idrisov, Alireza Esteghamati, Seok Jun Yoon, Kathryn H. Jacobsen, Kassebaum, Nicholas J., Bertozzi-Villa, Amelia, Coggeshall, Megan S., Shackelford, Katya A., Steiner, Caitlyn, Heuton, Kyle R., Gonzalez-Medina, Diego, Barber, Ryan, Huynh, Chantal, Dicker, Daniel, Templin, Tara, Wolock, Timothy M., Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw Ferede, Abubakar, Ibrahim, Achoki, Tom, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C., Agardh, Emilie E., Akena, Dicken, Alasfoor, Deena, Alemu, Zewdie Aderaw, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Al Kahbouri, Mazin J., Alla, Françoi, Allen, Peter J., Almazroa, Mohammad A., Alsharif, Ubai, Alvarez, Elena, Alvis-Guzmán, Nelson, Amankwaa, Adansi A., Amare, Azmeraw T., Amini, Hassan, Ammar, Walid, Antonio, Carl A.T., Anwari, Palwasha, Ärnlöv, Johan, Arsenijevic, Valentina S. Arsic, Artaman, Ali, Asad, Majed Masoud, Asghar, Rana J., Assadi, Reza, Atkins, Lydia S., Badawi, Alaa, Balakrishnan, Kalpana, Basu, Arindam, Basu, Sanjay, Beardsley, Justin, Bedi, Neeraj, Bekele, Tolesa, Bell, Michelle L., Bernabe, Eduardo, Beyene, Tariku J., Bhutta, Zulfiqar, Abdulhak, Aref Bin, Blore, Jed D., Basara, Berrak Bora, Bose, Dipan, Breitborde, Nichola, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A., Castro, Ruben Estanislao, Catalá-López, Ferrán, Cavlin, Alanur, Chang, Jung-Chen, Che, Xuan, Christophi, Costas A., Chugh, Sumeet S., Cirillo, Massimo, Colquhoun, Samantha M., Cooper, Leslie Trumbull, Cooper, Cyru, Da Costa Leite, Iuri, Dandona, Lalit, Dandona, Rakhi, Davis, Adrian, Dayama, Anand, Degenhardt, Louisa, De Leo, Diego, Del Pozo-Cruz, Borja, Deribe, Kebede, Dessalegn, Muluken, Deveber, Gabrielle A., Dharmaratne, Samath D., Dilmen, Uʇur, Ding, Eric L., Dorrington, Rob E., Driscoll, Tim R., Ermakov, Sergei Petrovich, Esteghamati, Alireza, Faraon, Emerito Jose A., Farzadfar, Farshad, Felicio, Manuela Mendonca, Fereshtehnejad, Seyed-Mohammad, De Lima, Graça Maria Ferreira, Forouzanfar, Mohammad H., França, Elisabeth B., Gaffikin, Lynne, Gambashidze, Ketevan, Gankpé, Fortuné Gbètoho, Garcia, Ana C., Geleijnse, Johanna M., Gibney, Katherine B., Giroud, Maurice, Glaser, Elizabeth L., Goginashvili, Ketevan, Gona, Philimon, González-Castell, Dinorah, Goto, Atsushi, Gouda, Hebe N., Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hammami, Mouhanad, Hankey, Graeme J., Harb, Hilda L., Havmoeller, Rasmu, Hay, Simon I., Pi, Ileana B. Heredia, Hoek, Hans W., Hosgood, H Dean, Hoy, Damian G., Husseini, Abdullatif, Idrisov, Bulat T., Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H., Jahangir, Eiman, Jee, Sun Ha, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Jonas, Jost B., Juel, Knud, Kabagambe, Edmond Kato, Kan, Haidong, Karam, Nadim E., Karch, André, Karema, Corine Kakizi, Kaul, Anil, Kawakami, Norito, Kazanjan, Konstantin, Kazi, Dhruv S., Kemp, Andrew H., Kengne, Andre Pascal, Kereselidze, Maia, Khader, Yousef Saleh, Khalifa, Shams Eldin Ali Hassan, Khan, Ejaz Ahmed, Khang, Young-Ho, Knibbs, Luke, Kokubo, Yoshihiro, Kosen, Soewarta, Defo, Barthelemy Kuate, Kulkarni, Chanda, Kulkarni, Veena S., Kumar, G. Anil, Kumar, Kaushalendra, Kumar, Ravi B., Kwan, Gene, Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lansingh, Van C., Larsson, Ander, Lee, Jong-Tae, Leigh, Jame, Leinsalu, Mall, Leung, Ricky, Li, Xiaohong, Li, Yichong, Li, Yongmei, Liang, Juan, Liang, Xiaofeng, Lim, Stephen S., Lin, Hsien-Ho, Lipshultz, Steven E., Liu, Shiwei, Liu, Yang, Lloyd, Belinda K., London, Stephanie J., Lotufo, Paulo A., Ma, Jixiang, Ma, Stefan, Machado, Vasco Manuel Pedro, Mainoo, Nana Kwaku, Majdan, Marek, Mapoma, Christopher Chabila, Marcenes, Wagner, Marzan, Melvin Barriento, Mason-Jones, Amanda J., Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Memish, Ziad A., Mendoza, Walter, Miller, Ted R., Mills, Edward J., Mokdad, Ali H., Mola, Glen Liddell, Monasta, Lorenzo, De La Cruz Monis, Jonathan, Hernandez, Julio Cesar Montañez, Moore, Ami R., Moradi-Lakeh, Maziar, Mori, Rintaro, Mueller, Ulrich O., Mukaigawara, Mitsuru, Naheed, Aliya, Naidoo, Kovin S., Nand, Devina, Nangia, Vinay, Nash, Deni, Nejjari, Chakib, Nelson, Robert G., Neupane, Sudan Prasad, Newton, Charles R., Ng, Marie, Nieuwenhuijsen, Mark J., Nisar, Muhammad Imran, Nolte, Sandra, Norheim, Ole F., Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Olusanya, Bolajoko O., Omer, Saad B., Opio, John Nelson, Orisakwe, Orish Ebere, Pandian, Jeyaraj D., Papachristou, Christina, Park, Jae-Hyun, Paternina Caicedo, Angel J., Patten, Scott B., Paul, Vinod K., Pavlin, Boris Igor, Pearce, Neil, Pereira, David M., Pesudovs, Konrad, Petzold, Max, Poenaru, Dan, Polanczyk, Guilherme V., Polinder, Suzanne, Pope, Dan, Pourmalek, Farshad, Qato, Dima, Quistberg, D. Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Ur Rahman, Sajjad, Raju, Murugesan, Rana, Saleem M., Refaat, Amany, Ronfani, Luca, Roy, Nobhojit, Pimienta, Tania Georgina Sánchez, Sahraian, Mohammad Ali, Salomon, Joshua A., Sampson, Uchechukwu, Santos, Itamar S., Sawhney, Monika, Sayinzoga, Felix, Schneider, Ione J.C., Schumacher, Austin, Schwebel, David C., Seedat, Soraya, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shakh-Nazarova, Marina, Sheikhbahaei, Sara, Shibuya, Kenji, Shin, Hwashin Hyun, Shiue, Ivy, Sigfusdottir, Inga Dora, Silberberg, Donald H., Silva, Andrea P., Singh, Jasvinder A., Skirbekk, Vegard, Sliwa, Karen, Soshnikov, Sergey S., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stroumpoulis, Konstantino, Sturua, Lela, Sykes, Bryan L., Tabb, Karen M., Talongwa, Roberto Tchio, Tan, Feng, Teixeira, Carolina Maria, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Thorne-Lyman, Andrew L., Tirschwell, David L., Towbin, Jeffrey A., Tran, Bach X., Tsilimbaris, Miltiadi, Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen Begüm, Vallely, Andrew J., Van Gool, Coen H., Vasankari, Tommi J., Vavilala, Monica S., Venketasubramanian, N., Villalpando, Salvador, Violante, Francesco S., Vlassov, Vasiliy Victorovich, Vos, Theo, Waller, Stephen, Wang, Haidong, Wang, Linhong, Wang, Xiao Rong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Westerman, Ronny, Wilkinson, James D., Woldeyohannes, Solomon Meseret, Wong, John Q., Wordofa, Muluemebet Abera, Xu, Gelin, Yang, Yang C., Yano, Yuichiro, Yentur, Gokalp Kadri, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Jin, Kim Yun, El Sayed Zaki, Maysaa, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zhu, Jun, Zou, Xiao Nong, Lopez, Alan D., Naghavi, Mohsen, Murray, Christopher J.L., Lozano, Rafael, Kassebaum, Nj, Bertozzi-Villa, A, Coggeshall, M, Shackelford, Ka, Steiner, C, Heuton, Kr, Gonzalez-Medina, D, Barber, R, Huynh, C, Dicker, D, Templin, T, Wolock, Tm, Ozgoren, Aa, Abd-Allah, F, Abera, Sf, Achoki, T, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Agardh, Ee, Akena, D, Alasfoor, D, Alemu, Za, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Al Kahbouri, Mj, Alla, F, Allen, Pj, Almazroa, Ma, Alsharif, U, Alvarez, E, Alvis-Guzmán, N, Amankwaa, Aa, Amare, At, Amini, H, Ammar, W, Antonio, Ca, Anwari, P, Arnlöv, J, Arsenijevic, V, Artaman, A, Asad, Mm, Asghar, Rj, Assadi, R, Atkins, L, Badawi, A, Balakrishnan, K, Basu, A, Basu, S, Beardsley, J, Bedi, N, Bekele, T, Bell, Ml, Bernabe, E, Beyene, Tj, Bhutta, Z, Bin Abdulhak, A, Blore, J, Basara, Bb, Bose, D, Breitborde, N, Cárdenas, R, Castañeda-Orjuela, Ca, Castro, Re, Catalá-López, F, Cavlin, A, Chang, Jc, Che, X, Christophi, Ca, Chugh, S, Cirillo, M, Colquhoun, Sm, Cooper, Lt, Cooper, C, da Costa Leite, I, Dandona, L, Dandona, R, Davis, A, Dayama, A, Degenhardt, L, De Leo, D, Del Pozo-Cruz, B, Deribe, K, Dessalegn, M, Deveber, Ga, Dharmaratne, Sd, Dilmen, U, Ding, El, Dorrington, Re, Driscoll, Tr, Ermakov, Sp, Esteghamati, A, Faraon, Ej, Farzadfar, F, Felicio, Mm, Fereshtehnejad, Sm, de Lima, Gm, Forouzanfar, Mh, França, Eb, Gaffikin, L, Gambashidze, K, Gankpé, Fg, Garcia, Ac, Geleijnse, Jm, Gibney, Kb, Giroud, M, Glaser, El, Goginashvili, K, Gona, P, González-Castell, D, Goto, A, Gouda, Hn, Gugnani, Hc, Gupta, R, Hafezi-Nejad, N, Hamadeh, Rr, Hammami, M, Hankey, Gj, Harb, Hl, Havmoeller, R, Hay, S, Pi, Ib, Hoek, Hw, Hosgood, Hd, Hoy, Dg, Husseini, A, Idrisov, Bt, Innos, K, Inoue, M, Jacobsen, Kh, Jahangir, E, Jee, Sh, Jensen, Pn, Jha, V, Jiang, G, Juel, K, Kabagambe, Ek, Kan, H, Karam, Ne, Karch, A, Karema, Ck, Kaul, A, Kawakami, N, Kazanjan, K, Kazi, D, Kemp, Ag, Kengne, Ap, Kereselidze, M, Khader, Y, Khalifa, Se, Khan, Ea, Khang, Yh, Knibbs, L, Kokubo, Y, Kosen, S, Defo, Bk, Kulkarni, C, Kulkarni, V, Kumar, Ga, Kumar, K, Kumar, Rb, Kwan, G, Lai, T, Lalloo, R, Lam, H, Lansingh, Vc, Larsson, A, Lee, Jt, Leigh, J, Leinsalu, M, Leung, R, Li, X, Li, Y, Liang, J, Liang, X, Lim, S, Lin, Hh, Lipshultz, Se, Liu, S, Liu, Y, Lloyd, Bk, London, Sj, Lotufo, Pa, Ma, J, Ma, S, Machado, Vm, Mainoo, Nk, Majdan, M, Mapoma, Cc, Marcenes, W, Marzan, Mb, Mason-Jones, Aj, Mehndiratta, Mm, Mejia-Rodriguez, F, Memish, Za, Mendoza, W, Miller, Tr, Mills, Ej, Mokdad, Ah, Mola, Gl, Monasta, L, de la Cruz Monis, J, Hernandez, Jc, Moore, Ar, Mori, R, Mueller, Uo, Mukaigawara, M, Naheed, A, Naidoo, K, Nand, D, Nangia, V, Nash, D, Nejjari, C, Nelson, Rg, Neupane, Sp, Newton, Cr, Ng, M, Nieuwenhuijsen, Mj, Nisar, Mi, Nolte, S, Norheim, Of, Nyakarahuka, L, Oh, Ih, Ohkubo, T, Olusanya, Bo, Omer, Sb, Opio, Jn, Orisakwe, Oe, Pandian, Jd, Papachristou, C, Park, Jh, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pereira, Dm, Pesudovs, K, Petzold, M, Poenaru, D, Polanczyk, Gv, Polinder, S, Pope, D, Pourmalek, F, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Ur Rahman, S, Raju, M, Rana, Sm, Refaat, A, Ronfani, L, Roy, N, Pimienta, Tg, Sahraian, Ma, Salomon, J, Sampson, U, Santos, I, Sawhney, M, Sayinzoga, F, Schneider, Ij, Schumacher, A, Schwebel, Dc, Seedat, S, Sepanlou, Sg, Servan-Mori, Ee, Shakh-Nazarova, M, Sheikhbahaei, S, Shibuya, K, Shin, Hh, Shiue, I, Sigfusdottir, Id, Silberberg, Dh, Silva, Ap, Singh, Ja, Skirbekk, V, Sliwa, K, Soshnikov, S, Sposato, La, Sreeramareddy, Ct, Stroumpoulis, K, Sturua, L, Sykes, Bl, Tabb, Km, Talongwa, Rt, Tan, F, Teixeira, Cm, Tenkorang, Ey, Terkawi, A, Thorne-Lyman, Al, Tirschwell, Dl, Towbin, Ja, Tran, Bx, Tsilimbaris, M, Uchendu, U, Ukwaja, Kn, Undurraga, Ea, Uzun, Sb, Vallely, Aj, van Gool, Ch, Vasankari, Tj, Vavilala, M, Venketasubramanian, N, Villalpando, S, Violante, F, Vlassov, Vv, Vos, T, Waller, S, Wang, H, Wang, L, Wang, Sx, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Westerman, R, Wilkinson, Jd, Woldeyohannes, Sm, Wong, Jq, Wordofa, Ma, Xu, G, Yang, Yc, Yano, Y, Yentur, Gk, Yip, P, Yonemoto, N, Yoon, Sj, Younis, Mz, Yu, C, Jin, Ky, El Sayed Zaki, M, Zhao, Y, Zheng, Y, Zhou, M, Zhu, J, Zou, Xn, Lopez, Ad, Naghavi, M, Murray, Cj, Lozano, R, Cell biology, Epidemiology, Public Health, Erasmus MC other, Cardiothoracic Surgery, and Pathology

Subjects
Pediatrics, Time Factors, Nutrition and Disease, hiv-infection, immunodeficiency virus-1 infection, peripartum cardiomyopathy, Poison control, HIV Infections, IMMUNODEFICIENCY VIRUS-1 INFECTION, Socioeconomic Factor, Global Health, 0302 clinical medicine, PERIPARTUM CARDIOMYOPATHY, pregnancy-related mortality, Risk Factors, Pregnancy, Voeding en Ziekte, Cause of Death, Global health, HIV Infection, 030212 general & internal medicine, Pregnancy Complications, Infectious, 10. No inequality, Cause of death, 030219 obstetrics & reproductive medicine, south-africa, Medicine (all), 1. No poverty, WOMEN, PREGNANCY-RELATED MORTALITY, health initiatives, General Medicine, SOUTH-AFRICA, 3. Good health, Maternal Mortality, World Health, CHILD SURVIVAL, Female, Maternal death, women, Human, medicine.medical_specialty, Time Factor, DEATHS, child survival, Article, adult mortality, 03 medical and health sciences, Age Distribution, HEALTH INITIATIVES, SDG 3 - Good Health and Well-being, HIV-INFECTION, ADULT MORTALITY, Injury prevention, medicine, Organizational Objectives, Organizational Objective, Humans, VLAG, Models, Statistical, business.industry, Risk Factor, medicine.disease, deaths, Standardized mortality ratio, Socioeconomic Factors, Relative risk, Pregnancy Complications, Infectiou, business, Demography
Abstract

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.FUNDING: Bill & Melinda Gates Foundation.

Published
2016

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

Author

Vos, T, Barber, Rm, Bell, B, Bertozzi Villa, A, Biryukov, S, Bolliger, I, Charlson, F, Davis, A, Degenhardt, L, Dicker, D, Duan, L, Erskine, H, Feigin, Vl, Ferrari, Aj, Fitzmaurice, C, Fleming, T, Graetz, N, Guinovart, C, Haagsma, J, Hansen, Gm, Hanson, Sw, Heuton, Kr, Higashi, H, Kassebaum, N, Kyu, H, Laurie, E, Liang, X, Lofgren, K, Lozano, R, Macintyre, Mf, Moradi Lakeh, M, Naghavi, M, Nguyen, G, Odell, S, Ortblad, K, Roberts, Da, Roth, Ga, Sandar, L, Serina, Pt, Stanaway, Jd, Steiner, C, Thomas, B, Vollset, Se, Whiteford, H, Wolock, Tm, Ye, P, Zhou, M, Ãvila, Ma, Aasvang, Gm, Abbafati, C, Abbasoglu, Ozgoren, A, Abd Allah, F, Abdel, Aziz, Abera, Sf, Aboyans, V, Abraham, Jp, Abraham, B, Abubakar, I, Abu Raddad, Lj, Abu Rmeileh, Nm, Aburto, Tc, Achoki, T, Ackerman, In, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Arnlov, J, Agardh, Ee, Khabouri, Al, Alam, Ss, Alasfoor, D, Albittar, Mi, Alegretti, Ma, Aleman, Av, Alemu, Za, Alfonso Cristancho, R, Alhabib, S, Ali, R, Alla, F, Allebeck, 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Gabbe, Bj, Gankpe, Fg, Garcia, Guerra, Geleijnse, Fa, Gessner, Bd, Gibney, Kb, Gillum, Rf, Ginawi, Ia, Giroud, M, Giussani, G, Goenka, S, Goginashvili, K, Gona, P, Gonzalez, De, Cosio, T, Gosselin, Ra, Gotay, Cc, Goto, A, Gouda, Hn, Guerrant, Rl, Gugnani, Hc, Gunnell, D, Gupta, R, Gutierrez, Ra, Hafezi Nejad, N, Hagan, H, Halasa, Y, Hamadeh, Rr, Hamavid, H, Hammami, M, Hankey, Gj, Hao, Y, Harb, Hl, Haro, Jm, Havmoeller, R, Hay, Rj, Hay, S, Hedayati, Mt, Heredia, Pi, Heydarpour, P, Hijar, M, Hoek, Hw, Hoffman, Hj, Hornberger, Jc, Hosgood, Hd, Hossain, M, Hotez, Pj, Hoy, Dg, Hsairi, M, Hu, H, Hu, G, Huang, Jj, Huang, C, Huiart, L, Husseini, A, Iannarone, M, Iburg, Km, Innos, K, Inoue, M, Jacobsen, Kh, Jassal, Sk, Jeemon, P, Jensen, Pn, Jha, V, Jiang, G, Jiang, Y, Jonas, Jb, Joseph, J, Juel, K, Kan, H, Karch, A, Karimkhani, C, Karthikeyan, G, Katz, R, Kaul, A, Kawakami, N, Kazi, Ds, Kemp, Ah, Kengne, Ap, Khader, Ys, Khalifa, Se, Khan, Ea, Khan, G, Khang, Yh, Khonelidze, I, Kieling, C, 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M, Memish, Za, Mensah, G, Meretoja, A, Mhimbira, Fa, Micha, R, Miller, Tr, Mills, Ej, Mitchell, Pb, Mock, Cn, Moffitt, Te, Mohamed, Ibrahim, N, Mohammad, Ka, Mokdad, Ah, Mola, Gl, Monasta, L, Montico, M, Montine, Tj, Moore, Ar, Moran, Ae, Morawska, L, Mori, R, Moschandreas, J, Moturi, Wn, Moyer, M, Mozaffarian, D, Mueller, Uo, Mukaigawara, M, Murdoch, Me, Murray, J, Murthy, Ks, Naghavi, P, Nahas, Z, Naheed, A, Naidoo, Ks, Naldi, L, Nand, D, Nangia, V, Narayan, Km, Nash, D, Nejjari, C, Neupane, Sp, Newman, Lm, Newton, Cr, Ng, M, Ngalesoni, Fn, Nhung, Nt, Nisar, Mi, Nolte, S, Norheim, Of, Norman, Re, Norrving, B, Nyakarahuka, L, Ih, Oh, Ohkubo, T, Omer, Sb, Opio, Jn, Ortiz, A, Pandian, Jd, Panelo, Ci, Papachristou, C, Park, Ek, Parry, Cd, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pedraza, Ls, Pellegrini, Ca, Pereira, Dm, Perez Ruiz, Fp, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, Cb, Petzold, M, Phillips, Mr, Phillips, D, Phillips, B, Piel, Fb, Plass, D, Poenaru, D, Polanczyk, Gv, Polinder, S, Pope, Ca, Popova, S, Poulton, Rg, Pourmalek, F, Prabhakaran, D, Prasad, Nm, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi Movaghar, V, Rahman, Su, Raju, M, Rakovac, I, Rana, Sm, Razavi, H, Refaat, A, Rehm, J, Remuzzi, G, Resnikoff, S, Ribeiro, Al, Riccio, Pm, Richardson, L, Richardus, Jh, Riederer, Am, Robinson, M, Roca, A, Rodriguez, A, Rojas Rueda, D, Ronfani, L, Rothenbacher, D, Roy, N, Ruhago, Gm, Sabin, N, Sacco, Rl, Ksoreide, K, Saha, S, Sahathevan, R, Sahraian, Ma, Sampson, U, Sanabria, Jr, Sanchez Riera, L, Santos, Is, Satpathy, M, Saunders, Je, Sawhney, M, Saylan, Mi, Scarborough, P, Schoettker, B, Schneider, Ij, Schwebel, Dc, Scott, Jg, Seedat, S, Sepanlou, Sg, Serdar, B, Servan Mori, Ee, Shackelford, K, Shaheen, A, Shahraz, S, Shamah, Levy, T, Shangguan, S, She, J, Sheikhbahaei, S, Shepard, Ds, Shi, P, Shibuya, K, Shinohara, Y, Shiri, R, Shishani, K, Shiue, I, Shrime, Mg, Sigfusdottir, Id, Silberberg, Dh, Simard, Ep, Sindi, S, Singh, Ja, Singh, L, Skirbekk, V, Sliwa, K, Soljak, M, Soneji, S, Soshnikov, Ss, Speyer, P, Sposato, La, Sreeramareddy, Ct, Stoeckl, H, Stathopoulou, Vk, Steckling, N, Stein, Mb, Stein, Dj, Steiner, Tj, Stewart, A, Stork, E, Stovner, Lj, Stroumpoulis, K, Sturua, L, Sunguya, Bf, Swaroop, M, Sykes, Bl, Tabb, Km, Takahashi, K, Tan, F, Tandon, N, Tanne, D, Tanner, M, Tavakkoli, M, Taylor, Hr, Ao, Te, Temesgen, Am, Ten, Have, M, Tenkorang, Ey, Terkawi, As, Theadom, Am, Thomas, E, Thorne Lyman, Al, Thrift, Ag, Tleyjeh, Im, Tonelli, M, Topouzis, F, Towbin, Ja, Toyoshima, H, Traebert, J, Tran, Bx, Trasande, L, Trillini, M, Truelsen, T, Trujillo, U, Tsilimbaris, M, Tuzcu, Em, Ukwaja, Kn, Undurraga, Ea, Uzun, Sb, Van, Brakel, Van, Wh, Vijver, De, Van, S, Dingenen, R, Van, Gool, Varakin, Yy, Vasankari, Tj, Vavilala, Ms, Veerman, Lj, Velasquez, Melendez, G, Venketasubramanian, N, Vijayakumar, L, Villalpando, S, Violante, Fs, Vlassov, Vv, Waller, S, Wallin, Mt, Wan, X, Wang, L, Wang, J, Wang, Y, Warouw, Ts, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Werdecker, A, Wessells, Kr, Westerman, R, Wilkinson, Jd, Williams, Hc, Williams, Tn, Woldeyohannes, Sm, Wolfe, Cd, Wong, Jq, Wong, H, Woolf, Ad, Wright, Jl, Wurtz, B, Xu, G, Yang, G, Yano, Y, Yenesew, Ma, Yentur, Gk, Yip, P, Yonemoto, N, Yoon, Sj, Younis, M, Yu, C, Kim, Ky, Zaki, Mel, Zhang, Y, Zhao, Z, Zhao, Y, Zhu, J, Zonies, D, Zunt, Jr, Salomon, Ja, Murray, C. J., Vos, T, Barber, Rm, Bell, B, Bertozzi-Villa, A, Biryukov, S, Bolliger, I, Charlson, F, Davis, A, Degenhardt, L, Dicker, D, Duan, L, Erskine, H, Feigin, Vl, Ferrari, Aj, Fitzmaurice, C, Fleming, T, Graetz, N, Guinovart, C, Haagsma, J, Hansen, Gm, Hanson, Sw, Heuton, Kr, Higashi, H, Kassebaum, N, Kyu, H, Laurie ELiang, X, Lofgren, K, Lozano, R, Macintyre, Mf, Moradi-Lakeh, M, Naghavi, M, Nguyen, G, Odell, S, Ortblad, K, Roberts, Da, Roth, Ga, Sandar, L, Serina, Pt, Stanaway, Jd, Steiner, C, Thomas, B, Vollset, Se, Whiteford, H, Wolock, Tm, Ye, P, Zhou, M, Ãvila, Ma, Aasvang, Gm, Abbafati, C, Abbasoglu Ozgoren, A, Abd-Allah, F, Abdel Aziz MI, Abera, Sf, Aboyans, V, Abraham, Jp, Abraham, B, Abubakar, I, Abu-Raddad, Lj, Abu-Rmeileh, Nm, Aburto, Tc, Achoki TAckerman IN, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Arnlov, J, Agardh, Ee, Al Khabouri MJ, Alam, S, Alasfoor, D, Albittar, Mi, Alegretti MAAleman AV, Alemu, Za, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Alla, F, Allebeck, P, Allen, Pj, Almazroa, Ma, Alsharif, U, Alvarez, E, Alvis-Guzman NAmeli, O, Amini, H, Ammar, W, Anderson, Bo, Anderson, Hr, Antonio, Ca, Anwari, P, Apfel, H, Arsenijevic, V, Artaman, A, Asghar, Rj, Assadi, R, Atkins, L, Atkinson, C, Badawi, A, Bahit, Mc, Bakfalouni, T, Balakrishnan, K, Balalla, S, Banerjee, A, Barker-Collo, Sl, Barquera, S, Barregard, L, Barrero LHBasu, S, Basu, A, Baxter, A, Beardsley, J, Bedi, N, Beghi, E, Bekele, T, Bell, Ml, Benjet, C, Bennett, Da, Bensenor, Im, Benzian, H, Bernabe, E, Beyene TJBhala, N, Bhalla, A, Bhutta, Z, Bienhoff, K, Bikbov, B, Bin Abdulhak, A, Blore, Jd, Blyth, Fm, Bohensky, Ma, Bora Basara, B, Borges, G, Bornstein, Nm, Bose, D, Boufous, S, Bourne, Rr, Boyers, Ln, Brainin, M, Brauer, M, Brayne, Ce, Brazinova, A, Breitborde, Nj, Brenner, H, Briggs, Ad, Brooks, Pm, Brown JBrugha TS, Buchbinder, R, Buckle, Gc, Bukhman, G, Bulloch, Ag, Burch, M, Burnett, R, Cardenas, R, Cabral, Nl, Campos Nonato IR, Campuzano JCCarapetis JR, Carpenter, Do, Caso, V, Castaneda-Orjuela, Ca, Catala-Lopez, F, Chadha, Vk, Chang, Jc, Chen, H, Chen, W, Chiang, Pp, Chimed-Ochir, O, Chowdhury, R, Christensen, H, Christophi, Ca, Chugh, S, Cirillo, M, Coggeshall, M, Cohen, A, Colistro, V, Colquhoun, Sm, Contreras, Ag, Cooper LTCooper, C, Cooperrider, K, Coresh, J, Cortinovis, M, Criqui, Mh, Crump, Ja, Cuevas-Nasu, L, Dandona, R, Dandona, L, Dansereau, E, Dantes, Hg, Dargan, Pi, Davey, G, Davitoiu, Dv, Dayama, A, De la Cruz-Gongora, V, de la Vega SF, De Leo, D, del Pozo-Cruz, B, Dellavalle, Rp, Deribe, K, Derrett, S, Des Jarlais DC, Dessalegn, M, Deveber, Ga, Dharmaratne, Sd, Diaz-Torne, C, Ding, El, Dokova, K, Dorsey, Er, Driscoll, Tr, Duber, H, Durrani, Am, Edmond, Km, Ellenbogen, Rg, Endres, M, Ermakov, Sp, Eshrati, B, Esteghamati, A, Estep, K, Fahimi, S, Farzadfar, F, Fay, Df, Felson, Dt, Fereshtehnejad SMFernandes JG, Ferri, Cp, Flaxman, A, Foigt, N, Foreman, Kj, Fowkes, Fg, Franklin, Rc, Furst, T, Futran, Nd, Gabbe, Bj, Gankpe, Fg, Garcia-Guerra FAGeleijnse JM, Gessner, Bd, Gibney, Kb, Gillum, Rf, Ginawi, Ia, Giroud, M, Giussani, G, Goenka, S, Goginashvili, K, Gona, P, Gonzalez de Cosio TGosselin RA, Gotay, Cc, Goto, A, Gouda, Hn, Guerrant, Rl, Gugnani, Hc, Gunnell, D, Gupta, R, Gutierrez, Ra, Hafezi-Nejad, N, Hagan HHalasa, Y, Hamadeh, Rr, Hamavid, H, Hammami, M, Hankey, Gj, Hao, Y, Harb, Hl, Haro, Jm, Havmoeller, R, Hay, Rj, Hay, S, Hedayati, Mt, Heredia Pi IB, Heydarpour, P, Hijar, M, Hoek, Hw, Hoffman, Hj, Hornberger, Jc, Hosgood, Hd, Hossain, M, Hotez, Pj, Hoy, Dg, Hsairi, M, Hu, H, Hu, G, Huang JJHuang, C, Huiart, L, Husseini, A, Iannarone, M, Iburg, Km, Innos, K, Inoue, M, Jacobsen, Kh, Jassal, Sk, Jeemon, P, Jensen, Pn, Jha, V, Jiang, G, Jiang YJonas JB, Joseph, J, Juel, K, Kan, H, Karch, A, Karimkhani, C, Karthikeyan, G, Katz, R, Kaul, A, Kawakami, N, Kazi, D, Kemp, Ah, Kengne, Ap, Khader, Y, Khalifa, Se, Khan, Ea, Khan, G, Khang, Yh, Khonelidze, I, Kieling, C, Kim, D, Kim, S, Kimokoti, Rw, Kinfu, Y, Kinge, Jm, Kissela, Bm, Kivipelto MKnibbs, L, Knudsen, Ak, Kokubo, Y, Kosen, S, Kramer, A, Kravchenko, M, Krishnamurthi, Rv, Krishnaswami, S, Kuate Defo, B, Kucuk Bicer, B, Kuipers EJKulkarni VS, Kumar, K, Kumar, Ga, Kwan, Gf, Lai, T, Lalloo, R, Lam, H, Lan, Q, Lansingh, Vc, Larson, H, Larsson, A, Lawrynowicz, Ae, Leasher, Jl, Lee, Jt, Leigh, J, Leung, R, Levi, M, Li, B, Li, Y, Liang, J, Lim, S, Lin, Hh, Lind, M, Lindsay, Mp, Lipshultz, Se, Liu, S, Lloyd, Bk, Lockett Ohno, S, Logroscino, G, Looker, Kj, Lopez, Ad, Lopez-Olmedo, N, Lortet-Tieulent, J, Lotufo, Pa, Low, N, Lucas, Rm, Lunevicius, R, Lyons, Ra, Ma, J, Ma, S, Mackay MTMajdan, M, Malekzadeh, R, Mapoma, Cc, Marcenes, W, March, Lm, Margono, C, Marks, Gb, Marzan, Mb, Masci, Jr, Mason-Jones, Aj, Matzopoulos RGMayosi BM, Mazorodze, Tt, Mcgill, Nw, Mcgrath, Jj, Mckee, M, Mclain, A, Mcmahon, Bj, Meaney, Pa, Mehndiratta, Mm, Mejia-Rodriguez, F, Mekonnen, W, Melaku, Ya, Meltzer, M, Memish, Za, Mensah, G, Meretoja, A, Mhimbira, Fa, Micha, R, Miller, Tr, Mills, Ej, Mitchell, Pb, Mock, Cn, Moffitt TEMohamed Ibrahim, N, Mohammad, Ka, Mokdad, Ah, Mola, Gl, Monasta, L, Montico, M, Montine, Tj, Moore, Ar, Moran, Ae, Morawska, L, Mori RMoschandreas, J, Moturi, Wn, Moyer, M, Mozaffarian, D, Mueller, Uo, Mukaigawara, M, Murdoch, Me, Murray, J, Murthy, K, Naghavi, P, Nahas ZNaheed, A, Naidoo, K, Naldi, L, Nand, D, Nangia, V, Narayan, Km, Nash, D, Nejjari, C, Neupane, Sp, Newman, Lm, Newton, Cr, Ng, M, Ngalesoni FNNhung NT, Nisar, Mi, Nolte, S, Norheim, Of, Norman, Re, Norrving, B, Nyakarahuka, L, Oh, Ih, Ohkubo, T, Omer, Sb, Opio, Jn, Ortiz, A, Pandian JDPanelo CI, Papachristou, C, Park, Ek, Parry, Cd, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pedraza, L, Pellegrini, Ca, Pereira, Dm, Perez-Ruiz, Fp, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, Cb, Petzold, M, Phillips, Mr, Phillips, D, Phillips, B, Piel, Fb, Plass, D, Poenaru, D, Polanczyk GVPolinder, S, Pope, Ca, Popova, S, Poulton, Rg, Pourmalek, F, Prabhakaran, D, Prasad, Nm, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, Su, Raju, M, Rakovac, I, Rana, Sm, Razavi, H, Refaat, A, Rehm, J, Remuzzi, G, Resnikoff, S, Ribeiro, Al, Riccio, Pm, Richardson, L, Richardus, Jh, Riederer, Am, Robinson, M, Roca, A, Rodriguez, A, Rojas-Rueda, D, Ronfani, L, Rothenbacher, D, Roy, N, Ruhago, Gm, Sabin, N, Sacco, Rl, Ksoreide, K, Saha, S, Sahathevan, R, Sahraian, Ma, Sampson, U, Sanabria, Jr, Sanchez-Riera, L, Santos, I, Satpathy, M, Saunders, Je, Sawhney, M, Saylan MIScarborough, P, Schoettker, B, Schneider, Ij, Schwebel, Dc, Scott, Jg, Seedat, S, Sepanlou, Sg, Serdar, B, Servan-Mori, Ee, Shackelford, K, Shaheen AShahraz, S, Shamah Levy, T, Shangguan, S, She, J, Sheikhbahaei, S, Shepard, D, Shi, P, Shibuya, K, Shinohara, Y, Shiri, R, Shishani, K, Shiue, I, Shrime, Mg, Sigfusdottir, Id, Silberberg, Dh, Simard, Ep, Sindi, S, Singh, Ja, Singh, L, Skirbekk, V, Sliwa, K, Soljak, M, Soneji, S, Soshnikov, S, Speyer PSposato LA, Sreeramareddy, Ct, Stoeckl, H, Stathopoulou, Vk, Steckling, N, Stein, Mb, Stein, Dj, Steiner, Tj, Stewart, A, Stork, E, Stovner LJStroumpoulis, K, Sturua, L, Sunguya, Bf, Swaroop, M, Sykes, Bl, Tabb, Km, Takahashi, K, Tan, F, Tandon, N, Tanne, D, Tanner, M, Tavakkoli, M, Taylor, Hr, Te Ao BJ, Temesgen, Am, Ten Have, M, Tenkorang, Ey, Terkawi, A, Theadom, Am, Thomas, E, Thorne-Lyman, Al, Thrift, Ag, Tleyjeh, Im, Tonelli, M, Topouzis, F, Towbin, Ja, Toyoshima, H, Traebert, J, Tran, Bx, Trasande, L, Trillini, M, Truelsen, T, Trujillo, U, Tsilimbaris, M, Tuzcu, Em, Ukwaja KNUndurraga EA, Uzun, Sb, van Brakel WH, van de Vijver, S, Van Dingenen, R, van Gool CH, Varakin, Yy, Vasankari, Tj, Vavilala, M, Veerman LJVelasquez-Melendez, G, Venketasubramanian, N, Vijayakumar, L, Villalpando, S, Violante, F, Vlassov, Vv, Waller, S, Wallin, Mt, Wan, X, Wang, L, Wang, J, Wang, Y, Warouw, T, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Werdecker, A, Wessells, Kr, Westerman, R, Wilkinson, Jd, Williams HCWilliams TN, Woldeyohannes, Sm, Wolfe, Cd, Wong, Jq, Wong, H, Woolf, Ad, Wright, Jl, Wurtz, B, Xu, G, Yang, G, Yano, Y, Yenesew, Ma, Yentur GKYip, P, Yonemoto, N, Yoon, Sj, Younis, M, Yu, C, Kim, Ky, Zaki Mel, S, Zhang, Y, Zhao, Z, Zhao, Y, Zhu, J, Zonies, D, Zunt, Jr, Salomon, Ja, Murray, Cj., Vos, Theo, Barber, Ryan M., Bell, Brad, Bertozzi-Villa, Amelia, Biryukov, Stan, Bolliger, Ian, Charlson, Fiona, Davis, Adrian, Degenhardt, Louisa, Dicker, Daniel, Duan, Leilei, Erskine, Holly, Feigin, Valery L., Ferrari, Alize J., Fitzmaurice, Christina, Fleming, Thoma, Graetz, Nichola, Guinovart, Caterina, Haagsma, Juanita, Hansen, Gillian M., Hanson, Sarah Wulf, Heuton, Kyle R., Higashi, Hideki, Kassebaum, Nichola, Kyu, Hmwe, Laurie, Evan, Liang, Xiofeng, Lofgren, Katherine, Lozano, Rafael, Macintyre, Michael F., Moradi-Lakeh, Maziar, Naghavi, Mohsen, Nguyen, Grant, Odell, Shaun, Ortblad, Katrina, Roberts, David Allen, Roth, Gregory A., Sandar, Logan, Serina, Peter T., Stanaway, Jeffrey D., Steiner, Caitlyn, Thomas, Bernadette, Vollset, Stein Emil, Whiteford, Harvey, Wolock, Timothy M., Ye, Pengpeng, Zhou, Maigeng, Ãvila, Marco A., Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Aziz, Muna I. Abdel, Abera, Semaw F., Aboyans, Victor, Abraham, Jerry P., Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M.E., Aburto, Tania C., Achoki, Tom, Ackerman, Ilana N., Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène K., Adsuar, Josef C., Arnlov, Johan, Agardh, Emilie E., Al Khabouri, Mazin J., Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I., Alegretti, Miguel A., Aleman, Alicia V., Alemu, Zewdie A., Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Francoi, Allebeck, Peter, Allen, Peter J., Almazroa, Mohammad Abdulaziz, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O., Anderson, H. Ro, Antonio, Carl Abelardo T., Anwari, Palwasha, Apfel, Henry, Arsenijevic, Valentain S. Arsic, Artaman, Al, Asghar, Rana J., Assadi, Reza, Atkins, Lydia S., Atkinson, Charle, Badawi, Alaa, Bahit, Maria C., Bakfalouni, Talal, Balakrishnan, Kalpana, Balalla, Shivanthi, Banerjee, Amitava, Barker-Collo, Suzanne L., Barquera, Simon, Barregard, Lar, Barrero, Lope H., Basu, Sanjay, Basu, Arindam, Baxter, Amanda, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L., Benjet, Corina, Bennett, Derrick A., Bensenor, Isabela M., Benzian, Habib, Bernabe, Eduardo, Beyene, Tariku J., Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar, Bienhoff, Kelly, Bikbov, Bori, Abdulhak, Aref Bin, Blore, Jed D., Blyth, Fiona M., Bohensky, Megan A., Basara, Berrak Bora, Borges, Guilherme, Bornstein, Natan M., Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R., Boyers, Lindsay N., Brainin, Michael, Brauer, Michael, Brayne, Carol E.G., Brazinova, Alexandra, Breitborde, Nicholas J.K., Brenner, Hermann, Briggs, Adam D.M., Brooks, Peter M., Brown, Jonathan, Brugha, Traolach S., Buchbinder, Rachelle, Buckle, Geoffrey C., Bukhman, Gene, Bulloch, Andrew G., Burch, Michael, Burnett, Richard, Cardenas, Rosario, Cabral, Norberto L., Campos-Nonato, Ismael R., Campuzano, Julio C., Carapetis, Jonathan R., Carpenter, David O., Caso, Valeria, Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Chadha, Vineet K., Chang, Jung-Chen, Chen, Honglei, Chen, Wanqing, Chiang, Peggy P., Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A., Chugh, Sumeet S., Cirillo, Massimo, Coggeshall, Megan, Cohen, Aaron, Colistro, Valentina, Colquhoun, Samantha M., Contreras, Alejandra G., Cooper, Leslie T., Cooper, Cyru, Cooperrider, Kimberly, Coresh, Josef, Cortinovis, Monica, Criqui, Michael H., Crump, John A., Cuevas-Nasu, Lucia, Dandona, Rakhi, Dandona, Lalit, Dansereau, Emily, Dantes, Hector G., Dargan, Paul I., Davey, Gail, Davitoiu, Dragos V., Dayama, Anand, De La Cruz-Gongora, Vanessa, De La Vega, Shelley F., De Leo, Diego, Del Pozo-Cruz, Borja, Dellavalle, Robert P., Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C., Dessalegn, Muluken, Deveber, Gabrielle A., Dharmaratne, Samath D., Diaz-Torne, Cesar, Ding, Eric L., Dokova, Klara, Dorsey, E.R., Driscoll, Tim R., Duber, Herbert, Durrani, Adnan M., Edmond, Karen M., Ellenbogen, Richard G., Endres, Matthia, Ermakov, Sergey P., Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fahimi, Saman, Farzadfar, Farshad, Fay, Derek F.J., Felson, David T., Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G., Ferri, Cluesa P., Flaxman, Abraham, Foigt, Nataliya, Foreman, Kyle J., Fowkes, F Gerry R., Franklin, Richard C., Furst, Thoma, Futran, Neal D., Gabbe, Belinda J., Gankpe, Fortune G., Garcia-Guerra, Francisco A., Geleijnse, Johanna M., Gessner, Bradford D., Gibney, Katherine B., Gillum, Richard F., Ginawi, Ibrahim A., Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goginashvili, Ketevan, Gona, Philimon, De Cosio, Teresita Gonzalez, Gosselin, Richard A., Gotay, Carolyn C., Goto, Atsushi, Gouda, Hebe N., Guerrant, Richard L., Gugnani, Harish C., Gunnell, David, Gupta, Rajeev, Gupta, Rahul, Gutierrez, Reyna A., Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara, Hamadeh, Randah R., Hamavid, Hannah, Hammami, Mouhanad, Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Haro, Josep Maria, Havmoeller, Rasmu, Hay, Roderick J., Hay, Simon, Hedayati, Mohammad T., Pi, Ileana B. Heredia, Heydarpour, Pouria, Hijar, Martha, Hoek, Hans W., Hoffman, Howard J., Hornberger, John C., Hosgood, H. Dean, Hossain, Mazeda, Hotez, Peter J., Hoy, Damian G., Hsairi, Mohamed, Hu, Howard, Hu, Guoqing, Huang, John J., Huang, Cheng, Huiart, Laetitia, Husseini, Abdullatif, Iannarone, Marissa, Iburg, Kim M., Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H., Jassal, Simerjot K., Jeemon, Panniyammakal, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B., Joseph, Jonathan, Juel, Knud, Kan, Haidong, Karch, Andre, Karimkhani, Chante, Karthikeyan, Ganesan, Katz, Ronit, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S., Kemp, Andrew H., Kengne, Andre P., Khader, Yousef S., Khalifa, Shams Eldin A.H., Khan, Ejaz A., Khan, Gulfaraz, Khang, Young-Ho, Khonelidze, Irma, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kimokoti, Ruth W., Kinfu, Yohanne, Kinge, Jonas M., Kissela, Brett M., Kivipelto, Miia, Knibbs, Luke, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Kramer, Alexander, Kravchenko, Michael, Krishnamurthi, Rita V., Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J., Kulkarni, Veena S., Kumar, Kaushalendra, Kumar, G Anil, Kwan, Gene F., Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Lansingh, Van C., Larson, Heidi, Larsson, Ander, Lawrynowicz, Alicia E.B., Leasher, Janet L., Lee, Jong-Tae, Leigh, Jame, Leung, Ricky, Levi, Miriam, Li, Bin, Li, Yichong, Li, Yongmei, Liang, Juan, Lim, Stephen, Lin, Hsien-Ho, Lind, Margaret, Lindsay, M Patrice, Lipshultz, Steven E., Liu, Shiwei, Lloyd, Belinda K., Ohno, Summer Lockett, Logroscino, Giancarlo, Looker, Katharine J., Lopez, Alan D., Lopez-Olmedo, Nancy, Lortet-Tieulent, Joannie, Lotufo, Paulo A., Low, Nicola, Lucas, Robyn M., Lunevicius, Raimunda, Lyons, Ronan A., Ma, Jixiang, Ma, Stefan, Mackay, Mark T., Majdan, Marek, Malekzadeh, Reza, Mapoma, Christopher C., Marcenes, Wagner, March, Lyn M., Margono, Chri, Marks, Guy B., Marzan, Melvin B., Masci, Joseph R., Mason-Jones, Amanda J., Matzopoulos, Richard G., Mayosi, Bongani M., Mazorodze, Tasara T., Mcgill, Neil W., Mcgrath, John J., Mckee, Martin, Mclain, Abby, Mcmahon, Brian J., Meaney, Peter A., Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Wubegzier, Melaku, Yohannes A., Meltzer, Michele, Memish, Ziad A., Mensah, George, Meretoja, Atte, Mhimbira, Francis A., Micha, Renata, Miller, Ted R., Mills, Edward J., Mitchell, Philip B., Mock, Charles N., Moffitt, Terrie E., Ibrahim, Norlinah Mohamed, Mohammad, Karzan A., Mokdad, Ali H., Mola, Glen L., Monasta, Lorenzo, Montico, Marcella, Montine, Thomas J., Moore, Ami R., Moran, Andrew E., Morawska, Lidia, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N., Moyer, Madeline, Mozaffarian, Dariush, Mueller, Ulrich O., Mukaigawara, Mitsuru, Murdoch, Michele E., Murray, Joseph, Murthy, Kinnari S., Naghavi, Paria, Nahas, Ziad, Naheed, Aliya, Naidoo, Kovin S., Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K.M. Venkat, Nash, Deni, Nejjari, Chakib, Neupane, Sudan P., Newman, Lori M., Newton, Charles R., Ng, Marie, Ngalesoni, Frida N., Nhung, Nguyen T., Nisar, Muhammad I., Nolte, Sandra, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Oh, In Hwan, Ohkubo, Takayoshi, Omer, Saad B., Opio, John Nelson, Ortiz, Alberto, Pandian, Jeyaraj D., Panelo, Carlo Irwin A., Papachristou, Christina, Park, Eun-Kee, Parry, Charles D., Caicedo, Angel J. Paternina, Patten, Scott B., Paul, Vinod K., Pavlin, Boris I., Pearce, Neil, Pedraza, Lilia S., Pellegrini, Carlos A., Pereira, David M., Perez-Ruiz, Fernando P., Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B., Petzold, Max, Phillips, Michael R., Phillips, David, Phillips, Bryan, Piel, Frederic B., Plass, Dietrich, Poenaru, Dan, Polanczyk, Guilherme V., Polinder, Suzanne, Pope, C.A., Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M., Qato, Dima, Quistberg, D.A., Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Sajjad Ur, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M., Razavi, Homie, Refaat, Amany, Rehm, Jurgen, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Riccio, Patricia M., Richardson, Lee, Richardus, Jan Hendrik, Riederer, Anne M., Robinson, Margot, Roca, Anna, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Rothenbacher, Dietrich, Roy, Nobhojit, Ruhago, George M., Sabin, Nsanzimana, Sacco, Ralph L., Ksoreide, Kjetil, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Sampson, Uchechukwu, Sanabria, Juan R., Sanchez-Riera, Lidia, Santos, Itamar S., Satpathy, Maheswar, Saunders, James E., Sawhney, Monika, Saylan, Mete I., Scarborough, Peter, Schoettker, Ben, Schneider, Ione J.C., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Serdar, Berrin, Servan-Mori, Edson E., Shackelford, Katya, Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shepard, Donald S., Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga D., Silberberg, Donald H., Simard, Edgar P., Sindi, Shireen, Singh, Jasvinder A., Singh, Lavanya, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Soshnikov, Sergey S., Speyer, Peter, Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stoeckl, Heidi, Stathopoulou, Vasiliki Kalliopi, Steckling, Nadine, Stein, Murray B., Stein, Dan J., Steiner, Timothy J., Stewart, Andrea, Stork, Eden, Stovner, Lars J., Stroumpoulis, Konstantino, Sturua, Lela, Sunguya, Bruno F., Swaroop, Mamta, Sykes, Bryan L., Tabb, Karen M., Takahashi, Ken, Tan, Feng, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R., Te Ao, Braden J., Temesgen, Awoke Misganaw, Have, Margreet Ten, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Theadom, Alice M., Thomas, Elissa, Thorne-Lyman, Andrew L., Thrift, Amanda G., Tleyjeh, Imad M., Tonelli, Marcello, Topouzis, Foti, Towbin, Jeffrey A., Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X., Trasande, Leonardo, Trillini, Matia, Truelsen, Thoma, Trujillo, Ulise, Tsilimbaris, Miltiadi, Tuzcu, Emin M., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen B., Van Brakel, Wim H., Van De Vijver, Steven, Dingenen, Rita Van, Van Gool, Coen H., Varakin, Yuri Y., Vasankari, Tommi J., Vavilala, Monica S., Veerman, Lennert J., Velasquez-Melendez, Gustavo, Venketasubramanian, Narayanaswamy, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S., Vlassov, Vasiliy V., Waller, Stephen, Wallin, Mitchell T., Wan, Xia, Wang, Linhong, Wang, Jianli, Wang, Yanping, Warouw, Tati S., Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Wessells, K. Ryan, Westerman, Ronny, Wilkinson, James D., Williams, Hywel C., Williams, Thomas N., Woldeyohannes, Solomon M., Wolfe, Charles D.A., Wong, John Q., Wong, Haidong, Woolf, Anthony D., Wright, Jonathan L., Wurtz, Brittany, Xu, Gelin, Yang, Gonghuan, Yano, Yuichiro, Yenesew, Muluken A., Yentur, Gokalp K., Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa, Yu, Chuanhua, Kim, Kim Yun, Zaki, Maysaa El Sayed, Zhang, Yong, Zhao, Zheng, Zhao, Yong, Zhu, Jun, Zonies, David, Zunt, Joseph R., Salomon, Joshua A., Murray, Christopher J.L., Cell biology, Gastroenterology & Hepatology, Epidemiology, Health Technology Assessment (HTA), and Public Health

Subjects
Male, Gerontology, Nutrition and Disease, Epidemiology, years lived with disability, Global burden of disease, acute and chronic diseases, countries, Prevalence, Disease, Global Health, Medical and Health Sciences, Conduct disorder, Otitis-media, Cost of Illness, Residence Characteristics, Voeding en Ziekte, 80 and over, Global health, 2.2 Factors relating to the physical environment, 2.1 Biological and endogenous factors, countries, Aetiology, Child, Aged, 80 and over, Medicine(all), education.field_of_study, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, Incidence, Mortality rate, Incidence (epidemiology), Pain Research, Neglected Diseases, Alcohol dependence, General Medicine, Middle Aged, Global burden of disease, Global Burden of Disease Study 2013 Collaborators, Mental Health, Infectious Diseases, Attention deficit/Hyperactivity disorder, Burden of Illness, Child, Preschool, Acute Disease, Female, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Adolescent, GBD 2013, Population, acute and chronic diseases, Young Adult, Mental-disorders, Age Distribution, Medicine, General & Internal, Weights, General & Internal Medicine, medicine, Humans, Life Science, Disabled Persons, Sex Distribution, Preschool, education, Developing Countries, VLAG, Aged, Science & Technology, business.industry, Developed Countries, Cutaneous Leishmaniasis, Infant, Newborn, Infant, Health outcomes, Newborn, medicine.disease, Comorbidity, Brain Disorders, years lived with disability, Good Health and Well Being, Disease, injury, incidence, prevalence, YLDs, GBD 2010, Chronic Disease, Wounds and Injuries, business, 2.4 Surveillance and distribution, Iron-deficiency, Demography
Abstract

Summary Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. Funding Bill & Melinda Gates Foundation. Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. Funding Bill & Melinda Gates Foundation.

Published
2015

32. Daily steps and all-cause mortality: An umbrella review and meta-analysis.

Author

Rodríguez-Gutiérrez E, Torres-Costoso A, Del Pozo Cruz B, de Arenas-Arroyo SN, Pascual-Morena C, Bizzozero-Peroni B, and Martínez-Vizcaíno V

Subjects
Humans, Walking, Cause of Death, Systematic Reviews as Topic, Mortality trends, Exercise
Abstract

Objective: This study aimed to describe the variability in estimates of the association of daily steps and all-cause mortality in systematic reviews with meta-analyses, to identify the factors potentially responsible for it, and to provide an updated estimate., Methods: Five databases were systematically searched up to May 2024 to identify systematic reviews with meta-analyses and prospective cohort studies. A qualitative synthesis of previous reviews and an updated meta-analysis of cohort studies were performed. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using a random-effects model., Results: Eleven systematic reviews with meta-analyses and 14 cohort studies were included, revealing considerable variability in result presentation. Our updated meta-analysis showed a nonlinear association, indicating a lower risk of all-cause mortality with increased daily steps, with a protective threshold at 3143 steps/day, and a pooled HR of 0.91 (95% CI: 0.87, 0.95) per 1000 steps/day increment. Physical activity categories consistently indicated progressively reduced mortality risk, with the highly active category (>12,500 steps/day) exhibiting the lowest risk (0.35 (95% CI: 0.29, 0.42))., Conclusion: Systematic reviews and meta-analyses showed considerable variability in effect estimates due to different methods of quantifying exposure. Despite it, our study underscores the importance of increased daily steps in reducing all-cause mortality, with a minimum protective dose of 3000 steps/day, although the optimal dose differed according to age and sex. It is recommended that future studies categorise daily steps by physical activity category, perform dose-response analyses, and use increments of 1000 steps/day., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2024
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33. Device-measured sedentary time and intensity-specific physical activity in relation to all-cause and cardiovascular disease mortality: the UK Biobank cohort study.

Author

Rezende LFM, Ahmadi M, Ferrari G, Del Pozo Cruz B, Lee IM, Ekelund U, and Stamatakis E

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Cohort Studies, Prospective Studies, Risk Factors, UK Biobank, United Kingdom, Accelerometry, Cardiovascular Diseases mortality, Exercise, Sedentary Behavior
Abstract

Background and Aims: Understanding the amounts of intensity-specific movement needed to attenuate the association between sedentary time and mortality may help to inform personalized prescription and behavioral counselling. Herein, we examined the joint associations of sedentary time and intensity-specific physical activity with all-cause and cardiovascular disease (CVD) mortality., Methods: Prospective cohort study including 73,729 adults from the UK Biobank who wore an Axivity AX3 accelerometer on their dominant wrist for at least 3 days, being one a weekend day, between June 2013 and December 2015. We considered the median tertile values of sedentary time and physical activity in each intensity band to determine the amount of physical activity needed to attenuate the association between sedentary time and mortality., Results: During a median of 6.9 years of follow-up (628,807 person-years), we documented 1521 deaths, including 388 from CVD. Physical activity of any intensity attenuated the detrimental association of sedentary time with mortality. Overall, at least a median of 6 min/day of vigorous physical activity, 30 min/day of MVPA, 64 min/day of moderate physical activity, or 163 min/day of light physical activity (mutually-adjusted for other intensities) attenuated the association between sedentary time and mortality. High sedentary time was associated with higher risk of CVD mortality only among participants with low MVPA (HR 1.96; 95% CI 1.23 to 3.14)., Conclusions: Different amounts of each physical activity intensity may attenuate the association between high sedentary time and mortality., (© 2024. The Author(s).)

Published
2024
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34. Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies.

Author

Sánchez-Sánchez JL, Lu WH, Gallardo-Gómez D, Del Pozo Cruz B, de Souto Barreto P, Lucia A, and Valenzuela PL

Subjects
Humans, Aged, Longitudinal Studies, Geriatric Assessment methods, Aged, 80 and over, Female, Male, Activities of Daily Living psychology, Mortality trends
Abstract

Background: Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults., Methods: In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I 2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482., Findings: We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I 2 =18·4%), though within-study (I 2 =63·2%) heterogeneity was substantial., Interpretation: Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations., Funding: None., Translations: For the Spanish and French translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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35. Dose-response associations of the American Heart Association's new "Life's essential 8" metrics with all-cause and cardiovascular mortality in a nationally representative sample from the United States.

Author

López-Bueno R, Calatayud J, Del Pozo Cruz J, Yang L, and Del Pozo Cruz B

Subjects
Humans, Female, Male, United States epidemiology, Adult, Middle Aged, Risk Assessment, Time Factors, Prognosis, Heart Disease Risk Factors, Prospective Studies, Protective Factors, Health Status, Aged, Young Adult, Risk Reduction Behavior, Healthy Lifestyle, Risk Factors, Cardiovascular Diseases mortality, Nutrition Surveys, Cause of Death, American Heart Association
Abstract

Background: Our aim was to examine the prospective dose-response associations of American Heart Association's (AHA) LIFE's Essential 8 (LE8) score and number of cardiovascular health (CVH) factors with high score with all-cause and cardiovascular disease (CVD) related mortality., Methods: We pooled 6 consecutive waves of the National Health and Nutrition Examination Survey (NHANES) comprising rounds between 2007 and 2008 and 2017-2018. We calculated hazard ratios (HRs) and conducted restricted cubic splines models to assess the dose-response association of LE8 score and CVH factors with all-cause and CVD mortality., Results: Analyses included 23,531 adults aged 18 years and over (mean [SD] age, 43.6 [16.7] years; 11,979 [51%] female; 8960 [38.1%] non-Hispanic white individuals) with a median follow-up of 7.3 years (IQR 4.3-10.1), corresponding to 168,033 person-years. The dose-response analyses showed a significant inverse curvilinear trend for the association between LE8 score with all-cause and CVD mortality. The optimal risk reduction for all-cause mortality was found at 100 points of the LE8 Score (HR, 0.50; 95% CI, 0.27-0.93) compared to the reference (median LE8 score [62.5 points]). Moreover, the dose-response association between LE8 and CVD mortality also exhibited a significant inverse curvilinear association up to 90 points (HR, 0.41; 95% CI, 0.17-0.99). Optimal levels of LE8 score may be able to avert around 40% of the annual all-cause and CVD deaths among the US adult population., Conclusions: Best-case scenario of CVH may reduce around 40% of the all-cause and CVD annual mortality among adults in the United States., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)

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2024
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36. Relationship of device measured physical activity type and posture with cardiometabolic health markers: pooled dose-response associations from the Prospective Physical Activity, Sitting and Sleep Consortium.

Author

Ahmadi MN, Blodgett JM, Atkin AJ, Chan HW, Del Pozo Cruz B, Suorsa K, Bakker EA, Pulsford RM, Mielke GI, Johansson PJ, Hettiarachchi P, Thijssen DHJ, Stenholm S, Mishra GD, Teixeira-Pinot A, Rangul V, Sherar LB, Ekelund U, Hughes AD, Lee IM, Holtermann A, Koster A, Hamer M, and Stamatakis E

Subjects
Humans, Female, Middle Aged, Male, Sleep physiology, Prospective Studies, Accelerometry, Adult, Biomarkers blood, Aged, Waist Circumference physiology, Standing Position, Cholesterol, HDL blood, Cross-Sectional Studies, Triglycerides blood, Body Mass Index, Cardiovascular Diseases prevention & control, Cardiovascular Diseases epidemiology, Sedentary Behavior, Stair Climbing physiology, Exercise physiology, Walking physiology, Sitting Position, Posture physiology
Abstract

Aims/hypothesis: The aim of this study was to examine the dose-response associations of device-measured physical activity types and postures (sitting and standing time) with cardiometabolic health., Methods: We conducted an individual participant harmonised meta-analysis of 12,095 adults (mean ± SD age 54.5±9.6 years; female participants 54.8%) from six cohorts with thigh-worn accelerometry data from the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. Associations of daily walking, stair climbing, running, standing and sitting time with a composite cardiometabolic health score (based on standardised z scores) and individual cardiometabolic markers (BMI, waist circumference, triglycerides, HDL-cholesterol, HbA 1c and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines., Results: We observed more favourable composite cardiometabolic health (i.e. z score <0) with approximately 64 min/day walking (z score [95% CI] -0.14 [-0.25, -0.02]) and 5 min/day stair climbing (-0.14 [-0.24, -0.03]). We observed an equivalent magnitude of association at 2.6 h/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose-response associations for any activity type or standing. There was an inverse dose-response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 h/day. Associations for sitting time were no longer significant after excluding participants with prevalent CVD or medication use. The dose-response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers., Conclusions/interpretation: In this first activity type-specific analysis of device-based physical activity, ~64 min/day of walking and ~5.0 min/day of stair climbing were associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent CVD and medication use. Our findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification., (© 2024. The Author(s).)

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2024
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37. Feasibility and acceptability of a cohort study baseline data collection of device-measured physical behaviors and cardiometabolic health in Saudi Arabia: expanding the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) in the Middle East.

Author

Alaqil AI, Del Pozo Cruz B, Alothman SA, Ahmadi MN, Caserotti P, Al-Hazzaa HM, Holtermann A, Stamatakis E, and Gupta N

Subjects
Humans, Saudi Arabia, Male, Female, Adult, Middle Aged, Prospective Studies, Sedentary Behavior, Cohort Studies, Surveys and Questionnaires, Exercise, Feasibility Studies, Sleep physiology, Sitting Position
Abstract

Background: Physical behaviors such physical activity, sedentary behavior, and sleep are associated with mortality, but there is a lack of epidemiological data and knowledge using device-measured physical behaviors., Purpose: To assess the feasibility of baseline data collection using the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS) protocols in the specific context of Saudi Arabia. ProPASS is a recently developed global platform for collaborative research that aims to harmonize retrospective and prospective data on device-measured behaviors and health. Using ProPASS methods for collecting data to perform such studies in Saudi Arabia will provide standardized data from underrepresented countries., Method: This study explored the feasibility of baseline data collection in Saudi Arabia between November and December 2022 with a target recruitment of 50 participants aged ≥ 30 years. Established ProPASS methods were used to measure anthropometrics, measure blood pressure, collect blood samples, carry out physical function test, and measure health status and context of physical behaviors using questionnaires. The ActivPal™ device was used to assess physical behaviors and the participants were asked to attend two sessions at (LHRC). The feasibility of the current study was assessed by evaluating recruitment capability, acceptability, suitability of study procedures, and resources and abilities to manage and implement the study. Exit interviews were conducted with all participants., Result: A total of 75 participants expressed an interest in the study, out of whom 54 initially agreed to participate. Ultimately, 48 participants were recruited in the study (recruitment rate: 64%). The study completion rate was 87.5% of the recruited participants; 95% participants were satisfied with their participation in the study and 90% reported no negative feelings related to participating in the study. One participant reported experiencing moderate skin irritation related to placement of the accelerometer. Additionally, 96% of participants expressed their willingness to participate in the study again., Conclusion: Based on successful methodology, data collection results, and participants' acceptability, the ProPASS protocols are feasible to administer in Saudi Arabia. These findings are promising for establishing a prospective cohort in Saudi Arabia., (© 2024. The Author(s).)

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2024
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38. Do the associations of daily steps with mortality and incident cardiovascular disease differ by sedentary time levels? A device-based cohort study.

Author

Ahmadi MN, Rezende LFM, Ferrari G, Del Pozo Cruz B, Lee IM, and Stamatakis E

Subjects
Humans, Middle Aged, Aged, Cohort Studies, Prospective Studies, Sedentary Behavior, Risk, Cardiovascular Diseases
Abstract

Objectives: This study aims to examine the associations of daily step count with all-cause mortality and incident cardiovascular disease (CVD) by sedentary time levels and to determine if the minimal and optimal number of daily steps is modified by high sedentary time., Methods: Using data from the UK Biobank, this was a prospective dose-response analysis of total daily steps across low (<10.5 hours/day) and high (≥10.5 hours/day) sedentary time (as defined by the inflection point of the adjusted absolute risk of sedentary time with the two outcomes). Mortality and incident CVD was ascertained through 31 October 2021., Results: Among 72 174 participants (age=61.1±7.8 years), 1633 deaths and 6190 CVD events occurred over 6.9 (±0.8) years of follow-up. Compared with the referent 2200 steps/day (5th percentile), the optimal dose (nadir of the curve) for all-cause mortality ranged between 9000 and 10 500 steps/day for high (HR (95% CI)=0.61 (0.51 to 0.73)) and low (0.69 (0.52 to 0.92)) sedentary time. For incident CVD, there was a subtle gradient of association by sedentary time level with the lowest risk observed at approximately 9700 steps/day for high (0.79 (0.72 to 0.86)) and low (0.71 (0.61 to 0.83)) sedentary time. The minimal dose (steps/day associated with 50% of the optimal dose) of daily steps was between 4000 and 4500 steps/day across sedentary time groups for all-cause mortality and incident CVD., Conclusions: Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing 9000-10 500 steps/day was associated with the lowest mortality risk independent of sedentary time. For a roughly equivalent number of steps/day, the risk of incident CVD was lower for low sedentary time compared with high sedentary time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

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2024
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39. Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis.

Author

López-Bueno R, Núñez-Cortés R, Calatayud J, Salazar-Méndez J, Petermann-Rocha F, López-Gil JF, and Del Pozo Cruz B

Subjects
Humans, Prevalence, Risk Assessment, Female, Male, Middle Aged, Adult, Aged, Systematic Reviews as Topic, Young Adult, Adolescent, Risk Reduction Behavior, Aged, 80 and over, Prognosis, Risk Factors, Health Status, Cardiovascular Diseases epidemiology, Cardiovascular Diseases diagnosis, Cardiovascular Diseases prevention & control, Heart Disease Risk Factors, Global Health
Abstract

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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2024
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40. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

Author

Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, Del Pozo Cruz B, van den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, Pagano R, Pagano L, Vasconcellos R, Arnott H, Varley B, Parker P, Biddle S, and Lonsdale C

Subjects
Humans, Antidepressive Agents therapeutic use, Yoga, Exercise psychology, Psychotherapy methods, Treatment Outcome, Randomized Controlled Trials as Topic, Depressive Disorder, Major therapy, Exercise Therapy methods, Network Meta-Analysis
Abstract

Objective: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions., Design: Systematic review and network meta-analysis., Methods: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool., Data Sources: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases., Eligibility Criteria for Selecting Studies: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression., Results: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments., Conclusions: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression., Systematic Review Registration: PROSPERO CRD42018118040., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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2024
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41. Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study.

Author

Sanchez-Lastra MA, Ding D, Del Pozo Cruz B, Dalene KE, Ayán C, Ekelund U, and Tarp J

Subjects
Humans, Female, Male, Obesity, Abdominal complications, Obesity, Abdominal epidemiology, Prospective Studies, Obesity complications, Exercise, Risk Factors, Cardiovascular Diseases epidemiology
Abstract

Objective: To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events., Methods: We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment., Results: After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30-35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event., Conclusion: Physical activity equivalent to approximately 30-35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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2024
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42. Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis.

Author

Gallardo-Gómez D, Salazar-Martínez E, Alfonso-Rosa RM, Ramos-Munell J, Del Pozo-Cruz J, Del Pozo Cruz B, and Álvarez-Barbosa F

Subjects
Humans, Glycated Hemoglobin, Glycemic Control, Bayes Theorem, Exercise, Diabetes Mellitus, Type 2
Abstract

Background: The optimal dose or type of physical activity to control glycosylated hemoglobin (HbA1c) in people with diabetes remains unknown. Current guidelines do not include consideration of baseline HbA1c for activity prescription., Purpose: To examine the dose-response relationship between physical activity and HbA1c (%) in individuals with type 2 diabetes., Data Sources: A systematic search was performed in Embase, MEDLINE, Scopus, CINAHL, SPORTDiscus, and Web of Science., Study Selection: We included trials that involved participants diagnosed with type 2 diabetes that included any type of physical activity as intervention., Data Extraction: Pre- and postintervention HbA1c data, population and interventions characteristics, and descriptive statistics were collected to calculate change scores for each study arm., Data Synthesis: We used Bayesian random-effects meta-analyses to summarize high-quality evidence from 126 studies (6,718 participants). The optimal physical activity dose was 1,100 MET min/week, resulting in HbA1c reductions, ranging from -1.02% to -0.66% in severe uncontrolled diabetes, from -0.64% to -0.49% in uncontrolled diabetes, from -0.47% to -0.40% in controlled diabetes, and from -0.38% to -0.24% in prediabetes., Limitations: The time required to achieve these HbA1c reductions could not be estimated due to the heterogeneity between interventions' duration and protocols and the interpersonal variability of this outcome., Conclusions: The result of this meta-analysis provide key information about the optimal weekly dose of physical activity for people with diabetes with consideration of baseline HbA1c level, and the effectiveness of different types of active interventions. These results enable clinicians to prescribe tailored physical activity programs for this population., (© 2024 by the American Diabetes Association.)

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2024
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43. Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies.

Author

Sánchez-Sánchez JL, He L, Morales JS, de Souto Barreto P, Jiménez-Pavón D, Carbonell-Baeza A, Casas-Herrero Á, Gallardo-Gómez D, Lucia A, Del Pozo Cruz B, and Valenzuela PL

Subjects
Male, Humans, Female, Aged, Cross-Sectional Studies, Bayes Theorem, Muscle Strength physiology, Sarcopenia epidemiology
Abstract

Background: Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults., Methods: We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865., Findings: We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37-0·62) and longitudinally (four studies, n=7545; 0·51, 0·27-0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71-0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour)., Interpretation: Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia., Funding: None., Translation: For the Spanish translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

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2024
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44. The Equality Paradox: Gender Equality Intensifies Male Advantages in Adolescent Subjective Well-Being.

Author

Guo J, Basarkod G, Perales F, Parker PD, Marsh HW, Donald J, Dicke T, Sahdra BK, Ciarrochi J, Hu X, Lonsdale C, Sanders T, and Del Pozo Cruz B

Subjects
Humans, Male, Adolescent, Female, Gender Equity, Students
Abstract

Individuals' subjective well-being (SWB) is an important marker of development and social progress. As psychological health issues often begin during adolescence, understanding the factors that enhance SWB among adolescents is critical to devising preventive interventions. However, little is known about how institutional contexts contribute to adolescent SWB. Using Programme for International Student Assessment (PISA) 2015 and 2018 data from 78 countries ( N = 941,475), we find that gender gaps in adolescents' SWB (life satisfaction, positive and negative affect) are larger in more gender-equal countries. Results paradoxically indicated that gender equality enhances boys' but not girls' SWB, suggesting that greater gender equality may facilitate social comparisons across genders. This may lead to an increased awareness of discrimination against females and consequently lower girls' SWB, diluting the overall benefits of gender equality. These findings underscore the need for researchers and policy-makers to better understand macro-level factors, beyond objective gender equality, that support girls' SWB., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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45. An umbrella review of the benefits and risks associated with youths' interactions with electronic screens.

Author

Sanders T, Noetel M, Parker P, Del Pozo Cruz B, Biddle S, Ronto R, Hulteen R, Parker R, Thomas G, De Cocker K, Salmon J, Hesketh K, Weeks N, Arnott H, Devine E, Vasconcellos R, Pagano R, Sherson J, Conigrave J, and Lonsdale C

Subjects
Child, Humans, Adolescent, Bias, Risk Assessment, Parents
Abstract

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I 2  > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

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2024
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46. Dose-response association between cardiovascular health and mortality in cancer survivors.

Author

López-Bueno R, Yang L, Calatayud J, Andersen LL, and Del Pozo Cruz B

Subjects
United States epidemiology, Adult, Humans, Nutrition Surveys, Public Health, Risk Factors, Cancer Survivors, Neoplasms, Cardiovascular Diseases
Abstract

Background: There is little knowledge on the dose-response association between cardiovascular health (CVH) and risk of all-cause, cardiovascular disease (CVD) and cancer deaths among cancer survivors., Aims: We aimed to examine the dose-response association of CVH with all-cause, CVD, and cancer mortality., Methods: A total of 1701 US adult cancer survivors were followed-up during a median of 7.3 (IQR 4.0-10.2) years from 2007 to 2018 through the National Health and Nutrition Examination Survey (NHANES). We used the American Heart Association´s (AHA) Life´s Essential 8 (LE8) as a proxy for CVH., Results: Restricted cubic spline models indicated a close to inverse linear shape for the dose-response association between LE8 score and all-cause mortality with significant risk reductions within the range between 61.25 (Hazard ratio [HR]: 0.76, 95% CI, 0.59-0.98) and 100 points (HR: 0.28, 95%CI, 0.12-0.62), and a curvilinear shape for the dose-response association between LE8 score and CVD deaths with significant risk reductions within the range between 50.25 (HR: 0.72, 95% CI, 0.52-0.99) and 90.25 points (HR: 0.15, 95%CI, 0.02-0.98). No significant dose-response association was observed between LE8 and cancer deaths., Conclusions: Our study showed a close to inverse relationship between higher LE8 and risk of death from all cause, an inverse curvilinear relationship between higher LE8 and the risk for CVD death, and a non-significant association between higher LE8 and the risk of cancer death among US adult cancer survivors, which may translate to a substantial number of annual averted deaths and thus important public health implications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2024
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47. Moderate and vigorous leisure time physical activity in older adults and Alzheimer's disease-related mortality in the USA: a dose-response, population-based study.

Author

López-Bueno R, Yang L, Stamatakis E, and Del Pozo Cruz B

Subjects
Humans, Female, United States epidemiology, Aged, Male, Motor Activity, Exercise physiology, Surveys and Questionnaires, Leisure Activities, Alzheimer Disease
Abstract

Background: Data for the dose-response associations of moderate physical activity (MPA) and vigorous physical activity (VPA) with Alzheimer's disease-related mortality are scarce. We aimed to examine the prospective associations of such activity with Alzheimer's disease-related mortality., Methods: In this dose-response, population-based study, we pooled data from 22 consecutive waves of the US National Health Interview Survey (from 1997 to 2018). Participants aged 68 years or older were included in the study if they had full data for physical or muscle-strengthening activity, chronic conditions, functional limitations, marital status, education level, alcohol consumption, smoking status, and BMI, and follow-up time after study entry. Participants were linked to the National Death Index until Dec 31, 2019. We defined Alzheimer's disease-related mortality as a leading cause by using the G-30 code of the International Statistical Classification of Diseases and Related Health Problems tenth revision. Information on MPA and VPA was self-reported, with participants asked to answer four questions on the frequency and duration of both types of physical activity. We calculated hazard ratios (HRs) and used restricted cubic splines models to assess dose-response associations, and we estimated the annual number of Alzheimer's disease-related deaths that could be prevented through physical activity using adjusted population attributable fractions., Findings: After excluding 21 377 participants, 91 298 adults were included in the analysis. The weighted mean participant age was 75·8 years (SE 0·0); 55 658 (56·7%) were female and 76 796 (87·6%) were White (weighted percentages). The median follow-up was 6·5 years (IQR 3·6-10·7), corresponding to 703 393 person-years. 2176 (2·4%) participants died due to Alzheimer's disease as the leading cause. For MPA, we did not find a significant dose-response association with Alzheimer's disease-related mortality, whereas for VPA, we observed a significant L-shaped association between 20 weekly min and 190 weekly min. For VPA, we identified a minimal amount (ie, 50% of the optimal amount) at 40 min/week (HR 0·91, 95% CI 0·84-0·95) and an optimal amount (ie, the nadir of the curve) at 140 min/week (0·79, 0·66-0·95) for reducing Alzheimer's disease-related mortality. For the USA, we estimated that 40 weekly min of VPA would prevent 12 238 deaths per year (95% CI 89-23 172) and 140 weekly min of VPA would prevent 37 710 deaths per year (311-63 567), compared with a scenario in which US adults did not do any VPA., Interpretation: These findings might inform future guidelines for preventing Alzheimer's disease-related mortality by emphasising the importance of VPA over MPA and providing specific VPA targets., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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49. Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials.

Author

Gallardo-Gómez D, Del Pozo-Cruz J, Pedder H, Alfonso-Rosa RM, Álvarez-Barbosa F, Noetel M, Jasper U, Chastin S, Ramos-Munell J, and Del Pozo Cruz B

Abstract

Objective: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults., Design: Systematic review and Bayesian model-based network meta-analysis., Data Sources: Four databases were searched from inception to 20 June 2022., Eligibility Criteria for Selecting Studies: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models., Results: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days)., Conclusions: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population., Trial Registration Number: PROSPERO CRD42021271999., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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50. Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study.

Author

Luo M, Yu C, Del Pozo Cruz B, Chen L, and Ding D

Subjects
Humans, Middle Aged, Prospective Studies, Exercise, Risk Factors, Accelerometry, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 genetics, Diabetes Mellitus, Type 2 prevention & control
Abstract

Objective: Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk., Methods: This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013-2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models., Results: During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3-25.9 min/day, 0.41 (0.34 to 0.51) for 26.0-68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk., Conclusion: Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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