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1. Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17

Author: Aniruddha Deshpande, Molly K Miller-Petrie, Paulina A Lindstedt, Mathew M Baumann, Kimberly B Johnson, Brigette F Blacker, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Ayenew Negesse Abejie, Lucas Guimarães Abreu, Michael R.M. Abrigo, Ahmed Abualhasan, Manfred Mario Kokou Accrombessi, Abdu A Adamu, Oladimeji M Adebayo, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O Adetokunboh, Tara Ballav Adhikari, Mohsen Afarideh, Marcela Agudelo-Botero, Mehdi Ahmadi, Keivan Ahmadi, Muktar Beshir Ahmed, Anwar E Ahmed, Temesgen Yihunie Akalu, Ali S Akanda, Fares Alahdab, Ziyad Al-Aly, Samiah Alam, Noore Alam, Genet Melak Alamene, Turki M Alanzi, James Albright, Ammar Albujeer, Jacqueline Elizabeth Alcalde-Rabanal, Animut Alebel, Zewdie Aderaw Alemu, Muhammad Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J. Alvis-Zakzuk, Saeed Amini, Arianna Maever L. Amit, Gianna Gayle Herrera Amul, Catalina Liliana Andrei, Mina Anjomshoa, Ansariadi Ansariadi, Carl Abelardo T. Antonio, Benny Antony, Ernoiz Antriyandarti, Jalal Arabloo, Hany Mohamed Amin Aref, Olatunde Aremu, Bahram Armoon, Amit Arora, Krishna K Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Daniel Asmelash, Hagos Tasew Atalay, Seyyede Masoume Athari, Seyyed Shamsadin Athari, Sachin R Atre, Marcel Ausloos, Shally Awasthi, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Andrew S Azman, Ebrahim Babaee, Alaa Badawi, Mojtaba Bagherzadeh, Shankar M Bakkannavar, Senthilkumar Balakrishnan, Maciej Banach, Joseph Adel Mattar Banoub, Aleksandra Barac, Miguel A Barboza, Till Winfried Bärnighausen, Sanjay Basu, Vo Dinh Bay, Mohsen Bayati, Neeraj Bedi, Mahya Beheshti, Meysam Behzadifar, Masoud Behzadifar, Diana Fernanda Bejarano Ramirez, Michelle L Bell, Derrick A. Bennett, Habib Benzian, Dessalegn Ajema Berbada, Robert S Bernstein, Anusha Ganapati Bhat, Krittika Bhattacharyya, Soumyadeep Bhaumik, Zulfiqar A Bhutta, Ali Bijani, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Raaj Kishore Biswas, Somayeh Bohlouli, Soufiane Boufous, Oliver J Brady, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Gabrielle B Britton, Alexandria Brown, Sharath Burugina Nagaraja, Zahid A Butt, Luis Alberto Cámera, Ismael R Campos-Nonato, Julio Cesar Campuzano Rincon, Jorge Cano, Josip Car, Rosario Cárdenas, Felix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Ester Cerin, Binaya Chalise, Vijay Kumar Chattu, Ken Lee Chin, Devasahayam J Christopher, Dinh-Toi Chu, Natalie Maria Cormier, Vera Marisa Costa, Elizabeth A Cromwell, Abel Fekadu Fekadu Dadi, Tukur Dahiru, Saad M A Dahlawi, Rakhi Dandona, Lalit Dandona, Anh Kim Dang, Farah Daoud, Aso Mohammad Darwesh, Amira Hamed Darwish, Ahmad Daryani, Jai K Das, Rajat Das Gupta, Aditya Prasad Dash, Claudio Alberto Dávila-Cervantes, Nicole Davis Weaver, Fernando Pio De la Hoz, Jan-Walter De Neve, Dereje Bayissa Demissie, Gebre Teklemariam Demoz, Edgar Denova-Gutiérrez, Kebede Deribe, Assefa Desalew, Samath Dhamminda Dharmaratne, Preeti Dhillon, Meghnath Dhimal, Govinda Prasad Dhungana, Daniel Diaz, Isaac Oluwafemi Dipeolu, Hoa Thi Do, Christiane Dolecek, Kerrie E Doyle, Eleonora Dubljanin, Andre Rodrigues Duraes, Hisham Atan Edinur, Andem Effiong, Aziz Eftekhari, Nevine El Nahas, Maysaa El Sayed Zaki, Maha El Tantawi, Hala Rashad Elhabashy, Shaimaa I. El-Jaafary, Ziad El-Khatib, Hajer Elkout, Aisha Elsharkawy, Shymaa Enany, Daniel Adane Endalew, Babak Eshrati, Sharareh Eskandarieh, Arash Etemadi, Oluchi Ezekannagha, Emerito Jose A. Faraon, Mohammad Fareed, Andre Faro, Farshad Farzadfar, Alebachew Fasil Fasil, Mehdi Fazlzadeh, Valery L. Feigin, Wubalem Fekadu, Netsanet Fentahun, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Irina Filip, Florian Fischer, Carsten Flohr, Nataliya A. Foigt, Morenike Oluwatoyin Folayan, Masoud Foroutan, Richard Charles Franklin, Joseph Jon Frostad, Takeshi Fukumoto, Mohamed M Gad, Gregory M Garcia, Augustine Mwangi Gatotoh, Reta Tsegaye Gayesa, Ketema Bizuwork Gebremedhin, Yilma Chisha Dea Geramo, Hailay Abrha Gesesew, Kebede Embaye Gezae, Ahmad Ghashghaee, Farzaneh Ghazi Sherbaf, Tiffany K Gill, Paramjit Singh Gill, Themba G Ginindza, Alem Girmay, Zemichael Gizaw, Amador Goodridge, Sameer Vali Gopalani, Bárbara Niegia Garcia Goulart, Alessandra C Goulart, Ayman Grada, Manfred S Green, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Davide Guido, Rafael Alves Guimarães, Yuming Guo, Rajeev Gupta, Rahul Gupta, Giang Hai Ha, Juanita A. Haagsma, Nima Hafezi-Nejad, Dessalegn H Haile, Michael Tamene Haile, Brian J. Hall, Samer Hamidi, Demelash Woldeyohannes Handiso, Hamidreza Haririan, Ninuk Hariyani, Ahmed I. Hasaballah, Md. Mehedi Hasan, Amir Hasanzadeh, Hamid Yimam Hassen, Desta Haftu Hayelom, Mohamed I Hegazy, Behzad Heibati, Behnam Heidari, Delia Hendrie, Andualem Henok, Claudiu Herteliu, Fatemeh Heydarpour, Hagos Degefa de Hidru, Thomas R Hird, Chi Linh Hoang, Gillian I Hollerich, Praveen Hoogar, Naznin Hossain, Mehdi Hosseinzadeh, Mowafa Househ, Guoqing Hu, Ayesha Humayun, Syed Ather Hussain, Mamusha Aman A Hussen, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Milena D. Ilic, Mohammad Hasan Imani-Nasab, Usman Iqbal, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Rebecca Q Ivers, Chinwe Juliana Iwu, Nader Jahanmehr, Mihajlo Jakovljevic, Amir Jalali, Achala Upendra Jayatilleke, Ensiyeh Jenabi, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Jost B. Jonas, Jacek Jerzy Jozwiak, Ali Kabir, Zubair Kabir, Tanuj Kanchan, André Karch, Surendra Karki, Amir Kasaeian, Gebremicheal Gebreslassie Kasahun, Habtamu Kebebe Kasaye, Gebrehiwot G Kassa, Getachew Mullu Kassa, Gbenga A. Kayode, Mihiretu M Kebede, Peter Njenga Keiyoro, Daniel Bekele Ketema, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Nauman Khalid, Rovshan Khalilov, Ejaz Ahmad Khan, Junaid Khan, Md Nuruzzaman Khan, Khaled Khatab, Mona M Khater, Amir M Khater, Maryam Khayamzadeh, Mohammad Khazaei, Mohammad Hossein Khosravi, Jagdish Khubchandani, Ali Kiadaliri, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Sonali Kochhar, Tufa Kolola, Hamidreza Komaki, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Nuworza Kugbey, Pushpendra Kumar, G Anil Kumar, Manasi Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Aparna Lal, Dharmesh Kumar Lal, Hilton Lam, Faris Hasan Lami, Van Charles Lansingh, Savita Lasrado, Georgy Lebedev, Paul H Lee, Kate E LeGrand, Mostafa Leili, Tsegaye Lolaso Lenjebo, Cheru Tesema Leshargie, Aubrey J Levine, Sonia Lewycka, Shanshan Li, Shai Linn, Shiwei Liu, Jaifred Christian F Lopez, Platon D Lopukhov, Muhammed Magdy Abd El Razek, D.R. Mahadeshwara Prasad, Phetole Walter Mahasha, Narayan B. Mahotra, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Abdullah A Mamun, Navid Manafi, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Gabriel Martinez, Santi Martini, Francisco Rogerlândio Martins-Melo, Manu Raj Mathur, Benjamin K Mayala, Mohsen Mazidi, Colm McAlinden, Birhanu Geta Meharie, Man Mohan Mehndiratta, Entezar Mehrabi Nasab, Kala M Mehta, Teferi Mekonnen, Tefera Chane Mekonnen, Gebrekiros Gebremichael Meles, Hagazi Gebre Meles, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Ritesh G Menezes, Seid Tiku Mereta, Tuomo J Meretoja, Tomislav Mestrovic, Workua Mekonnen Metekiya, Bartosz Miazgowski, Ted R Miller, GK Mini, Erkin M Mirrakhimov, Babak Moazen, Bahram Mohajer, Yousef Mohammad, Dara K. Mohammad, Naser Mohammad Gholi Mezerji, Roghayeh Mohammadibakhsh, Shafiu Mohammed, Jemal Abdu Mohammed, Hassen Mohammed, Farnam Mohebi, Ali H Mokdad, Yoshan Moodley, Masoud Moradi, Ghobad Moradi, Mohammad Moradi-Joo, Paula Moraga, Linda Morales, Abbas Mosapour, Jonathan F. Mosser, Simin Mouodi, Seyyed Meysam Mousavi, Miliva Mozaffor, Sandra B Munro, Moses K. Muriithi, Christopher J L Murray, Kamarul Imran Musa, Ghulam Mustafa, Saravanan Muthupandian, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Mohsen Naghavi, Gurudatta Naik, Vinay Nangia, Bruno Ramos Nascimento, Javad Nazari, Duduzile Edith Ndwandwe, Ionut Negoi, Henok Biresaw Netsere, Josephine W. Ngunjiri, Cuong Tat Nguyen, Huong Lan Thi Nguyen, QuynhAnh P Nguyen, Solomon Gedlu Nigatu, Dina Nur Anggraini Ningrum, Chukwudi A Nnaji, Marzieh Nojomi, Ole F Norheim, Jean Jacques Noubiap, Bogdan Oancea, Felix Akpojene Ogbo, In-Hwan Oh, Andrew T Olagunju, Jacob Olusegun Olusanya, Bolajoko Olubukunola Olusanya, Obinna E Onwujekwe, Doris V. Ortega-Altamirano, Osayomwanbo Osarenotor, Frank B Osei, Mayowa O Owolabi, Mahesh P A, Jagadish Rao. Padubidri, Smita Pakhale, Adrian Pana, Eun-Kee Park, Sangram Kishor Patel, Ashish Pathak, Ajay Patle, Kebreab Paulos, Veincent Christian Filipino Pepito, Norberto Perico, Aslam Pervaiz, Julia Moreira Pescarini, Konrad Pesudovs, Hai Quang Pham, David M Pigott, Thomas Pilgrim, Meghdad Pirsaheb, Mario Poljak, Ian Pollock, Maarten J Postma, Farshad Pourmalek, Akram Pourshams, Sergio I Prada, Liliana Preotescu, Hedley Quintana, Navid Rabiee, Mohammad Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Siavash Rahimi, Vafa Rahimi-Movaghar, Muhammad Aziz Rahman, Mohammad Hifz Ur Rahman, Fatemeh Rajati, Chhabi Lal Ranabhat, Puja C Rao, Davide Rasella, Goura Kishor Rath, Salman Rawaf, Lal Rawal, Wasiq Faraz Rawasia, Giuseppe Remuzzi, Vishnu Renjith, Andre M.N. Renzaho, Serge Resnikoff, Seyed Mohammad Riahi, Ana Isabel Ribeiro, Jennifer Rickard, Leonardo Roever, Luca Ronfani, Enrico Rubagotti, Salvatore Rubino, Anas M Saad, Siamak Sabour, Ehsan Sadeghi, Sahar Saeedi Moghaddam, Yahya Safari, Rajesh Sagar, Mohammad Ali Sahraian, S. Mohammad Sajadi, Mohammad Reza Salahshoor, Nasir Salam, Ahsan Saleem, Hosni Salem, Marwa Rashad Salem, Yahya Salimi, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Itamar S Santos, Milena M. Santric-Milicevic, Bruno Piassi Sao Jose, Sivan Yegnanarayana Iyer Saraswathy, Nizal Sarrafzadegan, Benn Sartorius, Brijesh Sathian, Thirunavukkarasu Sathish, Maheswar Satpathy, Monika Sawhney, Mehdi Sayyah, Alyssa N Sbarra, Lauren E Schaeffer, David C Schwebel, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Azadeh Shafieesabet, Amira A Shaheen, Izza Shahid, Masood Ali Shaikh, Ali S Shalash, Mehran Shams-Beyranvand, MohammadBagher Shamsi, Morteza Shamsizadeh, Mohammed Shannawaz, Kiomars Sharafi, Rajesh Sharma, Aziz Sheikh, B Suresh Kumar Shetty, Wondimeneh Shibabaw Shiferaw, Mika Shigematsu, Jae Il Shin, Rahman Shiri, Reza Shirkoohi, K M Shivakumar, Si Si, Soraya Siabani, Tariq Jamal Siddiqi, Diego Augusto Santos Silva, Virendra Singh, Narinder Pal Singh, Balbir Bagicha Singh Singh, Jasvinder A. Singh, Ambrish Singh, Dhirendra Narain Sinha, Malede Mequanent Sisay, Eirini Skiadaresi, David L Smith, Adauto Martins Soares Filho, Mohammad Reza Sobhiyeh, Anton Sokhan, Joan B Soriano, Muluken Bekele Sorrie, Ireneous N Soyiri, Emma Elizabeth Spurlock, Chandrashekhar T Sreeramareddy, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Hafiz Ansar Rasul Suleria, Bryan L. Sykes, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Degena Bahrey Tadesse, Ingan Ukur Tarigan, Bineyam Taye, Yonatal Mesfin Tefera, Arash Tehrani-Banihashemi, Shishay Wahdey Tekelemedhin, Merhawi Gebremedhin Tekle, Mohamad-Hani Temsah, Berhe Etsay Tesfay, Fisaha Haile Tesfay, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan, Akhil Soman ThekkePurakkal, Nihal Thomas, Robert L Thompson, Alan J Thomson, Roman Topor-Madry, Marcos Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Bhaskaran Unnikrishnan, Muhammad Shariq Usman, Olalekan A Uthman, Benjamin S. Chudi Uzochukwu, Pascual R Valdez, Santosh Varughese, Yousef Veisani, Francesco S Violante, Sebastian Vollmer, Feleke Gebremeskel W/hawariat, Yasir Waheed, Mitchell Taylor Wallin, Yuan-Pang Wang, Yafeng Wang, Kinley Wangdi, Daniel J Weiss, Girmay Teklay Weldesamuel, Adhena Ayaliew Werkneh, Ronny Westerman, Taweewat Wiangkham, Kirsten E Wiens, Tissa Wijeratne, Charles Shey Wiysonge, Haileab Fekadu Wolde, Dawit Zewdu Wondafrash, Tewodros Eshete Wonde, Getasew Taddesse Worku, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Mehdi Yaseri, Hiroshi Yatsuya, Alex Yeshaneh, Mekdes Tigistu Yilma, Paul Yip, Engida Yisma, Naohiro Yonemoto, Mustafa Z Younis, Hebat-Allah Salah A Yousof, Chuanhua Yu, Hasan Yusefzadeh, Siddhesh Zadey, Telma Zahirian Moghadam, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Hamed Zandian, Heather J Zar, Taddese Alemu Zerfu, Yunquan Zhang, Arash Ziapour, Sanjay Zodpey, Yves Miel H Zuniga, Simon I Hay, and Robert C Reiner, Jr
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill & Melinda Gates Foundation.
Published: 2020
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2. The global distribution of lymphatic filariasis, 2000–18: a geospatial analysis

Author: Aniruddha Deshpande, Molly K Miller-Petrie, Paulina A Lindstedt, Mathew M Baumann, Kimberly B Johnson, Brigette F Blacker, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Ayenew Negesse Abejie, Lucas Guimarães Abreu, Michael R.M. Abrigo, Ahmed Abualhasan, Manfred Mario Kokou Accrombessi, Abdu A Adamu, Oladimeji M Adebayo, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O Adetokunboh, Tara Ballav Adhikari, Mohsen Afarideh, Marcela Agudelo-Botero, Mehdi Ahmadi, Keivan Ahmadi, Muktar Beshir Ahmed, Anwar E Ahmed, Temesgen Yihunie Akalu, Ali S Akanda, Fares Alahdab, Ziyad Al-Aly, Samiah Alam, Noore Alam, Genet Melak Alamene, Turki M Alanzi, James Albright, Ammar Albujeer, Jacqueline Elizabeth Alcalde-Rabanal, Animut Alebel, Zewdie Aderaw Alemu, Muhammad Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J. Alvis-Zakzuk, Saeed Amini, Arianna Maever L. Amit, Gianna Gayle Herrera Amul, Catalina Liliana Andrei, Mina Anjomshoa, Ansariadi Ansariadi, Carl Abelardo T. Antonio, Benny Antony, Ernoiz Antriyandarti, Jalal Arabloo, Hany Mohamed Amin Aref, Olatunde Aremu, Bahram Armoon, Amit Arora, Krishna K Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Daniel Asmelash, Hagos Tasew Atalay, Seyyede Masoume Athari, Seyyed Shamsadin Athari, Sachin R Atre, Marcel Ausloos, Shally Awasthi, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Andrew S Azman, Ebrahim Babaee, Alaa Badawi, Mojtaba Bagherzadeh, Shankar M Bakkannavar, Senthilkumar Balakrishnan, Maciej Banach, Joseph Adel Mattar Banoub, Aleksandra Barac, Miguel A Barboza, Till Winfried Bärnighausen, Sanjay Basu, Vo Dinh Bay, Mohsen Bayati, Neeraj Bedi, Mahya Beheshti, Meysam Behzadifar, Masoud Behzadifar, Diana Fernanda Bejarano Ramirez, Michelle L Bell, Derrick A. Bennett, Habib Benzian, Dessalegn Ajema Berbada, Robert S Bernstein, Anusha Ganapati Bhat, Krittika Bhattacharyya, Soumyadeep Bhaumik, Zulfiqar A Bhutta, Ali Bijani, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Raaj Kishore Biswas, Somayeh Bohlouli, Soufiane Boufous, Oliver J Brady, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Gabrielle B Britton, Alexandria Brown, Sharath Burugina Nagaraja, Zahid A Butt, Luis Alberto Cámera, Ismael R Campos-Nonato, Julio Cesar Campuzano Rincon, Jorge Cano, Josip Car, Rosario Cárdenas, Felix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Ester Cerin, Binaya Chalise, Vijay Kumar Chattu, Ken Lee Chin, Devasahayam J Christopher, Dinh-Toi Chu, Natalie Maria Cormier, Vera Marisa Costa, Elizabeth A Cromwell, Abel Fekadu Fekadu Dadi, Tukur Dahiru, Saad M A Dahlawi, Rakhi Dandona, Lalit Dandona, Anh Kim Dang, Farah Daoud, Aso Mohammad Darwesh, Amira Hamed Darwish, Ahmad Daryani, Jai K Das, Rajat Das Gupta, Aditya Prasad Dash, Claudio Alberto Dávila-Cervantes, Nicole Davis Weaver, Fernando Pio De la Hoz, Jan-Walter De Neve, Dereje Bayissa Demissie, Gebre Teklemariam Demoz, Edgar Denova-Gutiérrez, Kebede Deribe, Assefa Desalew, Samath Dhamminda Dharmaratne, Preeti Dhillon, Meghnath Dhimal, Govinda Prasad Dhungana, Daniel Diaz, Isaac Oluwafemi Dipeolu, Hoa Thi Do, Christiane Dolecek, Kerrie E Doyle, Eleonora Dubljanin, Andre Rodrigues Duraes, Hisham Atan Edinur, Andem Effiong, Aziz Eftekhari, Nevine El Nahas, Maysaa El Sayed Zaki, Maha El Tantawi, Hala Rashad Elhabashy, Shaimaa I. El-Jaafary, Ziad El-Khatib, Hajer Elkout, Aisha Elsharkawy, Shymaa Enany, Daniel Adane Endalew, Babak Eshrati, Sharareh Eskandarieh, Arash Etemadi, Oluchi Ezekannagha, Emerito Jose A. Faraon, Mohammad Fareed, Andre Faro, Farshad Farzadfar, Alebachew Fasil Fasil, Mehdi Fazlzadeh, Valery L. Feigin, Wubalem Fekadu, Netsanet Fentahun, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Irina Filip, Florian Fischer, Carsten Flohr, Nataliya A. Foigt, Morenike Oluwatoyin Folayan, Masoud Foroutan, Richard Charles Franklin, Joseph Jon Frostad, Takeshi Fukumoto, Mohamed M Gad, Gregory M Garcia, Augustine Mwangi Gatotoh, Reta Tsegaye Gayesa, Ketema Bizuwork Gebremedhin, Yilma Chisha Dea Geramo, Hailay Abrha Gesesew, Kebede Embaye Gezae, Ahmad Ghashghaee, Farzaneh Ghazi Sherbaf, Tiffany K Gill, Paramjit Singh Gill, Themba G Ginindza, Alem Girmay, Zemichael Gizaw, Amador Goodridge, Sameer Vali Gopalani, Bárbara Niegia Garcia Goulart, Alessandra C Goulart, Ayman Grada, Manfred S Green, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Davide Guido, Rafael Alves Guimarães, Yuming Guo, Rajeev Gupta, Rahul Gupta, Giang Hai Ha, Juanita A. Haagsma, Nima Hafezi-Nejad, Dessalegn H Haile, Michael Tamene Haile, Brian J. Hall, Samer Hamidi, Demelash Woldeyohannes Handiso, Hamidreza Haririan, Ninuk Hariyani, Ahmed I. Hasaballah, Md. Mehedi Hasan, Amir Hasanzadeh, Hamid Yimam Hassen, Desta Haftu Hayelom, Mohamed I Hegazy, Behzad Heibati, Behnam Heidari, Delia Hendrie, Andualem Henok, Claudiu Herteliu, Fatemeh Heydarpour, Hagos Degefa de Hidru, Thomas R Hird, Chi Linh Hoang, Gillian I Hollerich, Praveen Hoogar, Naznin Hossain, Mehdi Hosseinzadeh, Mowafa Househ, Guoqing Hu, Ayesha Humayun, Syed Ather Hussain, Mamusha Aman A Hussen, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Milena D. Ilic, Mohammad Hasan Imani-Nasab, Usman Iqbal, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Rebecca Q Ivers, Chinwe Juliana Iwu, Nader Jahanmehr, Mihajlo Jakovljevic, Amir Jalali, Achala Upendra Jayatilleke, Ensiyeh Jenabi, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Jost B. Jonas, Jacek Jerzy Jozwiak, Ali Kabir, Zubair Kabir, Tanuj Kanchan, André Karch, Surendra Karki, Amir Kasaeian, Gebremicheal Gebreslassie Kasahun, Habtamu Kebebe Kasaye, Gebrehiwot G Kassa, Getachew Mullu Kassa, Gbenga A. Kayode, Mihiretu M Kebede, Peter Njenga Keiyoro, Daniel Bekele Ketema, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Nauman Khalid, Rovshan Khalilov, Ejaz Ahmad Khan, Junaid Khan, Md Nuruzzaman Khan, Khaled Khatab, Mona M Khater, Amir M Khater, Maryam Khayamzadeh, Mohammad Khazaei, Mohammad Hossein Khosravi, Jagdish Khubchandani, Ali Kiadaliri, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Sonali Kochhar, Tufa Kolola, Hamidreza Komaki, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Nuworza Kugbey, Pushpendra Kumar, G Anil Kumar, Manasi Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Aparna Lal, Dharmesh Kumar Lal, Hilton Lam, Faris Hasan Lami, Van Charles Lansingh, Savita Lasrado, Georgy Lebedev, Paul H Lee, Kate E LeGrand, Mostafa Leili, Tsegaye Lolaso Lenjebo, Cheru Tesema Leshargie, Aubrey J Levine, Sonia Lewycka, Shanshan Li, Shai Linn, Shiwei Liu, Jaifred Christian F Lopez, Platon D Lopukhov, Muhammed Magdy Abd El Razek, D.R. 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Ngunjiri, Cuong Tat Nguyen, Huong Lan Thi Nguyen, QuynhAnh P Nguyen, Solomon Gedlu Nigatu, Dina Nur Anggraini Ningrum, Chukwudi A Nnaji, Marzieh Nojomi, Ole F Norheim, Jean Jacques Noubiap, Bogdan Oancea, Felix Akpojene Ogbo, In-Hwan Oh, Andrew T Olagunju, Jacob Olusegun Olusanya, Bolajoko Olubukunola Olusanya, Obinna E Onwujekwe, Doris V. Ortega-Altamirano, Osayomwanbo Osarenotor, Frank B Osei, Mayowa O Owolabi, Mahesh P A, Jagadish Rao. 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Chudi Uzochukwu, Pascual R Valdez, Santosh Varughese, Yousef Veisani, Francesco S Violante, Sebastian Vollmer, Feleke Gebremeskel W/hawariat, Yasir Waheed, Mitchell Taylor Wallin, Yuan-Pang Wang, Yafeng Wang, Kinley Wangdi, Daniel J Weiss, Girmay Teklay Weldesamuel, Adhena Ayaliew Werkneh, Ronny Westerman, Taweewat Wiangkham, Kirsten E Wiens, Tissa Wijeratne, Charles Shey Wiysonge, Haileab Fekadu Wolde, Dawit Zewdu Wondafrash, Tewodros Eshete Wonde, Getasew Taddesse Worku, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Mehdi Yaseri, Hiroshi Yatsuya, Alex Yeshaneh, Mekdes Tigistu Yilma, Paul Yip, Engida Yisma, Naohiro Yonemoto, Mustafa Z Younis, Hebat-Allah Salah A Yousof, Chuanhua Yu, Hasan Yusefzadeh, Siddhesh Zadey, Telma Zahirian Moghadam, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Hamed Zandian, Heather J Zar, Taddese Alemu Zerfu, Yunquan Zhang, Arash Ziapour, Sanjay Zodpey, Yves Miel H Zuniga, Simon I Hay, and Robert C Reiner, Jr
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods: A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding: Bill & Melinda Gates Foundation.
Published: 2020
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3. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Author: Kirsten E Wiens, Paulina A Lindstedt, Brigette F Blacker, Kimberly B Johnson, Mathew M Baumann, Lauren E Schaeffer, Hedayat Abbastabar, Sr, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Ayenew Negesse Abejie, Lucas Guimarães Abreu, Michael R M Abrigo, Ahmed Abualhasan, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Maryam Adabi, Abdu A Adamu, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Sr, Victor Adekanmbi, Olatunji O Adetokunboh, Sr, Beyene Meressa Adhena, Mohsen Afarideh, Sohail Ahmad, Keivan Ahmadi, Anwar E Ahmed, Muktar Beshir Ahmed, Rushdia Ahmed, Temesgen Yihunie Akalu, Fares Alahdab, Ziyad Al-Aly, Noore Alam, Sr, Samiah Alam, Genet Melak Alamene, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Beriwan Abdulqadir Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Sr, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Saeed Amini, Sr, Arianna Maever L 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K Muriithi, Christopher J L Murray, GVS Murthy, Kamarul Imran Musa, Ghulam Mustafa, Sr, Saravanan Muthupandian, Sr, Ashraf F Nabhan, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Kovin S Naidoo, Gurudatta Naik, Farid Najafi, Vinay Nangia, Sr, Jobert Richie Nansseu, Bruno Ramos Nascimento, Sr, Javad Nazari, Duduzile Edith Ndwandwe, Sr, Ionut Negoi, Sr, Henok Biresaw Netsere Netsere, Sr, Josephine W Ngunjiri, Sr, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Trang Huyen Nguyen, Dabere Nigatu, Solomon Gedlu Nigatu, Dina Nur Anggraini Ningrum, Chukwudi A Nnaji, Marzieh Nojomi, Vuong Minh Nong, Ole F Norheim, Sr, Jean Jacques Noubiap, Soraya Nouraei Motlagh, Bogdan Oancea, Okechukwu Samuel Ogah, Felix Akpojene Ogbo, In-Hwan Oh, Andrew T Olagunju, Tinuke O Olagunju, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Sr, Eyal Oren, Doris V V Ortega-Altamirano, Sr, Osayomwanbo Osarenotor, Frank B Osei, Sr, Mayowa O Owolabi, Mahesh P A, Sr, Jagadish Rao Padubidri, Smita Pakhale, Sangram Kishor Patel, Angel J Paternina-Caicedo, Sr, Ashish Pathak, Sr, George C Patton, Deepak Paudel, Sr, Kebreab Paulos, Sr, Veincent Christian Filipino Pepito, Alexandre Pereira, Norberto Perico, Aslam Pervaiz, Julia Moreira Pescarini, Bakhtiar Piroozi, Meghdad Pirsaheb, Maarten J Postma, Hadi Pourjafar, Farshad Pourmalek, Sr, Akram Pourshams, Hossein Poustchi, Sergio I Prada, Sr, Narayan Prasad, Liliana Preotescu, Hedley Quintana, Navid Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Afarin Rahimi-Movaghar, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, SHAFIUR Rahman, Fatemeh Rajati, Sr, Saleem Muhammad Rana, Sr, Chhabi Lal Ranabhat, Davide Rasella, David Laith Rawaf, Salman Rawaf, Sr, Lal Rawal, Wasiq Faraz Rawasia, Vishnu Renjith, Andre M N Renzaho, Sr, Serge Resnikoff, Sr, Melese Abate Reta, Negar Rezaei, Mohammad sadegh Rezai, Seyed Mohammad Riahi, Ana Isabel Ribeiro, Jennifer Rickard, Sr, Maria Rios-Blancas, Leonardo Roever, Luca Ronfani, Elias Merdassa Roro, Sr, Jennifer M Ross, Enrico Rubagotti, Salvatore Rubino, Anas M Saad, Yogesh Damodar Sabde, Siamak Sabour, Ehsan Sadeghi, Sr, Yahya Safari, Roya Safari-Faramani, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, S Mohammad Sajadi, Mohammad Reza Salahshoor, Nasir Salam, Sr, Payman Salamati, Hosni Salem, Marwa R Rashad Salem I, Yahya Salimi, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Sr, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Sivan Yegnanarayana Iyer Saraswathy, Kaushik Sarkar, Sr, Abdur Razzaque Sarker, Nizal Sarrafzadegan I, Benn Sartorius, Brijesh Sathian, Thirunavukkarasu Sathish, Monika Sawhney, Sonia Saxena, Sr, David C Schwebel, Sr, Anbissa Muleta Senbeta IV, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Sr, Hosein Shabaninejad, Azadeh Shafieesabet, Sr, Masood Ali Shaikh, Ali S Shalash, Sr, Seifadin Ahmed Shallo, Mehran Shams-Beyranvand, MohammadBagher Shamsi, Morteza Shamsizadeh, Mohammed Shannawaz, Kiomars Sharafi, Hamid Sharifi, Hatem Samir Shehata, Sr, Aziz Sheikh, B Suresh Kumar Shetty, Sr, Kenji Shibuya, Sr, Wondimeneh Shibabaw Shiferaw, Sr, Desalegn Markos Shifti, Mika Shigematsu, Jae Il Shin, Rahman Shiri, Sr, Reza Shirkoohi, Soraya Siabani, Tariq Jamal Siddiqi, Diego Augusto Santos Silva, Ambrish Singh, Jasvinder A Singh, Narinder Pal Singh, Virendra Singh, Malede Mequanent Sisay, Eirini Skiadaresi, Mohammad Reza Sobhiyeh, Sr, Anton Sokhan, Shahin Soltani, Ranjani Somayaji, Moslem Soofi, Muluken Bekele Sorrie, Sr, Ireneous N Soyiri, Chandrashekhar T Sreeramareddy, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Sr, Hafiz Ansar Rasul Suleria, Marufa Sultana, Bruno Fokas Sunguya, Bryan L Sykes, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Degena Bahrey Tadesse, Jr, Ingan Ukur Tarigan, Aberash Abay Tasew, Yonatal Mesfin Tefera, Sr, Merhawi Gebremedhin Tekle, Mohamad-Hani Temsah, Berhe Etsay Tesfay I, Fisaha Haile Haile Tesfay, Belay Tessema, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan, Nihal Thomas, Alemayehu Toma Toma, Sr, Roman Topor-Madry, Marcos Roberto Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Bhaskaran Unnikrishnan, Muhammad Shariq Usman, Sr, Benjamin S Chudi Uzochukwu, Sr, Pascual R Valdez, Santosh Varughese, Sr, Francesco S Violante, Sr, Sebastian Vollmer, Sr, Feleke Gebremeskel W/hawariat, Sr, Yasir Waheed, Mitchell Taylor Wallin, Yafeng Wang, Yuan-Pang Wang, Marcia Weaver, Bedilu Girma Weji, Girmay Teklay Weldesamuel, Catherine A Welgan, Andrea Werdecker, Ronny Westerman, Sr, Taweewat Wiangkham, Charles Shey Wiysonge, Sr, Haileab Fekadu Wolde, Sr, Dawit Zewdu Wondafrash, Tewodros Eshete Wonde, Sr, Getasew Taddesse Worku, Sr, Ai-Min Wu, Gelin Xu, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Sr, Hiroshi Yatsuya, Alex Yeshaneh, Christopher Sabo Yilgwan, Mekdes Tigistu Yilma, Paul Yip, Sr, Engida Yisma, Naohiro Yonemoto, Sr, Seok-Jun Yoon, Mustafa Z Younis, Mahmoud Yousefifard, Hebat-Allah Salah A Yousof, Chuanhua Yu, Hasan Yusefzadeh, Siddhesh Zadey, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Hamed Zandian, Nejimu Biza Zepro, Taddese Alemu Zerfu, Yunquan Zhang, Xiu-Ju George Zhao, Arash Ziapour, Sanjay Zodpey, Sr, Yves Miel H Zuniga, Simon I Hay, and Robert C Reiner, Jr
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.
Published: 2020
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4. First trimester screening using ultrasound and serum markers in Panamanians : f0 actors associated with adverse pregnancy outcomes

Author: Tania T Herrera, Scarlett Sinisterra, Alcibiades Solis, and Gabrielle B Britton
Subjects: Fetal ultrasonography, nuchal translucency, panama, pregnancy outcome, prenatal screening, Medicine
Abstract: Background: There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians. Materials and Methods: This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG) and pregnancy associated plasma protein-A (PAPP-A), and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV), were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects. Results: A total of 454 (97%) pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50). Maternal age was significantly greater in cases of adverse outcome (P = 0.007). The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps < 0.001). No differences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A. Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.
Published: 2014

5. New evidence on α-synuclein and Tau binding to conformation and sequence specific GCFNx01 rich DNA: Relevance to neurological disorders

Author: P Vasudevaraju, Erika Guerrero, Muralidhar L Hegde, T B Collen, Gabrielle B Britton, and K S Rao
Subjects: α-Synuclein, Alzheimer′s disease, oligonucleotide-protein interaction, Parkinson′s disease, Tau, Z-DNA, Pharmacy and materia medica, RS1-441, Analytical chemistry, QD71-142
Abstract: Background: Deoxyribonucleic acid (DNA) topology plays a critical role in maintaining the integrity of the genome and cellular functions. Although changes in DNA conformation and structural dynamics in the brain have been associated with various neurological disorders, its precise role in the pathogenesis is still unclear. Previous studies from our laboratory have shown that there is a conformational change in the genomic DNA of Parkinson′s disease (PD) (B to altered B-DNA) and Alzheimer′s disease brain (B to Z-DNA). However, there is limited information on the mechanism on DNA dynamics changes in brain. Objective: In the present study, we have investigated the DNA conformation and sequence specific binding ability of α-Synuclein and Tau with reference to B-DNA and Z-DNA using oligonucleotide (CGCGCGCG) 2 as a novel model DNA system. This sequence is predominantly present in the promoter region of the genes of biological relevance. Materials and Methods: Natively, (CGCGCGCG) 2 sequence exists in B-DNA conformation, but in the presence of high sodium concentration (4 M NaCl), the oligo converts into Z-DNA form. We used circular dichroism, melting temperature and fluorescence studies to understand protein-DNA interactions. Results: CD studies indicated that both α-Synuclein and Tau bind to B-DNA conformation of (CGCGCGCG) 2 and induce altered B-form. Further, these proteins increased the melting temperature and decreased the number of EtBr molecules bound per base pair of DNA in B-form indicating that DNA stability is favored to alter B-DNA conformation, which could be an intermediate form favoring Z-DNA conformation. Moreover, both α-Synuclein and Tau also bound to disease-linked Z-DNA conformation of (CGCGCGCG) 2 and further stabilized the Z-conformation. Conclusions: The present study provides vital mechanistic information on Synuclein and Tau binding to DNA in a conformation-specific manner causing conformational transition. Furthermore, both the proteins stabilize Z-DNA conformation. These have altered minor and major groove patterns and thus may have significant biological implications in relevance to gene expression pattern in neurodegeneration. We discuss the implications of α-Synuclein/Tau binding to DNA and stabilizing the altered conformations of DNA in neuronal cell dysfunction.
Published: 2012
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6. Antioxidant activity and polyphenol content in cultivated and wild edible fruits grown in Panama

Author: Enrique Murillo, Gabrielle B Britton, and Armando A Durant
Subjects: Antioxidant activity, food composition, Panamanian tropical fruits, total polyphenol content, vitamin C, Pharmacy and materia medica, RS1-441, Analytical chemistry, QD71-142
Abstract: Objectives: The present research was undertaken to determine the antioxidant activity and total polyphenol content of cultivated and wild edible fruits consumed in Panama. Materials and Methods: 39 cultivated and wild edible fruits antioxidant activity and total polyphenol content was assessed by using the DPPH and the Folin-Ciocalteu assays, respectively. Results and Discussion: The antioxidant composition of the fruits varied between 1083.33 and 16.22 mg TEAC/100 g fresh weight. On the other hand, the total phenolic content of the 39 fruits tested ranged from 604.80 to 35.10 mg GAE/100 g FW. Ziziphus mauritania presented the highest antioxidant activity and the largest phenolic content, whereas most fruits had a moderate TEAC value. Conclusion: Fruits polyphenol content was strongly correlated with antioxidant properties, which pointed out the important role of these compounds in the prevention of many types of cancer, neurological ailments, and cardiovascular diseases through diverse antioxidant mechanisms.
Published: 2012
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7. Predictors of cognitive change in cognitively healthy older women in Panama: the PARI-HD study

Author: Diana C. Oviedo, Adam E. Tratner, Sofía Rodríguez-Araña, Alcibiades E. Villarreal, Giselle Rangel, María B. Carreira, and Gabrielle B. Britton
Subjects: Hispanic, cognition, cardiovascular, depressive symptoms, health behaviors, older adults, Gynecology and obstetrics, RG1-991, Women. Feminism, HQ1101-2030.7
Abstract: BackgroundEvidence suggests that a combination of biological and social factors influence risk of dementia differently for women and men. In healthy older women, several factors may contribute to changes in cognition.ObjectiveDescribe the characteristics associated with variation in cognition in a sample of cognitively healthy older Panamanian women.MethodsThe study includes cross-sectional analyses of cognitive domains at baseline (n = 357) and 17-month (SD = 2.0) follow-up (n = 200) for women aged 60 years and older enrolled in the Panama Aging Research Initiative-Health Disparities (PARI-HD) study. Instruments included clinical questionnaires, physiological measures, and a neuropsychological test battery assessing global cognition and seven cognitive domains. Multiple regression analyses examined the associations between demographic and clinical characteristics and cognition at baseline. Repeated measures analyses were used to investigate changes in cognition from baseline to follow-up.ResultsOn average, participants were 68.6 years of age (SD = 5.9) with 16.1 years of education (SD = 4.7). Age, income, and education showed robust associations with baseline cognition. Subjective cognitive impairment was associated with lower performance in global cognition, verbal learning, and memory domains. Only performance in the attention domain decreased at follow-up, and subjective health state and depressive symptoms significantly predicted the change in attention.DiscussionOur study findings contribute to the investigation of cognitive health in older Hispanic women and to the understanding of sociodemographic and health-related factors associated with cognitive decline and the progression to cognitive impairment and dementia.
Published: 2024
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8. Resilience mediates the effect of the COVID-19 pandemic on mental health in a sample of adults in Panama

Author: Diana C. Oviedo, Adam E. Tratner, María Sofía Pinzón, Sofía Rodríguez-Araña, Elianne Pauli-Quirós, Carlos Chavarría, Camilo Posada Rodríguez, and Gabrielle B. Britton
Subjects: mental health, COVID-19, resilience, Latin America, mediation, stress, Psychology, BF1-990
Abstract: BackgroundThe COVID-19 pandemic was characterized by global increases in depression, anxiety, and stress symptoms. Previous studies have shown that resilience mitigates these symptoms, however there is limited research exploring the link between resilience and mental illness during the COVID-19 pandemic in Central America.ObjectiveTo examine the role of resilience as it relates to the perceived effect of the pandemic on mental health symptoms.MethodsA sample of 480 adults in Panama were recruited from March to May 2021 to complete an online survey. The online survey consisted of sociodemographic questions and scale measures assessing depression, anxiety and stress symptoms, resilience, and social support.ResultsResults indicated that resilience mediated the relationship between the perceived effect of the COVID-19 pandemic and mental health symptoms; participants who felt more personally affected by the pandemic reported more depression, anxiety, and stress symptoms via decreased resilience. Further analyses revealed that resilience was moderated by sex and social support, showing that the indirect effect of resilience was greater for women and individuals who perceived low social support.DiscussionThese findings contribute to a growing body of research documenting the adverse effects of the COVID-19 pandemic on mental health and reveal potential mechanisms through which pandemic-related distress decreases resilience, thereby increasing symptoms of mental illness.
Published: 2023
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9. Digital phenotyping: An equal opportunity approach to reducing disparities in Alzheimer's disease and related dementia research

Author: Gabrielle B. Britton, Li‐Kai Huang, Alcibiades E. Villarreal, Allan Levey, Anthony Philippakis, Chaur‐Jong Hu, Cheng Chang Yang, Declare Mushi, Diana C. Oviedo, Giselle Rangel, Jor Sam Ho, Louisa Thompson, Mahdi Khemakhem, Makayla Ross, María B. Carreira, Nicole Kim, Philip Joung, Omar Albastaki, Po Chih Kuo, Spencer Low, Stella‐Maria Paddick, Yi‐Chun Kuan, and Rhoda Au
Subjects: biomarkers, digital technologies, health disparity, minority and vulnerable populations, Neurology. Diseases of the nervous system, RC346-429, Geriatrics, RC952-954.6
Abstract: Abstract A rapidly aging world population is fueling a concomitant increase in Alzheimer's disease (AD) and related dementias (ADRD). Scientific inquiry, however, has largely focused on White populations in Australia, the European Union, and North America. As such, there is an incomplete understanding of AD in other populations. In this perspective, we describe research efforts and challenges of cohort studies from three regions of the world: Central America, East Africa, and East Asia. These cohorts are engaging with the Davos Alzheimer's Collaborative (DAC), a global partnership that brings together cohorts from around the world to advance understanding of AD. Each cohort is poised to leverage the widespread use of mobile devices to integrate digital phenotyping into current methodologies and mitigate the lack of representativeness in AD research of racial and ethnic minorities across the globe. In addition to methods that these three cohorts are already using, DAC has developed a digital phenotyping protocol that can collect ADRD‐related data remotely via smartphone and/or in clinic via a tablet to generate a common data elements digital dataset that can be harmonized with additional clinical and molecular data being collected at each cohort site and when combined across cohorts and made accessible can provide a global data resource that is more racially/ethnically represented of the world population.
Published: 2023
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10. Correction: De Jesus et al. Body Temperature Drop as a Humane Endpoint in Snake Venom-Lethality Neutralization Tests. Toxins 2023, 15, 525

Author: Rosa De Jesus, Adam E. Tratner, Alanna Madrid, Andrés Rivera-Mondragón, Goy E. Navas, Ricardo Lleonart, Gabrielle B. Britton, and Patricia L. Fernández
Subjects: n/a, Medicine
Abstract: In the original publication [...]
Published: 2024
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11. A fresh look at the multi‐level social determinants of disparities in Alzheimer's disease and related dementias

Author: Gabrielle B. Britton and Ozioma C. Okonkwo
Subjects: Neurology. Diseases of the nervous system, RC346-429, Geriatrics, RC952-954.6
Published: 2023
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12. Body Temperature Drop as a Humane Endpoint in Snake Venom-Lethality Neutralization Tests

Author: Rosa De Jesus, Adam E. Tratner, Alanna Madrid, Andrés Rivera-Mondragón, Goy E. Navas, Ricardo Lleonart, Gabrielle B. Britton, and Patricia L. Fernández
Subjects: venom, antivenom, temperature, refinement, Medicine
Abstract: Snake venom neutralization potency tests are required for quality control assessment by manufacturers and regulatory authorities. These assays require the use of large numbers of mice that manifest severe signs associated with pain and distress and long periods of suffering. Despite this, many animals make a full recovery; therefore, the observation of clinical signs as a predictor of animal death is highly subjective and could affect the accuracy of the results. The use of a more objective parameter such as body temperature measurement could help establish a humane endpoint that would contribute to significantly reducing the suffering of large numbers of animals. We determined the temperature drop in BALB/c mice exposed to the mixtures of Bothrops asper or Lachesis stenophrys venom and a polyvalent antivenom by using an infrared thermometer. Our data show that, based on the temperature change from baseline, it is possible to predict which animals will survive during the first 3 h after inoculation. The data provided in this study may contribute to future reductions in animal suffering, in concordance with general trends in the use of laboratory animals for the quality control of biologicals.
Published: 2023
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13. Depression Mediates the Association Between Occupational Complexity and Late-Life Cognition in Hispanics

Author: Camilo Posada Rodríguez, Sofía Rodríguez-Araña, Diana C. Oviedo, María B. Carreira, Julio Flores-Cuadra, Alcibiades E. Villarreal, Giselle Rangel, and Gabrielle B. Britton
Subjects: Aging, Psychiatry and Mental health, Clinical Psychology, Latin America, Short Communication, General Neuroscience, risk factors, Geriatrics and Gerontology, cognitive reserve, executive functions
Abstract: There is a dearth of research in Latin America regarding risk and protective factors affecting older adults’ cognition. This study aimed to investigate the factors mediating the association between occupational complexity and late-life cognition and daily function in a sample of Hispanic older adults. Participants (n = 588) aged 65 years and older underwent clinical, functional, and cognitive assessments. Mediation analyses revealed that depressive symptoms mediated the relationship between occupational complexity and cognitive as well as functional outcomes. Results provide evidence that depression may act as a risk factor for worse outcomes, even if older adults had a cognitively demanding occupation.
Published: 2021

14. The Panama Aging Research Initiative: Dementia‐related biomarker research in a low‐resourced setting

Author: Gabrielle B Britton, Alcibiades E Villarreal, Diana C Oviedo, Sid E. O'Bryant, Melissa Edwards, Maria B Carreira, and Giselle Rangel
Subjects: Psychiatry and Mental health, Cellular and Molecular Neuroscience, Developmental Neuroscience, Epidemiology, Health Policy, Neurology (clinical), Geriatrics and Gerontology
Published: 2022

15. Psychosocial response to the COVID-19 pandemic in Panama

Author: Diana C. Oviedo, María Sofía Pinzón, Sofía Rodríguez-Araña, Adam E. Tratner, Elianne Pauli-Quirós, Carlos Chavarría, Camilo Posada Rodríguez, and Gabrielle B. Britton
Subjects: Adult, Male, Depression, SARS-CoV-2, Sleep Initiation and Maintenance Disorders, Public Health, Environmental and Occupational Health, COVID-19, Humans, Female, Pandemics
Abstract: BackgroundThe impact of the COVID-19 pandemic and the associated restrictions on mental health is being studied.ObjectiveTo analyze the psychosocial response to the COVID-19 pandemic in adults residing in Panama.MethodsA community sample of 480 adult residents of Panama completed a survey that included sociodemographic questions, COVID-19 related questions (e.g., health concerns regarding the virus, knowledge and behaviors in biosafety) and scales of stress, anxiety, depression, prosocial behavior, resilience, perceived social support, and insomnia.ResultsMost of the participants (>60%) reported being negatively affected by the pandemic. Women experienced greater depression, anxiety, and stress symptoms than men, and age was negatively associated with depression, anxiety, and stress symptoms. Self-perceived health status and self-perceived social support were negatively associated with depression, anxiety, and stress symptoms. Self-perceived social isolation was positively associated with depression, anxiety, and stress symptoms. Psychiatric illness and insomnia were positively associated with depression, anxiety, and stress symptoms, whereas psychological resilience was negatively associated with depression, anxiety, and stress symptoms.DiscussionThese results corroborate other studies regarding COVID-19 and mental health. This study highlights the need for specific prevention and intervention mechanisms related to the COVID-19 pandemic in different population groups. This is the first report of the psychological impact of COVID-19 in the general Panamanian population and one of the only studies in the Latin American region and, therefore, contributes to research in the Latino population and lower-middle income countries.
Published: 2022
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16. Critical Review of the Alzheimer’s Disease Non-Transgenic Models: Can They Contribute to Disease Treatment?

Author: Ambar R Pérez-Lao, Patricia L. Fernández, Diana C Oviedo, Maria B. Carreira, Alanna Madrid, Gabrielle B Britton, and Julio A Flores-Cuadra
Subjects: 0301 basic medicine, Amyloid, Transgene, Anti-Inflammatory Agents, Disease, Bioinformatics, Streptozocin, Adenoviridae, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Intervention (counseling), medicine, Animals, Humans, Dementia, Exercise, Pathological, Disease treatment, Clinical Trials as Topic, Amyloid beta-Peptides, Drug discovery, business.industry, General Neuroscience, General Medicine, medicine.disease, Disease Models, Animal, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, 030104 developmental biology, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract: Alzheimer’s disease (AD) is a growing neurodegenerative disease without effective treatments or therapies. Despite the use of different approaches and an extensive variety of genetic amyloid based models, therapeutic strategies remain elusive. AD is characterized by three main pathological hallmarks that include amyloid-β plaques, neurofibrillary tangles, and neuroinflammatory processes; however, many other pathological mechanisms have been described in the literature. Nonetheless, the study of the disease and the screening of potential therapies is heavily weighted toward the study of amyloid-β transgenic models. Non-transgenic models may aid in the study of complex pathological states and provide a suitable complementary alternative to evaluating therapeutic biomedical and intervention strategies. In this review, we evaluate the literature on non-transgenic alternatives, focusing on the use of these models for testing therapeutic strategies, and assess their contribution to understanding AD. This review aims to underscore the need for a shift in preclinical research on intervention strategies for AD from amyloid-based to alternative, complementary non-amyloid approaches.
Published: 2021

17. Relación entre las funciones ejecutivas y el rendimiento académico en una muestra de escolares

Author: Marita Mojica, Gabrielle B. Britton, Ambar Pérez, Julio Flores, and Diana C Oviedo
Subjects: Sample size determination, Cognition, Sample (statistics), Academic achievement, Descriptive research, Executive functions, Quarter (United States coin), Psychology, Developmental psychology, Test (assessment)
Abstract: En la última década, la integración entre las neurociencias y la educación ha contribuido a la comprensión y mejoramiento del sistema educativo, además, se ha mostrado un interés en el estudio de las funciones ejecutivas y el rendimiento académico de los estudiantes. Las funciones ejecutivas son un sistema multimodal que coordinan procesos mentales superiores. Las investigaciones con población infantil han enfatizado la relación entre las funciones ejecutivas y las capacidades cognitivas, habilidades en lectoescritura y competencias matemáticas. Se ha reportado que alteraciones en las funciones ejecutivas podría llevar a un bajo rendimiento académico. El objetivo de este estudio fue evaluar la relación entre las funciones ejecutivas y el rendimiento académico en una muestra de escolares. Materiales y método: Se realizó un estudio descriptivo correlacional con 34 estudiantes, a los cuales se les aplicó la prueba ENFEN y se tomó el promedio de las notas del primer y segundo trimestre del año escolar como valor para medir rendimiento académico. Los datos se analizaron con el coeficiente de correlación de Spearman. Resultados: Se encontró que el desempeño de la mayoría de los estudiantes en la prueba ENFEN fue bajo y medio, mientras el rendimiento académico de los participantes fue medio y alto. No se encontraron correlaciones significativas entre la ejecución en el ENFEN y el rendimiento académico. Conclusiones: Los resultados encontrados fueron opuestos a lo planteado por la literatura, lo que conllevaría a plantear una revisión por parte del sistema educativo a la evaluación de las capacidades cognitivas y académicas de los estudiantes. Se recomienda aumentar el tamaño de la muestra y el uso de otros diseños de investigación en estudios futuros.
Published: 2020

18. Asociación entre cognición y depresión en adultos mayores panameños con cognición normal y deterioro cognitivo leve

Author: Diana C Oviedo, Gabrielle B. Britton, and Ambar Pérez
Subjects: Activities of daily living, medicine, Neuropsychology, Dementia, Geriatric Depression Scale, Cognition, Cognitive skill, Effects of sleep deprivation on cognitive performance, Executive functions, medicine.disease, Psychology, Clinical psychology
Abstract: La depresión y el deterioro cognitivo leve (DCL) en el adulto mayor están relacionados con el desarrollo de distintos tipos de demencia y disminución en la funcionalidad. Se realizó un estudio descriptivo de corte transversal con una muestra de 73 adultos mayores panameños de 65 años o más, de la cohorte del Panama Aging Research Initiative (PARI). Se midió estado de salud y funcionalidad en las actividades de la vida diaria. El funcionamiento cognitivo fue medido con pruebas neuropsicológicas cuyos puntajes se combinaron para formar seis dominios: cognición global, memoria, lenguaje, habilidades visuoespaciales, atención y funciones ejecutivas. Para medir síntomas depresivos se utilizó la Escala de Depresión Geriátrica (GDS-30). Se realizó un análisis de covarianza (ANCOVA) comparando sujetos con y sin posible depresión para cada dominio cognitivo, en sujetos con DCL y cognición normal (CN) y controlando por las variables de edad y escolaridad. Se encontraron diferencias significativas entre los grupos, el grupo con posible depresión y DCL tenía menores puntuaciones en comparación con los otros grupos en cognición global. Se realizaron dos análisis de regresión lineal para determinar los factores asociados con el desempeño cognitivo en cada grupo diagnóstico individualmente. En el grupo CN la escolaridad fue un predictor significativo del desempeño en los dominios cognitivos, mientras que en el DCL se encontró que la edad, la educación, la depresión y el índice de masa corporal (IMC) estaban relacionados con menor desempeño cognitivo. En el grupo de DCL, depresión predijo bajo desempeño en los dominios cognitivos de funciones ejecutivas y atención. Estos resultados podrían aportar al desarrollo de políticas de salud dirigidas a adultos mayores, y a esfuerzos especializados de prevención e intervención enfocados en minimizar la discapacidad y sus mediadores.
Published: 2020

19. The link between blood‐based biomarkers and mild cognitive impairment and Alzheimer's disease in a Panamanian sample

Author: Diana C. Oviedo, Alcibiades E. Villarreal, Giselle Rangel, Maria B. Carreira, Ambar R. Perez‐Lao, Sofía A. Rodriguez, Camilo Posada, and Gabrielle B. Britton
Subjects: Psychiatry and Mental health, Cellular and Molecular Neuroscience, Developmental Neuroscience, Epidemiology, Health Policy, Neurology (clinical), Geriatrics and Gerontology
Published: 2021

20. Translational Research and Drug Discovery for Neurodegeneration: Challenges for Latin America

Author: Adrian G. Palacios, Ricardo B. Maccioni, Luisa Lilia Rocha Arrieta, Gabrielle B. Britton, Norberto Garcia-Cairasco, Alberto Lazarowski, Antoni Camins Espuny, and K. S. Jagannatha Rao
Subjects: Latin Americans, Drug discovery, business.industry, General Neuroscience, Neurodegeneration, Malalties neurodegeneratives, Neurosciences, Brain, Translational research, Neurodegenerative Diseases, General Medicine, Computational biology, medicine.disease, Translational Research, Biomedical, Psychiatry and Mental health, Clinical Psychology, Latin America, Drug Discovery, medicine, Humans, Neurociències, Geriatrics and Gerontology, business, Cervell
Abstract: Perhaps one of the most significant scientific challenges is to understand the human brain. Neuroscience research has had a considerable impact on individuals, families, and society. However, before we can have a real impact on public health, we need a greater understanding of biological processes that underlie the wide variety of neurological and psychiatric disorders such as Alzheimer's disease (AD), Parkinson's disease, schizophrenia, depression, traumatic brain injury, epilepsy, and many others. It is a great challenge and responsibility of science to unravel the brain's secrets through translational research and drug discovery in order to improve the lives of individuals with these devastating conditions. In the past decade, outstanding discoveries have been made that have made possible novel and multidisciplinary approaches to understanding the brain's mysteries.
Published: 2021

21. Valoración de la conducta en ratas Sprague Dawley sometidas a enriquecimiento ambiental

Author: Rosa De Jesús, Maria B. Carreira, René Rivera, L Herrera, Alanna Madrid, and Gabrielle B. Britton
Abstract: En los animales de laboratorio, se conoce que los procedimientos de rutina como la manipulación, la sujeción, las inyecciones o la toma de muestras de sangre provocan una respuesta aguda de estrés. El objetivo de este ensayo fue determinar si la condición de enriquecimiento del alojamiento de las ratas Sprague Dawley producidas en el Bioterio de INDICASAT-AIP, puede favorecer una conducta ansiolítica luego de un procedimiento aversivo como la toma de muestra de sangre. Al destete, los animales se segregaron en 2 grupos que incluyeron: grupo con y sin enriquecimiento. El enriquecimiento ambiental consistió en 2 tubos de policloruro de vinilo por caja. Ocho semanas después, los animales se sometieron a las pruebas de conducta de campo abierto y laberinto en cruz elevado antes y después de un procedimiento de toma de muestra sanguínea vía retroorbital previa sedación con isofluorano. En los parámetros valorados en campo abierto: tiempo de movilidad e inmovilidad, no se observó un efecto significativo entre los grupos con enriquecimiento y sin enriquecimiento. En relación a los parámetros del laberinto en cruz elevado, se encontró que los animales alojados en el ambiente con enriquecimiento pasaron en promedio una mayor cantidad de tiempo (35±21s), en brazos abiertos, que el grupo sin enriquecimiento (7±6s). Estos datos permitieron comprobar que el enriquecimiento ayudó a disminuir la ansiedad en las ratas del ensayo, luego de ser sometidas a un procedimiento aversivo como la toma de muestra sanguínea.
Published: 2021

22. The Role of Clinical Researchers During COVID-19: Balancing Individual, Scientific, and Social Benefits of Research

Author: Diana C. Oviedo, Ambar R. Perez-Lao, Alcibiades E. Villarreal, Maria B. Carreira, and Gabrielle B. Britton
Subjects: Opinion, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Social benefits, Psychological distress, COVID-19, lcsh:RA1-1270, Bioethics, Research Personnel, Professional Role, Clinical research, Nursing, clinical research, psychological distress, Humans, Public Health, Psychology, bioethics, death and mourning
Published: 2021

23. Apolipoprotein ɛ4 Affects Multiple Domains of Neuropsychological Functioning in a Sample of Elderly Hispanics

Author: Alcibiades E. Villarreal, Ambar R Pérez-Lao, Maria B. Carreira, Julio A Flores-Cuadra, Shantal Grajales, Gabrielle B Britton, and Diana C Oviedo
Subjects: Male, Outpatient Clinics, Hospital, Apolipoprotein B, Apolipoprotein E4, Disease, Neuropsychological Tests, 03 medical and health sciences, Executive Function, 0302 clinical medicine, Alzheimer Disease, Medicine, Humans, Cognitive Dysfunction, Allele, Association (psychology), Aged, Aged, 80 and over, 030214 geriatrics, biology, business.industry, General Neuroscience, Neuropsychology, Cognition, General Medicine, Hispanic or Latino, Executive functions, Psychiatry and Mental health, Clinical Psychology, Cross-Sectional Studies, biology.protein, Female, Geriatrics and Gerontology, Verbal memory, business, 030217 neurology & neurosurgery, Clinical psychology
Abstract: Apolipoprotein ɛ4 allele (APOE ɛ4) is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD), but inconsistencies have arisen in studies with Hispanics. The objective of this study was to explore APOE ɛ4 expression and cognitive function in a sample of Panamanian older adults, including healthy controls, mild cognitive impairment, and AD. Participants with at least one copy of APOE ɛ4 had a significantly lower performance in global cognition, verbal memory, executive functions, visuospatial abilities, regardless of diagnosis. The present study contributes to the understanding of the association of APOE ɛ4 and impairment in specific cognitive domains in elderly Hispanics.
Published: 2020

24. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. Stokes, Veincent Christian Filipino Pepito, Lidia Morawska, Fiona J Charlson, Babak Moazen, Dejana Braithwaite, Jonathan M. Kocarnik, Sergio I. Prada, Andrea Farioli, Zahra Atafar, Heather Orpana, Daniela Balzi, Marco Vacante, Rahmatollah Moradzadeh, Jacek A. Kopec, Iván Landires, Robert G. Weintraub, Leonardo Roever, Yannick Béjot, Markus P. Schlaich, Hamed Zandian, Subramanian Senthilkumaran, Klara Dokova, Vahid Alipour, Sowmya J. Rao, Rakesh Ghosh, Omar Mukhtar Salman, Faris Lami, Marcos Roberto Tovani-Palone, Hamid Reza Tohidinik, Seyed Mohammad Riahi, Adnan Kisa, Ghasem Azarian, Caroline Stein, Zulfiqar A. Bhutta, Sinead Langan, Kunihiro Matsushita, Lauren E. Schaeffer, Kathryn H. Jacobsen, Mehdi Naderi, Mehdi Hosseinzadeh, Nizal Sarrafzadegan, Bahram Armoon, Dan J. Stein, Jessica Fanzo, Morenike Oluwatoyin Folayan, Luca Ronfani, Phetole Walter Mahasha, Nicholas J K Breitborde, Adrian Oţoiu, Arash Sarveazad, Marc L. Serre, Mostafa Hosseini, Nicolas Cherbuin, George D. Thurston, Jalal Arabloo, Mokhtar Mahdavi, Andre Rodrigues Duraes, Ana Laura Manda, Ahmed Abualhasan, Nima Rezaei, Yuan-Pang Wang, Theodore Patrick Younker, Alireza Ansari-Moghaddam, Borhan Mansouri, Adam E. Berman, Khezar Hayat, Rosario Cárdenas, Bolajoko O. Olusanya, Tommi Vasankari, Simon I. Hay, Fatemeh Ghaffarifar, Leo Stockfelt, Ai Koyanagi, Giorgia Giussani, Yuming Guo, Sonia Saxena, Deborah Carvalho Malta, Mehedi Hasan, Negar Rezaei, Maja Pasovic, Jukka Takala, Bogdan Oancea, Sare Safi, A. Werdecker, Florian Fischer, Beatriz Paulina Ayala Quintanilla, Muhammad Shahdaat Bin Sayeed, Takeshi Fukumoto, Maha Atout, Brijesh Sathian, Cristina Bosetti, Mitchell T. Wallin, Agegnehu Bante, Helen Ippolito, Anthony Masaka, Chantal Huynh, Justin Lo, Jordan Weiss, Joemer C. Maravilla, Alberto Raggi, Peter W. Gething, Cristiana Abbafati, Daniela Ribeiro, Mohammad Farahmand, Yetunde O. John-Akinola, Isabela M. Benseñor, Emilie R Maddison, John J. McGrath, Salman Khazaei, Scott B. Patten, Jean Jacques Noubiap, Emmanuela Gakidou, Celine M. Barthelemy, Ashish Badiye, George C. Patton, Obinna Onwujekwe, Peter Allebeck, Victor Aboyans, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Nicholas L S Roberts, Joht Singh Chandan, Hans W. Hoek, Usman Iqbal, Nima Hafezi-Nejad, Haley Lescinsky, Naohiro Yonemoto, Ahmad Ghashghaee, Anders Larsson, David C. Schwebel, Milena Ilic, Richard T. Burnett, Yang Liu, Carlo La Vecchia, Felix Akpojene Ogbo, Morteza Naserbakht, Sangram Kishor Patel, Melanie S. Hammer, Prasanna Mithra, Mohammad Amin Bahrami, Kanyin L. Ong, Mona Pathak, Afshin Maleki, Saeid Safiri, Masood Ali Shaikh, Kate Causey, Michael R.M. Abrigo, Jost B. Jonas, Dian Kusuma, Jagadish Rao Padubidri, Mihajlo Jakovljevic, Ali S. Shalash, Abdiwahab Hashi, Ionut Negoi, Nataliya A. Foigt, Andrey Nikolaevich Briko, François Alla, Giuseppe Grosso, Houman Goudarzi, Di H. Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. Khater, Ehsan Sadeghi, Mahalaqua Nazli Khatib, Antonio Biondi, Valentin Yurievich Skryabin, Mohsen Abbasi-Kangevari, Andrew T Olagunju, Amir Radfar, Laith J. Abu-Raddad, Marcello Tonelli, Hesam Ghiasvand, Hanne Christensen, Juan Jesus Carrero, Maryam Adabi, Saravanan Muthupandian, Kurt Straif, Hossein Samadi Kafil, Lope H Barrero, Harish Chander Gugnani, Mohammad Fareed, Morteza Shamsizadeh, Jemal Abdu Mohammed, Juan A Rivera, Shai Linn, Saad M.A. Dahlawi, Janni Leung, Shokofeh Maleki, Mohd Anisul Karim, Kamarul Imran Musa, Farshad Pourmalek, Dietrich Rothenbacher, Kiomars Sharafi, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Helena Manguerra, Olatunji O. Adetokunboh, Srinivasa Vittal Katikireddi, Nermin Ghith, Maha El Tantawi, Awoke Misganaw, Yunquan Zhang, Carl Abelardo T. Antonio, Vahid Rashedi, Mehran Shams-Beyranvand, Bhaskaran Unnikrishnan, Holly E. Erskine, Ann Kristin Knudsen, Marissa B Reitsma, Getayeneh Antehunegn Tesema, Javad Javidnia, Ismael R. Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. 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W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. 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J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. 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Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.
Subjects: Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract: Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020

25. Performance of a point of care test for detecting IgM and IgG antibodies against SARS-CoV-2 and seroprevalence in blood donors and health care workers in Panama

Author: María B. Carreirra, Rao Kosagisharaf, Yamitzel Zaldivar, Ivonne Torres-Atencio, Fernando Diaz Subía, Chong Li, Giselle Rangel, Fangjing Fan, Baojun Wang, Ricardo Lleonart, Xavier Sáez-Llorens, Dexi Zhang, Eduardo Ortega-Barria, Patricia L. Fernández, Carlos M. Restrepo, Gilberto A. Eskildsen, Danilo Franco, Ambar Pérez, Sandra López-Vergès, Digna Wong, Amador Goodridge, Rodrigo DeAntonio, Xu Zhang, Diana C Oviedo, Carolina De La Guardia, Gabrielle B Britton, Dilcia Sambrano, and Alcibiades E. Villarreal
Subjects: medicine.medical_specialty, biology, business.industry, Point-of-care testing, Vaccine efficacy, Confidence interval, Serology, Internal medicine, biology.protein, Medicine, Seroprevalence, Antibody, business, Contact tracing, Kappa
Abstract: Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has reached 28 million cases worldwide in eight months. The serological detection of antibodies against the virus will play a pivotal role in complementing molecular tests to improve diagnostic accuracy, contact tracing, vaccine efficacy testing and seroprevalence surveillance. Here, we aimed first to evaluate a lateral flow assay’s ability to identify specific IgM and IgG antibodies against SARS-CoV-2 and second, to report the seroprevalence of these antibodies among health care workers and healthy volunteer blood donors in Panama. We recruited study participants between April 30thand July 7th, 2020. For the test validation and performance evaluation, we analyzed serum samples from participants with clinical symptoms and confirmed positive RT-PCR for SARS-CoV-2, participants with other confirmed infectious diseases, and a set of pre-pandemic serum samples. We used two by two table analysis to determine the test sensitivity and specificity as well as the kappa agreement value with a 95% confidence interval. Then, we used the lateral flow assay to determine seroprevalence among serum samples from COVID-19 patients, potentially exposed health care workers, and healthy volunteer donors. Our results show this assay reached a positive percent agreement of 97.2% (95% CI 84.2-100.0%) for detecting both IgM and IgG. The assay showed akappaof 0.898 (95%CI 0.811-0.985) and 0.918 (95% CI 0.839-0.997) for IgM and IgG, respectively. The evaluation of serum samples from hospitalized COVID-19 patients indicates a correlation between test sensitivity and the number of days since symptom onset; the highest positive percent agreement (87% (95% CI 67.0-96.3%)) was observed at ≥15 days post-symptom onset. We found an overall antibody seroprevalence of 11.6% (95% CI 8.5-15.8%) among both health care workers and healthy blood donors. Our findings suggest this lateral flow assay could contribute significantly to implementing seroprevalence testing in locations with active community transmission of SARS-CoV-2.
Published: 2020

26. Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Author: Joseph Frostad, Eirini Skiadaresi, Mehran Asadi-Aliabadi, Aleksandra Barac, Simon I. Hay, Deborah Carvalho Malta, Achala Upendra Jayatilleke, David L. Smith, Mohamad-Hani Temsah, Brigette F. Blacker, Nuworza Kugbey, Bineyam Taye, Carlo La Vecchia, Kavumpurathu Raman Thankappan, Benny Antony, Cheru Tesema Leshargie, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Turki Alanzi, Amir Jalali, Chukwudi A Nnaji, Daniel Asmelash, Manu Raj Mathur, Jai K Das, Ana Isabel Ribeiro, Sachin R Atre, Tomislav Mestrovic, Rajeev Gupta, Smita Pakhale, Félix Carvalho, Yun Jin Kim, Quynh Anh P. Nguyen, Sameer Vali Gopalani, Chi Linh Hoang, Jean Jacques Noubiap, Manfred Accrombessi, Christopher J L Murray, Ninuk Hariyani, Ken Lee Chin, Jagadish Rao Padubidri, Mehdi Fazlzadeh, Mohammad Fareed, Mustafa Z. Younis, Navid Rabiee, Osayomwanbo Osarenotor, Brian J. Hall, Ejaz Ahmad Khan, Daniel Diaz, Salman Rawaf, Tara Ballav Adhikari, Mayowa O. Owolabi, Sonia Lewycka, Catalina Liliana Andrei, Henok Biresaw Netsere, Hagos Degefa Hidru, Morteza Shamsizadeh, Shai Linn, Saad M.A. Dahlawi, Demelash Woldeyohannes Handiso, Jemal Abdu Mohammed, Thomas Pilgrim, Alessandra C. Goulart, Ravi Prakash Jha, Norberto Perico, Sergio I. Prada, Ted R. Miller, Rebecca Ivers, Habib Benzian, David C. Schwebel, Milena Ilic, Siddhesh Zadey, Davide Rasella, Hedayat Abbastabar, Aso Mohammad Darwesh, Kinley Wangdi, Ritesh G. Menezes, Jost B. Jonas, Dian Kusuma, Molly K. Miller-Petrie, Savita Lasrado, Goura Kishor Rath, Lalit Dandona, Farshad Farzadfar, Georgy Lebedev, Ahmed I. Hasaballah, Shaimaa I. El-Jaafary, Aniruddha Deshpande, Jacek Jerzy Jozwiak, Joseph Adel Mattar Banoub, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Vafa Rahimi-Movaghar, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Ambrish Singh, Fatemeh Rajati, Sonali Kochhar, Amir Khater, Ali Almasi, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Telma Zahirian Moghadam, Rajesh Sharma, Abel Fekadu Dadi, Sezer Kisa, Arash Etemadi, Zubair Kabir, Aslam Pervaiz, Muhammed Magdy Abd El Razek, Syed Ather Hussain, Mohsen Mazidi, Hamidreza Komaki, Reza Shirkoohi, Alex Yeshaneh, Faris Lami, Maha El Tantawi, Yunquan Zhang, Hamidreza Haririan, Lucas Guimarães Abreu, Tissa Wijeratne, Giuseppe Remuzzi, Bahram Mohajer, Christiane Dolecek, Vinay Nangia, Gebremicheal Gebreslassie Kasahun, Usman Iqbal, Nataliya A. Foigt, Andrey Nikolaevich Briko, Workua Mekonnen Metekiya, Chuanhua Yu, Elizabeth A. Cromwell, Pascual R. Valdez, Jennifer Rickard, Masoud Moradi, Hailay Abrha Gesesew, Naser Mohammad Gholi Mezerji, Getasew Taddesse Worku, Dinh-Toi Chu, Claudiu Herteliu, Dawit Zewdu Wondafrash, Gianna Gayle Herrera Amul, Mostafa Leili, Gebrehiwot G. Kassa, Soumyadeep Bhaumik, Ester Cerin, Bahram Armoon, Martin Amogre Ayanore, Shafiu Mohammed, Alexandria Brown, Charles Shey Wiysonge, Abbas Mosapour, Bach Xuan Tran, Lal B. Rawal, Muktar Beshir Ahmed, Wondimeneh Shibabaw Shiferaw, Mohamed M. Gad, Eugenio Traini, Aisha Elsharkawy, David M. Pigott, Temesgen Yihunie Akalu, Syed Mohamed Aljunid, Reza Malekzadeh, Ahmad Daryani, Olatunde Aremu, Mohammad Reza Salahshoor, Merhawi Gebremedhin Tekle, Derrick A Bennett, Oladimeji M. Adebayo, Bogdan Oancea, Jagdish Khubchandani, Sandra B. Munro, Naohiro Yonemoto, Ahmad Ghashghaee, Mohammed Ibrahim Mohialdeen Gubari, Marcela Agudelo-Botero, Bárbara Niegia Garcia de Goulart, Daniel Adane Endalew, Davide Guido, Alyssa N. Sbarra, Kerrie E. Doyle, Olalekan A. Uthman, Olatunji O. Adetokunboh, Zemichael Gizaw, Muhammad Usman, Farzaneh Ghazi Sherbaf, MohammadBagher Shamsi, Degena Bahrey Tadesse, Aziz Eftekhari, André Karch, Narinder Pal Singh, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Amira Hamed Darwish, Soufiane Boufous, Mohammad Reza Sobhiyeh, Frank B. Osei, Adhena Ayaliew Werkneh, Zahid A Butt, Paulina A. Lindstedt, Gregory M. Garcia, Balbir Bagicha Singh, Daniel Bekele Ketema, Genet Melak Alamene, Andem Effiong, André Faro, Amit Arora, Mohammad Hossein Khosravi, Dhirendra N Sinha, Amir Kasaeian, Ali Kabir, Josephine W. Ngunjiri, Hosni Salem, Sharareh Eskandarieh, Akhil Soman ThekkePurakkal, Anwar Ahmed, Tanuj Kanchan, Mu'awiyyah Babale Sufiyan, Bhaskaran Unnikrishnan, Daniel J. Weiss, Ziad El-Khatib, Jorge Cano, Javad Nazari, Ashish Pathak, Krishna Kumar Aryal, Nuruzzaman Khan, Roghayeh Mohammadibakhsh, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Dharmesh Kumar Lal, Habtamu Kebebe Kasaye, Harish Chander Gugnani, Ali S. Akanda, Mohammad Hifz Ur Rahman, Muluken Bekele Sorrie, Vivekanand Jha, Abdu A. Adamu, Zulfiqar A. Bhutta, Mohsen Afarideh, Tiffany K. Gill, Nelson Alvis-Guzman, Oliver J. Brady, Ebrahim Babaee, Takahiro Tabuchi, Alebachew Fasil, Anusha Ganapati Bhat, Marwa Rashad Salem, Till Winfried Bärnighausen, Sadaf G. Sepanlou, Paula Moraga, J. Car, Hoa Thi Do, Samad Azari, hawariat, Cuong Tat Nguyen, Michelle L. Bell, Mohamed I Hegazy, Mehedi Hasan, Mamusha Aman Hussen, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Santi Martini, Vishnu Renjith, Haileab Fekadu Wolde, Chabila C Mapoma, Aubrey J. Levine, Solomon Gedlu Nigatu, Hamid Yimam Hassen, Anh Kim Dang, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Doris D. V. Ortega-Altamirano, Kala M. Mehta, Boris Bikbov, Assefa Desalew, Carsten Flohr, Yahya Safari, Michael R.M. Abrigo, Mohammad Moradi-Joo, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Julia Moreira Pescarini, Saeed Amini, Mehdi Ahmadi, Benjamin Uzochukwu, Anas M. Saad, Robert C. Reiner, Ammar Albujeer, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Lauren E. Schaeffer, Irina Filip, Ali Yadollahpour, Ali Kiadaliri, Hamed Zandian, Fisaha Haile Tesfay, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Rafael Tabarés-Seisdedos, Paramjit Gill, Ketema Bizuwork Gebremedhin, Nicole Davis Weaver, Surendra Karki, Masoud Behzadifar, Vo Dinh Bay, Giang Hai Ha, Nizal Sarrafzadegan, In-Hwan Oh, Puja C Rao, Van Charles Lansingh, Kewal Krishan, Hany Aref, Man Mohan Mehndiratta, Shymaa Enany, Ayman Grada, Amador Goodridge, Salvatore Rubino, Zemenu Tadesse Tessema, Maheswar Satpathy, Amir Radfar, Aparna Lal, Isaac Akinkunmi Adedeji, Mehdi Naderi, Siavash Rahimi, Animut Alebel, Mohammad Rabiee, Diana Fernanda Bejarano Ramirez, Sivan Yegnanarayana Iyer Saraswathy, Sojib Bin Zaman, Alem Girmay, Ansariadi Ansariadi, Abdallah M. Samy, Mario Poljak, G Anil Kumar, Beatriz Paulina Ayala Quintanilla, Andrew S. Azman, Ronny Westerman, Thomas R. Hird, Themba G. Ginindza, Babak Moazen, Feleke Gebremeskel W, Meghdad Pirsaheb, Shally Awasthi, Morenike Oluwatoyin Folayan, Roman Topor-Madry, Phetole Walter Mahasha, Kamarul Imran Musa, Hebat Allah Salah A. Yousof, Afsaneh Arzani, Yousef Veisani, Farshad Pourmalek, Sharath Burugina Nagaraja, Ayesha Humayun, Michael Tamene Haile, Kiomars Sharafi, Wasiq Faraz Rawasia, Zoubida Zaidi, Getachew Mullu Kassa, Tsegaye Lolaso Lenjebo, Maryam Khayamzadeh, Nima Hafezi-Nejad, Mohammad Zamani, Takeshi Fukumoto, Masoud Foroutan, Noore Alam, Simin Mouodi, Miliva Mozaffor, Khanh Bao Tran, Farnam Mohebi, Sanjay Basu, Robert L. Thompson, Behzad Heibati, Santosh Varughese, Olayinka Stephen Ilesanmi, Neeraj Bedi, Hafiz Ansar Rasul Suleria, Oluchi Ezekannagha, Gabriel Martinez, Getinet Ayano, Farah Daoud, Konrad Pesudovs, Julio Cesar Campuzano Rincon, Tukur Dahiru, Mehdi Hosseinzadeh, Andualem Henok, Mina Anjomshoa, Rovshan Khalilov, Ai Koyanagi, Raaj Kishore Biswas, Navid Manafi, Yousef Mohammad, Keivan Ahmadi, Seyyed Shamsadin Athari, Binaya Chalise, Masood Ali Shaikh, Joan B. Soriano, Victor Adekanmbi, Seid Tiku Mereta, Delia Hendrie, Vijay Kumar Chattu, Gebrekiros Gebremichael Meles, Si Si, Manasi Kumar, Netsanet Fentahun, Amira Shaheen, Seyyede Masoume Athari, Marcos Roberto Tovani-Palone, Ben Lacey, Peter Njenga Keiyoro, Yared Asmare Aynalem, Entezar Mehrabi Nasab, K M Shivakumar, Tewodros Eshete Wonde, Dessalegn Ajema Berbada, Yahya Salimi, Adnan Kisa, Hisham Atan Edinur, Benn Sartorius, Kate E. LeGrand, Azadeh Shafieesabet, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Mona M. Khater, Reta Tsegaye Gayesa, Natalie Maria Cormier, Ghulam Mustafa, Ehsan Sadeghi, Nikolay Ivanovich Briko, Robert S. Bernstein, Samiah Alam, Duduzile Ndwandwe, Andrew T Olagunju, Obinna Onwujekwe, B. Suresh Kumar Shetty, Behnam Heidari, Arianna Maever L. Amit, John S. Ji, Pushpendra Kumar, Sangram Kishor Patel, Vera Marisa Costa, Yafeng Wang, Irfan Ullah, Sahar Saeedi Moghaddam, Virendra Singh, Tufa Kolola, Mehdi Yaseri, Abdullah Al Mamun, Hilton Y. Lam, Diego Augusto Santos Silva, Samath D Dharmaratne, Hajer Elkout, Yoshan Moodley, Linda Morales, Adrian Pana, Nauman Khalid, Hassen Mohammed, Fakher Rahim, Emma Elizabeth Spurlock, Mika Shigematsu, Bryan L. Sykes, Isaac Oluwafemi Dipeolu, Platon D. Lopukhov, Marzieh Nojomi, Khalid A Altirkawi, Dessalegn Haile, Mohsen Bayati, Senthilkumar Balakrishnan, Mohammad Ali Sahraian, Yasir Waheed, Ernoiz Antriyandarti, Tomohide Yamada, Alireza Rafiei, Bruno Ramos Nascimento, Ian Pollock, Ahamarshan Jayaraman Nagarajan, Kebede Embaye Gezae, Anton Sokhan, Mehran Shams-Beyranvand, Junaid Khan, Jacqueline Elizabeth Alcalde-Rabanal, Enrico Rubagotti, Mehran Alijanzadeh, Gillian I. Hollerich, Ismael R. Campos-Nonato, Eleonora Dubljanin, Itamar S. Santos, Wubalem Fekadu, Ole Frithjof Norheim, Florian Fischer, Kedir Hussein Abegaz, Nihal Thomas, Alaa Badawi, Amir Hasanzadeh, Nasir Salam, Muhammad Ali, Mohammad Ali Mansournia, Marcel Ausloos, Ensiyeh Jenabi, Bruno Piassi Sao Jose, Edgar Denova-Gutiérrez, Jae Il Shin, Jacob Olusegun Olusanya, Mohammad Hasan Imani-Nasab, Rajesh Sagar, Ahmed Abdelalim, Benjamin K. Mayala, Fatemeh Heydarpour, Maysaa El Sayed Zaki, Shiwei Liu, Soraya Siabani, Jonathan F. Mosser, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Valery L. Feigin, Yuan-Pang Wang, Mathew M. Baumann, Saravanan Muthupandian, Ingan Ukur Tarigan, Jasvinder A. Singh, Sebastian Vollmer, Felix Akpojene Ogbo, Alan J Thomson, Agus Sudaryanto, Birhanu Geta Meharie, Mihajlo Jakovljevic, Ahsan Saleem, Ali S. Shalash, Rakhi Dandona, Mojtaba Bagherzadeh, Ahmed Abualhasan, Muhammad Shahdaat Bin Sayeed, Meghnath Dhimal, Yves Miel H Zuniga, Akram Pourshams, Ionut Negoi, Yilma Chisha Dea Geramo, Franz Castro, Nefsu Awoke, Vahid Alipour, Rosario Cárdenas, Mohammad Khazaei, Mitchell T. Wallin, Yonatal Mesfin Tefera, Sanjay Zodpey, Bolajoko O. Olusanya, Ziad A. Memish, Taddese Alemu Zerfu, Claudio Alberto Dávila-Cervantes, Samer Hamidi, Gbenga A. Kayode, Peter Memiah, Sheikh Mohammed Shariful Islam, Francesco Saverio Violante, Bartosz Miazgowski, Babak Eshrati, Moses K. Muriithi, Mihiretu Kebede, Mowafa Househ, Monika Sawhney, Preeti Dhillon, Desta Haftu Hayelom, Ajay Patle, Thirunavukkarasu Sathish, Krittika Bhattacharyya, Hiroshi Yatsuya, Jaifred Christian F. Lopez, Barthelemy Kuate Defo, Arash Ziapour, Paul H. Lee, Emerito Jose A. Faraon, Seyed Sina Naghibi Irvani, Hagos Tasew Atalay, Tariq Jamal Siddiqi, Rafael Alves Guimarães, Aziz Sheikh, Adauto Martins Soares Filho, Eun-Kee Park, Kirsten E. Wiens, Hai Quang Pham, Berhe Etsay Tesfay, G. K. Mini, Zewdie Aderaw Alemu, Hedley Quintana, Milena Santric-Milicevic, Rajat Das Gupta, Parvaiz A Koul, Edson Serván-Mori, Foad Abd-Allah, Rahul Gupta, Dereje Bayissa Demissie, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Ayenew Negesse Abejie, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Liliana Preotescu, Walter Mendoza, Manfred S. Green, Mahesh P A, Somayeh Bohlouli, Huong Lan Thi Nguyen, Khaled Khatab, Ziyad Al-Aly, Ali H. Mokdad, Aditya P Dash, Andre M. N. Renzaho, Muhammad Aziz Rahman, Ghobad Moradi, Ruth W Kimokoti, Jalal Arabloo, Kimberly B. Johnson, Seyyed Meysam Mousavi, Hesham M. Al-Mekhlafi, D. R. Mahadeshwara Prasad, Rufus A. Adedoyin, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Engida Yisma, Azeem Majeed, Dina Nur Anggraini Ningrum, Hagazi Gebre Meles, Hala Elhabashy, Devasahayam J. Christopher, Malede Mequanent Sisay, Juan Sanabria, Gebre Teklemariam Demoz, Leonardo Roever, Shishay Wahdey Tekelemedhin, Guoqing Hu, Yousef Khader, Heather J. Zar, Hamideh Salimzadeh, Ali Bijani, Mehdi Sayyah, Shanshan Li, Kebreab Paulos, Tefera Chane Mekonnen, Mahya Beheshti, Siamak Sabour, Izza Shahid, Tuomo J. Meretoja, Ireneous N. Soyiri, Luca Ronfani, James Albright, Brijesh Sathian, Maciej Banach, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Mekdes Tigistu Yilma, Taweewat Wiangkham, Soewarta Kosen, Fernando de la Hoz, Mohammed Shannawaz, Luis Camera, Nevine El Nahas, Paul S. F. Yip, Miguel A Barboza, Ibrahim Abdollahpour, Augustine Mwangi Gatotoh, Gurudatta Naik, Kebede Deribe, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Instituto de Saúde Pública da Universidade do Porto, IRAS OH Epidemiology Chemical Agents, Local Burden of Disease WaSH Collaborator, Violante FS, Public Health, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, HUS Comprehensive Cancer Center, Clinicum, University of Helsinki, Department of Oncology, Yisma, Engida, and Local Burden of Disease WaSH Collaborators
Subjects: Drinking water access, Sanitation, Universal design, Geographic Mapping, Socioeconomic Factor, DISEASE, 0302 clinical medicine, RA0421, Hygiene, 11. Sustainability, Global health, 030212 general & internal medicine, media_common, 2. Zero hunger, Public health, lcsh:Public aspects of medicine, 1. No poverty, General Medicine, 3142 Public health care science, environmental and occupational health, 6. Clean water, Low-income countries, 3. Good health, A990 Medicine and Dentistry not elsewhere classified, CHILD GROWTH, TERRITORIES, HYGIENE, Human, 0605 Microbiology, Diarrhea, AFRICA, medicine.medical_specialty, media_common.quotation_subject, 030231 tropical medicine, Local Burden of Disease WaSH Collaborators, Developing country, Article, Geographical inequalities, 1117 Public Health and Health Services, 12. Responsible consumption, Developing Countrie, 03 medical and health sciences, NUTRITIONAL INTERVENTIONS, Environmental health, medicine, SYSTEMATIC ANALYSIS, Humans, QUALITY, Sanitation/statistics & numerical data, Open defecation, Improved sanitation, hand washing, Developing Countries, Models, Statistical, Middle-income countries, Drinking Water, lcsh:RA1-1270, Bayes Theorem, GLOBAL BURDEN, diarrheal disease, DIARRHEA, Diarrhea/epidemiology, Local Burden of Disease WaSH Collaborator, Socioeconomic Factors, 0605 Microbiology, 1117 Public Health and Health Services, ITC-ISI-JOURNAL-ARTICLE, Business, Human medicine, Sanitation facilities, ITC-GOLD
Abstract: Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce highresolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. This work was primarily supported by a grant from the Gates Foundation (OPP1132415). LGA has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado de Minas Gerais. OOA acknowledges the Department of Science and Innovation, National Research Foundation, and DSI/NRF Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch, South Africa. SMAl acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. HTA acknowledges Aksum University. MAu and CH are partly supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. AAz acknowledges funding from the Gates Foundation (OPP1171700). ABad is supported by the Public Health Agency of Canada. TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; the EU; the Wellcome Trust; and from National Institute of Child Health and Human Development of National Institutes of Health (NIH; R01-HD084233), National Institute on Aging of NIH (P01AG041710), National Institute of Allergy and Infectious Diseases of NIH (R01-AI124389 and R01-AI112339), as well as Fogarty International Center of NIH (D43-TW009775). DABen was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. GBB is supported by Sistema Nacional de Investigación (SNI) de la Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) of Panamá. FCar acknowledges UID/ MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/Ministério da Ciência, Tecnologia e Ensino Superior through national funds. VMC acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. JDN acknowledges support from the Alexander von Humboldt Foundation. DBD acknowledges support from the Gates Foundation. KD is supported by a Wellcome Trust grant (number 201900/Z/16/Z) as part of his International Intermediate Fellowship. AGo acknowledges Sistema Nacional de Investigadores de Panamá (SNI), Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). CH is partly supported by a grant co-funded by European Fund for Regional Development through the Operational Program for Competitiveness (project ID P_40_382). SMSI is funded by a Fellowship from National Heart Foundation of Australia and Deakin University. MJ and the Serbian part of this GBD contribution was co-funded through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. JK is a recipient of the 2020 Benjamin V Cohen Peace Fellowship from Ball State University Center for Peace and Conflict Studies. YJK’s work was supported by the Research Management Centre, Xiamen University Malaysia, grants number XMUMRF/2018-C2/ ITCM/0001. KKr is supported by a DST PURSE grant and UGC Center of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. BL acknowledges support from the NIHR Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence, Oxford. PTNM acknowledges the Council for the Development of Social Science Research in Africa. ANA acknowledges Debre Markos University for its support in-terms of office and internet access while reviewing this paper. AMSam received a fellowship from the Egyptian Fulbright Mission programme. MMS-M acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). AShi acknowledges the support of Health Data Research UK. MRS acknowledges the Clinical Research Development Center of Imam Reza Hospital, Kermanshah university of Medical sciences for their wise advice. JBS is part of Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. RT-S was supported in part by grant PI17/00719 from Instituto de Salud Carlos III–FEDER. BU acknowledges Manipal Academy of Higher Education, Manipal. TWij acknowledges the Migraine Foundation Australia and the Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapuraya, Sri Lanka. CSW was supported by the South African Medical Research Council. SBZ received a scholarship from the Australian Government research training program in support of his academic career.
Published: 2020

27. Mapping disparities in education across low- and middle-income countries

Author: Lauren E. Schaeffer, Belay Tessema, Reza Malekzadeh, Olatunde Aremu, Mehdi Hosseinzadeh, Milena M Santric Milicevic, Seyyed Meysam Mousavi, Azeem Majeed, Badr Hasan Sobaih, Jalal Arabloo, Philimon Gona, Aliasghar Ahmad Kiadaliri, Mostafa Qorbani, Fatemeh Rajati, Ipsita Sutradhar, Giuseppe Remuzzi, Babak Eshrati, Olufemi Ajumobi, Lauren Woyczynski, Parul Puri, Vinay Nangia, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Hamideh Salimzadeh, Félix Carvalho, Yun Jin Kim, Moslem Soofi, Ali Bijani, Shanshan Li, Catalina Liliana Andrei, Ali Kazemi Karyani, Mehran Asadi-Aliabadi, Andrea Sylvia Winkler, Arya Haj-Mirzaian, Maziar Moradi-Lakeh, Farnam Mohebi, Mohamad-Hani Temsah, Kala M. Mehta, Simon I. Hay, Benjamin B. Massenburg, Sanjay Zodpey, Tuomo J. Meretoja, Ireneous N. Soyiri, Bach Xuan Tran, George C Patton, Kavumpurathu Raman Thankappan, Engida Yisma, Vasily Vlassov, Samer Hamidi, Ghulam Mustafa, André Faro, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Rajat Gupta, Shirin Djalalinia, Dina Nur Anggraini Ningrum, Sheikh Mohammed Shariful Islam, Juan Sanabria, Leonardo Roever, Dayane Gabriele Alves Silveira, Samad Azari, Vahid Alipour, Gabrielle B. Britton, Luca Ronfani, Rosario Cárdenas, Maarten J. Postma, Hamid Yimam Hassen, Pn Sylaja, Brijesh Sathian, Paul S. F. Yip, Vegard Skirbekk, Chhabi Lal Ranabhat, Paramjit Gill, Walter Mendoza, Lorenzo Monasta, Dara K. Mohammad, Naznin Hossain, Dhirendra N Sinha, Ali H. Mokdad, Aziz Rezapour, Megan F. Schipp, Ziyad Al-Aly, Takeshi Fukumoto, Kebede Deribe, Paula Moraga, Mohammad Ebrahimi Kalan, Ai Koyanagi, Andre M. N. Renzaho, Cyrus Cooper, Ghobad Moradi, Ruth W Kimokoti, Swayam Prakash, Rafael Tabarés-Seisdedos, Zahra Jorjoran Shushtari, Zemenu Tadesse Tessema, Amir Radfar, Jean Jacques Noubiap, Emmanuela Gakidou, Mahdi Afshari, Suleman Atique, Reza Majdzadeh, Kiomars Sharafi, Seyed-Mohammad Fereshtehnejad, Foad Abd-Allah, Zahid A Butt, Beruk Berhanu Desalegn, Ruxandra Irina Negoi, Marek Majdan, Yoshan Moodley, Jianrong Zhang, Farid Najafi, Aso Mohammad Darwesh, Benn Sartorius, Amber Sligar, Nicole Davis Weaver, Naohiro Yonemoto, Jacob Olusegun Olusanya, Olayinka Stephen Ilesanmi, Neeraj Bedi, Suraj Bhattarai, Sadaf G. Sepanlou, Francisco Rogerlandio Martins-Melo, Malihe Nourollahpour Shiadeh, Bernardo Hernández Prado, Masood Ali Shaikh, Khalid A Altirkawi, Carlos Rios-Gonzalez, Claudiu Herteliu, Jason B. Hall, Irina Filip, Abdullah Sulieman Terkawi, Sojib Bin Zaman, Nathaniel J Henry, Eleonora Dubljanin, Jasvinder A. Singh, Pushpendra Kumar, Akram Pourshams, Jung-Chen Chang, Irfan Ullah, Lorainne Tudor Car, Franz Castro, George A. Mensah, Delia Hendrie, Mehran Shams-Beyranvand, Zulfiqar A Bhutta, Jaifred Christian F. Lopez, Laura Dwyer-Lindgren, Lee Ling Lim, Charles D.A. Wolfe, Adnan Kisa, Seyed Sina Naghibi Irvani, Alaa Badawi, Bolajoko O. Olusanya, Tomohide Yamada, Gholamreza Roshandel, Jonathan F. Mosser, Jose A. Garcia, Andre Rodrigues Duraes, Mohammadreza Amiresmaili, Krittika Bhattacharyya, Yuan-Pang Wang, Sebastian Vollmer, Felix Akpojene Ogbo, Birkneh Tilahun Tadesse, Mihajlo Jakovljevic, Songhomitra Panda-Jonas, Paul H. Lee, Michael Collison, Sanghamitra Pati, Aziz Sheikh, Kalkidan Hassen Abate, Anthony Barnett, Ejaz Ahmad Khan, Michael A. Cork, Meghnath Dhimal, Norberto Perico, Francesco Saverio Violante, Daniel N. Kiirithio, Ted R. Miller, Arundhati R. Sawant, Olalekan A. Uthman, Kewal Krishan, Ashish Awasthi, Anthony Masaka, Katherine F. Wilson, Padukudru Anand Mahesh, Roy Burstein, Amir Kasaeian, Yuming Guo, Peter Nyasulu, Chuanhua Yu, Pascual R. Valdez, Josephine W. Ngunjiri, Vipin Gupta, Tomislav Mestrovic, Long Hoang Nguyen, Neda Izadi, Faris Lami, Marcos Roberto Tovani-Palone, Azin Nahvijou, Jun She, Christopher J L Murray, Krishna K. Aryal, Payman Salamati, Mona M. Khater, Rajeev Gupta, Robert Reiner, Mustafa Z. Younis, Ali Rostami, Duduzile Ndwandwe, Obinna Onwujekwe, Manasi Kumar, Nafis Sadat, Nahla Anber, Joan B. Soriano, Victor Adekanmbi, John C. Wilkinson, Babak Moazen, Andrew T Olagunju, Nicholas Graetz, Andualem Henok, Mina Anjomshoa, Boris Bikbov, Melaku Desta, Yahya Safari, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Mohammad Fareed, Ayman Grada, Eduardo Ortiz-Panozo, Rajesh Sharma, Beatriz Paulina Ayala Quintanilla, Enrico Rubagotti, John S. Ji, Mika Shigematsu, Fakher Rahim, Randah R. Hamadeh, G. K. Mini, Yasir Waheed, Meghdad Pirsaheb, Yousef Veisani, Daniel Diaz, Adrian Pana, Salman Rawaf, Ehsan Sadeghi, Yahya Salimi, Joseph Adel Mattar Banoub, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, David M. Pigott, Fares Alahdab, Vafa Rahimi-Movaghar, Anbissa Muleta Senbeta, Tomi Akinyemiju, Damaris K. Kinyoki, Morteza Shamsizadeh, Ziad El-Khatib, Abdallah M. Samy, Roman Topor-Madry, Farah Daoud, Cuong Tat Nguyen, Aubrey J. Levine, Sameer Vali Gopalani, Ravi Prakash Jha, Mesfin Tadese Dinberu, Shafiu Mohammed, Simon Øverland, David Laith Rawaf, Arvin Haj-Mirzaian, Satar Rezaei, Oladimeji Adebayo, Nasir Salam, Mohammad Ali Mansournia, Rajesh Sagar, Alex Yeshaneh, Michael K. Hole, Agus Sudaryanto, Yunquan Zhang, Mahbobeh Faramarzi, Natalia V. Bhattacharjee, Aniruddha Deshpande, Soewarta Kosen, Mahmoud Yousefifard, Jacek Jerzy Jozwiak, Mehedi Hasan, Shane D. Morrison, Erkin M. Mirrakhimov, Marcel Ausloos, Ionut Negoi, Jacqueline Elizabeth Alcalde Rabanal, Barthelemy Kuate Defo, Giang Thu Vu, Lucas Earl, Doris D. V. Ortega-Altamirano, Yu Liao, Peter Njenga Keiyoro, Tanuj Kanchan, Chandrasekharan Nair Kesavachandran, Mu'awiyyah Babale Sufiyan, Mohammad Hifz Ur Rahman, Lidia Morawska, Tiffany K. Gill, Manisha Dubey, David C. Schwebel, Jost B. Jonas, Ester Cerin, Mehran Alijanzadeh, Florian Fischer, Stefan Listl, Benjamin K. Mayala, Mahmood Moosazadeh, Soraya Siabani, Derrick A Bennett, Collaborators, Local Burden of Disease Educational Attainment, Institute for Molecular Medicine Finland, HUS Comprehensive Cancer Center, Clinicum, Helsinki University Hospital Area, University of Helsinki, Local Burden Dis Educ Attainment C, Graetz N., Woyczynski L., Wilson K.F., Hall J.B., Abate K.H., Abd-Allah F., Adebayo O.M., Adekanmbi V., Afshari M., Ajumobi O., Akinyemiju T., Alahdab F., Al-Aly Z., Rabanal J.E.A., Alijanzadeh M., Alipour V., Altirkawi K., Amiresmaili M., Anber N.H., Andrei C.L., Anjomshoa M., Antonio C.A.T., Arabloo J., Aremu O., Aryal K.K., Asadi-Aliabadi M., Atique S., Ausloos M., Awasthi A., Quintanilla B.P.A., Azari S., Badawi A., Banoub J.A.M., Barker-Collo S.L., Barnett A., Bedi N., Bennett D.A., Bhattacharjee N.V., Bhattacharyya K., Bhattarai S., Bhutta Z.A., Bijani A., Bikbov B., Britton G., Burstein R., Butt Z.A., Cardenas R., Carvalho F., Castaneda-Orjuela C.A., Castro F., Cerin E., Chang J.-C., Collison M.L., Cooper C., Cork M.A., Daoud F., Das Gupta R., Weaver N.D., De Neve J.-W., Deribe K., Desalegn B.B., Deshpande A., Desta M., Dhimal M., Diaz D., Dinberu M.T., Djalalinia S., Dubey M., Dubljanin E., Duraes A.R., Dwyer-Lindgren L., Earl L., Kalan M.E., El-Khatib Z., Eshrati B., Faramarzi M., Fareed M., Faro A., Fereshtehnejad S.-M., Fernandes E., Filip I., Fischer F., Fukumoto T., Garcia J.A., Gill P.S., Gill T.K., Gona P.N., Gopalani S.V., Grada A., Guo Y., Gupta R., Gupta V., Haj-Mirzaian A., Hamadeh R.R., Hamidi S., Hasan M., Hassen H.Y., Hendrie D., Henok A., Henry N.J., Prado B.H., Herteliu C., Hole M.K., Hossain N., Hosseinzadeh M., Hu G., Ilesanmi O.S., Irvani S.S.N., Islam S.M.S., Izadi N., Jakovljevic M., Jha R.P., Ji J.S., Jonas J.B., Shushtari Z.J., Jozwiak J.J., Kanchan T., Kasaeian A., Karyani A.K., Keiyoro P.N., Kesavachandran C.N., Khader Y.S., Khafaie M.A., Khan E.A., Khater M.M., Kiadaliri A.A., Kiirithio D.N., Kim Y.J., Kimokoti R.W., Kinyoki D.K., Kisa A., Kosen S., Koyanagi A., Krishan K., Defo B.K., Kumar M., Kumar P., Lami F.H., Lee P.H., Levine A.J., Li S., Liao Y., Lim L.-L., Listl S., Lopez J.C.F., Majdan M., Majdzadeh R., Majeed A., Malekzadeh R., Mansournia M.A., Martins-Melo F.R., Masaka A., Massenburg B.B., Mayala B.K., Mehta K.M., Mendoza W., Mensah G.A., Meretoja T.J., Mestrovic T., Miller T.R., Mini G.K., Mirrakhimov E.M., Moazen B., Mohammad D.K., Darwesh A.M., Mohammed S., Mohebi F., Mokdad A.H., Monasta L., Moodley Y., Moosazadeh M., Moradi G., Moradi-Lakeh M., Moraga P., Morawska L., Morrison S.D., Mosser J.F., Mousavi S.M., Murray C.J.L., Mustafa G., Nahvijou A., Najafi F., Nangia V., Ndwandwe D.E., Negoi I., Negoi R.I., Ngunjiri J.W., Nguyen C.T., Nguyen L.H., Ningrum D.N.A., Noubiap J.J., Shiadeh M.N., Nyasulu P.S., Ogbo F.A., Olagunju A.T., Olusanya B.O., Olusanya J.O., Onwujekwe O.E., Ortega-Altamirano D.D.V., Ortiz-Panozo E., Overland S., Mahesh P.A., Pana A., Panda-Jonas S., Pati S., Patton G.C., Perico N., Pigott D.M., Pirsaheb M., Postma M.J., Pourshams A., Prakash S., Puri P., Qorbani M., Radfar A., Rahim F., Rahimi-Movaghar V., Rahman M.H.U., Rajati F., Ranabhat C.L., Rawaf D.L., Rawaf S., Reiner R.C., Remuzzi G., Renzaho A.M.N., Rezaei S., Rezapour A., Rios-Gonzalez C., Roever L., Ronfani L., Roshandel G., Rostami A., Rubagotti E., Sadat N., Sadeghi E., Safari Y., Sagar R., Salam N., Salamati P., Salimi Y., Salimzadeh H., Samy A.M., Sanabria J., Santric Milicevic M.M., Sartorius B., Sathian B., Sawant A.R., Schaeffer L.E., Schipp M.F., Schwebel D.C., Senbeta A.M., Sepanlou S.G., Shaikh M.A., Shams-Beyranvand M., Shamsizadeh M., Sharafi K., Sharma R., She J., Sheikh A., Shigematsu M., Siabani S., Silveira D.G.A., Singh J.A., Sinha D.N., Skirbekk V., Sligar A., Sobaih B.H., Soofi M., Soriano J.B., Soyiri I.N., Sreeramareddy C.T., Sudaryanto A., Babale Sufiyan M., Sutradhar I., Sylaja P., Tabares-Seisdedos R., Tadesse B.T., Temsah M.-H., Terkawi A.S., Tessema B., Tessema Z.T., Thankappan K.R., Topor-Madry R., Tovani-Palone M.R., Tran B.X., Car L.T., Ullah I., Uthman O.A., Valdez P.R., Veisani Y., Violante F.S., Vlassov V., Vollmer S., Thu Vu G., Waheed Y., Wang Y.-P., Wilkinson J.C., Winkler A.S., Wolfe C.D.A., Yamada T., Yeshaneh A., Yip P., Yisma E., Yonemoto N., Younis M.Z., Yousefifard M., Yu C., Bin Zaman S., Zhang J., Zhang Y., Zodpey S., Gakidou E., Hay S.I., Graetz, Nicholas, Woyczynski, Lauren, Wilson, Katherine F, Hall, Jason B, Yisma, Engida, Hay, Simon I, Local Burden of Disease Educational Attainment Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Value, Affordability and Sustainability (VALUE)
Subjects: Male, ATTAINMENT, Health Status, Disease, education, low- and middle-income countries, 0302 clinical medicine, WORLD, gender, Global health, risk factors, 030212 general & internal medicine, Aetiology, 10. No inequality, media_common, Developing world, Pediatric, Multidisciplinary, 1. No poverty, Multidisciplinary Sciences, Geography, Science & Technology - Other Topics, Female, HEALTH, developing world, social and economic factors, Engineering sciences. Technology, disparitie, AFRICA, medicine.medical_specialty, Inequality, General Science & Technology, media_common.quotation_subject, MODELS, Developing country, Local Burden of Disease Educational Attainment Collaborators, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Education, 03 medical and health sciences, 2.3 Psychological, medicine, Humans, Society, Social determinants of health, Developing Countries, Science & Technology, Equity (economics), MORTALITY, Public health, Bayes Theorem, Educational attainment, 3141 Health care science, society, Good Health and Well Being, Risk factors, Socioeconomic Factors, Demographic economics, 030217 neurology & neurosurgery
Abstract: Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12–14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations., Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations.
Published: 2020

28. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Author: Ninuk Hariyani, Benjamin Uzochukwu, Anas M. Saad, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Behzad Karami Matin, Abdallah M. Samy, Roman Topor-Madry, Nelson G.M. Gomes, Afsaneh Arzani, Simin Liu, Maryam Khayamzadeh, Ejaz Ahmad Khan, Asmamaw Bizuneh Demis, Anelisa Jaca, Amir Kasaeian, Fereshteh Ansari, Abdur Razzaque Sarker, Ali Kabir, Jorge Cano, Marcos Roberto Tovani-Palone, Tufa Kolola, Josephine W. Ngunjiri, Roghiyeh Faridnia, Kedir Hussein Abegaz, Hosni Salem, Sharareh Eskandarieh, Norberto Perico, Sergio I. Prada, Fisaha Haile Tesfay, Jai K Das, Ana Isabel Ribeiro, Sameer Vali Gopalani, Dessalegn Haile, Shivakumar Km Marulasiddaiah M. KMShivakumar, Narayan Prasad, Pranab Chatterjee, Shafiu Mohammed, Ravi Prakash Jha, Xiu Ju George Zhao, Farshad Farzadfar, Ahmad Daryani, Pramesh Raj Ghimire, Abbas Mosapour, Ebrahim Babaee, Rajat Das Gupta, Jean Jacques Noubiap, Daniel Bekele Ketema, Teshome Bekele Elema I, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Muktar Beshir Ahmed, Wondimeneh Shibabaw Shiferaw, Mehran Asadi-Aliabadi, Mohamed M. Gad, Eugenio Traini, Milena Santric-Milicevic, Bakhtiar Piroozi, Mohsen Afarideh, Duduzile Ndwandwe, Ibrahim Abdollahpour, Aisha Elsharkawy, Bárbara Niegia Garcia de Goulart, Soufiane Boufous, Obinna Onwujekwe, Seyyed Meysam Mousavi, Azeem Majeed, Meghnath Dhimal, Bruno F. Sunguya, Daniel Adane Endalew, Hosein Shabaninejad, Siddhesh Zadey, Takahiro Tabuchi, Gebrekiros Gebremichael Meles, Davide Guido, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Hala Elhabashy, Devasahayam J. Christopher, Malede Mequanent Sisay, Davide Rasella, Hedayat Abbastabar, Maziar Moradi-Lakeh, Anthony Masaka, Wagaye Fentahun Chanie, B. Suresh Kumar Shetty, Matiwos Soboka Daba, Tesfaye Yitna Yitna Chichiabellu, Arianna Maever L. Amit, Tomohide Yamada, Alireza Rafiei, Reinhard Busse, Abdullah Al Mamun, Genet Melak Alamene, George C Patton, Andem Effiong, Rushdia Ahmed, Jagadish Rao Padubidri, Mohamad-Hani Temsah, Nizal Sarrafzadegan I, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Kimberly B. Johnson, Benn Sartorius, Shirin Djalalinia, Mohsen Bayati, Merhawi Gebremedhin Tekle, Navid Rabiee, Javad Nazari, Krishna K. Aryal, Kavumpurathu Raman Thankappan, Yoshan Moodley, Anh Kim Dang, Mohammad Khazaei, Parvaiz A Koul, Edson Serván-Mori, Foad Abd-Allah, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Sonia Saxena, Bayu Begashaw Bekele, Hagos Degefa de Hidru I, Enayatollah Homaie Rad, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Oliver J. Brady, Natalie Maria Cormier, Ghulam Mustafa, Samiah Alam, Guoqing Hu, Yousef Khader, Mohsen Mazidi, Hamed Kalani, Hamideh Salimzadeh, Mayowa O. Owolabi, Ali Bijani, Getu Debalkie Demissie, Tsegaye Lolaso Lenjebo, German Martinez, Elias Merdassa Roro, Hamidreza Komaki, Giovanni Damiani, Nelson Alvis-Guzman, Reza Shirkoohi, Aditya Prasad Dash, Benny Antony, Cheru Tesema Leshargie, Josip Car, Turki Alanzi, Amir Jalali, Shahin Soltani, Arvin Haj-Mirzaian, John S. Ji, Nima Hafezi-Nejad, S. Mohammad Sajadi, Khalid A Altirkawi, Shanshan Li, Hunduma Amensisa Amensisa Bojia I, Estifanos Baye, Hany Aref, Kebreab Paulos, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Felix Lam, Themba G.G. Ginindza, Behnam Heidari, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Mostafa Leili, Sohail Ahmad, Babak Moazen, Samad Azari, Feleke Gebremeskel W, Jacqueline Elizabeth Alcalde-Rabanal, Khanh Bao Tran, Okechukwu S Ogah, Bruno Ramos Nascimento, Tefera Chane Mekonnen, Irina Filip, Bogdan Oancea, Lalit Dandona, Desalegn Markos Shifti, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Mohammad Ebrahimi Kalan, Sheetal D. Lad, Michael R.M. Abrigo, Ken Lee Chin, Masoud Moradi, Temesgen Yihunie Akalu, Behzad Heibati, Ole Frithjof Norheim, Man Mohan Mehndiratta, Mahya Beheshti, Ali Yadollahpour, Gelin Xu, Siamak Sabour, Neda Izadi, Carlos Culquichicón, Tuomo J. Meretoja, Ireneous N. Soyiri, Jacob Olusegun Olusanya, Félix Carvalho, Hamid Yimam Hassen, Dereje Bayissa Demissie, Yun Jin Kim, Rajesh Sagar, Fakher Rahim, Catrin E. Moore, Thomas R. Hird, Amjad Mohamadi-Bolbanabad, Naser Mohammad Gholi Mezerji, Ahamarshan Jayaraman Nagarajan, Anton Sokhan, Faris Lami, Masoud Behzadifar, Ritesh G. Menezes, Amira Hamed Darwish, Mohammad Zamani, Tesleem Kayode Babalola, Navid Manafi, Charles Shey Wiysonge, Diego Augusto Santos Silva, Daniel Diaz, Eleonora Dubljanin, Soraya Nouraei Motlagh, Suraj Bhattarai, Getasew Taddesse Worku, Noore Alam, Jasvinder A. Singh, Catalina Liliana Andrei, Ali Kazemi Karyani, Robert C. Reiner, Mohammedaman Mama Hussen, Fatemeh Heydarpour, Nuruzzaman Khan I, Bach Xuan Tran, Lal B. Rawal, Bereket Duko, Joemer C. Maravilla, Rakhi Dandona, Sandra B. Munro, Jae Il Shin, Julia Moreira Pescarini, Claudiu Herteliu, Ahmed Abdelalim, Manasi Kumar, Pushpendra Kumar, Saleem Muhammad Rana, Hedley Quintana, Akram Pourshams, Franz Castro, Muhammad Aziz Rahman, Beyene Meressa Adhena, Aberash Abay Tasew, Linda Morales, Dawit Zewdu Wondafrash, Wasiq Faraz Rawasia, David Laith Rawaf, Zoubida Zaidi, Tomislav Mestrovic, Rajeev Gupta, Seyyede Masoume Athari, Peter Njenga Keiyoro, Andrea Werdecker, Santi Martini, Fatemeh Rajati, Andre Pascal Kengne, Victor Adekanmbi, Seid Tiku Mereta, Yared Asmare Aynalem, Kewal Krishan, Marzieh Nojomi, Yves Miel H Zuniga, Mohammad Reza Sobhiyeh, Frank B. Osei, Nefsu Awoke, Randah R. Hamadeh, G. K. Mini, Edris Hasanpoor, Ayele Geleto Bali, Moslem Soofi, Prabhat Lamichhane, Peter Azzopardi, Amir Khater, G Anil Kumar, Catherine A. Welgan, Abraham Getachew Kelbore, Jaifred Christian F. Lopez, Senthilkumar Balakrishnan, Mohammad Ali Sahraian, Ahmed I. Hasaballah, Virendra Singh, Arash Ziapour, Zahid A Butt, Hebat Allah Salah A. Yousof, Tewodros Eshete Wonde, Sanjay Zodpey, Amaha Kahsay, Achala Upendra Jayatilleke, Segun Emmanuel Ibitoye, Beriwan Abdulqadir Ali, Simin Mouodi, Salman Rawaf, Iqbal R. F. Elyazar, Ai-Min Wu, Seyed Sina Naghibi Irvani, Yasir Waheed, Delia Hendrie, Hadi Pourjafar, Farnam Mohebi, Naohiro Yonemoto, Ahmad Ghashghaee, Veincent Christian Filipino Pepito, Paulina A. Lindstedt, Nauman Khalid, Sezer Kisa, Chi Linh Hoang, Niranjan Kissoon, Kindie Fentahun Muchie, Valery L. Feigin, Mathew M. Baumann, Alemayehu Toma, Andre Rodrigues Duraes, Benjamin B. Massenburg, Santosh Varughese, Yuan-Pang Wang, Ingan Ukur Tarigan, Ali Kiadaliri, Hamed Zandian, Demelash Woldeyohannes Handiso, Hassan Magdy Abd El Razek, Ketema Bizuwork Gebremedhin, Hafiz Ansar Rasul Suleria, Oluchi Ezekannagha, Getinet Ayano, Bolajoko O. Olusanya, Manu Raj Mathur, Manfred Accrombessi, Christopher J L Murray, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Yousef Mohammad, Luis Camera, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Negar Rezaei, Ted R. Miller, Aziz Eftekhari, Nevine El Nahas, Sebastian Vollmer, Sanjay Basu, Hesham M. Al-Mekhlafi, D. R. Mahadeshwara Prasad, Rufus A. Adedoyin, Miliva Mozaffor I, Mihiretu Kebede, Preeti Dhillon, Dilaram Acharya, Iman El Sayed, Narendar Manohar, Paul S. F. Yip, Ben Lacey, Felix Akpojene Ogbo, Adrian Davis, Dinh-Toi Chu, Ranjani Somayaji, Raaj Kishore Biswas, Taddese Alemu Zerfu, Claudio Alberto Dávila-Cervantes, Sharath Burugina Nagaraja, Getachew Mullu Kassa, Mohan Bairwa, Gurudatta Naik, André Karch, Gudlavalleti V S Murthy, Avula Laxmaiah, Farid Najafi, Birhanu Geta Meharie, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Samer Hamidi, Keivan Ahmadi, Kebede Deribe, Ehimario U. Igumbor, Engida Yisma, Henok Biresaw Netsere, Mihajlo Jakovljevic, Ali S. Shalash, Thirunavukkarasu Sathish, Sachin R Atre, Mohamed I Hegazy, Mehedi Hasan, Hamidreza Haririan, Lucas Guimarães Abreu, Nejimu Biza Zepro, Surendra Karki, Krittika Bhattacharyya, Hiroshi Yatsuya, Gbenga A. Kayode, Osayomwanbo Osarenotor, Paul H. Lee, Deepak Paudel, Hagos Tasew Atalay, Hatem S Shehata, Mohammad Fareed, Adnan Kisa, Hisham Atan Edinur, Mehran Alijanzadeh, Shafiur Rahman, Mohammad Hossein Khosravi, Anusha Ganapati Bhat, Bahram Mohajer, Narinder Pal Singh, Shai Linn, Savita Lasrado, Joseph Adel Mattar Banoub, Amir Almasi-Hashiani, Mohd Anisul Karim, Praveen Hoogar, Kerrie E. Doyle, Bedilu Girma Weji, Juan Sanabria, Olatunji O. Adetokunboh, Mohamed Hsairi, Alireza Esteghamati, Seok Jun Yoon, Paramjit Gill, Dabere Nigatu, Tariq Jamal Siddiqi, Muhammad Usman, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Florian Fischer, Peter Memiah, Rakesh Lodha, Nihal Thomas, Karzan Abdulmuhsin Mohammad, Mohammad Sadegh Rezai, Tanuj Kanchan, Vinay Nangia, Ashraf Nabhan, Gebre Teklemariam Demoz, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Sadaf G. Sepanlou, Michellr L. Bell, Nicola Luigi Bragazzi, Aklilu Endalamaw, Vishnu Renjith, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Ayenew Negesse Abejie, Smita Pakhale, Doris V.V. Ortega-Altamirano, Noushin Mohammadifard, Deborah Carvalho Malta, Vo Dinh Bay, Kirsten E. Wiens, Hamidreza Karimi-Sari, Mustafa Z. Younis, Shaimaa I. El-Jaafary, Morenike Oluwatoyin Folayan, Phetole Walter Mahasha, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Mohammad Hifz Ur Rahman, Sheikh Mohammed Shariful Islam, Maarten J. Postma, Usman Iqbal, Abdu A. Adamu, Marwa R.Rashad Salem I, Fares Alahdab, Vafa Rahimi-Movaghar, Zulfiqar A. Bhutta, Masoud Foroutan, Muhammad Shahzeb Khan, In-Hwan Oh, Yahya Salimi, Takeshi Fukumoto, Chhabi Lal Ranabhat, Tiffany K. Gill, Angel Paternina-Caicedo, Walter Mendoza, Sojib Bin Zaman, Olayinka Stephen Ilesanmi, Brigette F. Blacker, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Ambrish Singh, Mehdi Fazlzadeh, Mahesh P A, Carlo La Vecchia, Alex Yeshaneh, Benjamin K. Mayala, Aniruddha Deshpande, Agus Sudaryanto, Neeraj Bedi, Morteza Shamsizadeh, Jemal Abdu Mohammed, Vahid Alipour, Haileab Fekadu Wolde, Boris Bikbov, Ahmed Abualhasan, Ali H. Mokdad, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Jacek Jerzy Jozwiak, Alessandra C. Goulart, Mahmoud Yousefifard, Masood Ali Shaikh, Roya Safari-Faramani, MohammadBagher Shamsi, Aso Mohammad Darwesh, Amir Anoushiravani, Kebede Embaye Gezae, Degena Bahrey Tadesse, Paula Moraga, Maha El Tantawi, Rosario Cárdenas, Assefa Desalew, Vivek Kumar, Mina Anjomshoa, Junaid Khan, Jagdish Khubchandani, Marcel Ausloos, Soraya Siabani, Anwar E. Ahmed, Mohammed Ibrahim Mohialdeen Gubari, Andre M. N. Renzaho, Vuong Minh Nong, Kaushik Sarkar, Bruno Piassi Sao Jose, Yafeng Wang, Mitchell T. Wallin, Edgar Denova-Gutiérrez, Mohammad Hasan Imani-Nasab, Melese Abate Reta, Kala M. Mehta, Yahya Safari, Marufa Sultana, David C. Schwebel, Roghayeh Mohammadibakhsh, Samath D Dharmaratne, Maysaa El Sayed Zaki, Shiwei Liu, Gail Davey, Milena Ilic, Yunquan Zhang, Bahram Armoon, Seyed-Mohammad Fereshtehnejad, Jost B. Jonas, Dian Kusuma, Yawukal chane Kasahun, Beatriz Paulina Ayala Quintanilla, Mohammad Moradi-Joo, Gebrehiwot G. Kassa, Maria Jesus Rios-Blancas, Serge Resnikoff, Seifadin Ahmed Shallo, Bartosz Miazgowski, Huda Basaleem, Jobert Richie Nansseu, Enrico Rubagotti, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Maryam Adabi, Saravanan Muthupandian, Soumyadeep Bhaumik, hawariat, Carlos A Castañeda-Orjuela, Bhaskaran Unnikrishnan, Martin Amogre Ayanore, Dragos Virgil Davitoiu, Hossein Poustchi, Moses K. Muriithi, Dharmesh Kumar Lal, Ayman Grada, Rafael Tabarés-Seisdedos, Seyyed Shamsadin Athari, Ashish Pathak, Salvatore Rubino, Kenji Shibuya, Ana Laura Manda, Muluken Bekele Sorrie, Vivekanand Jha, Habtamu Kebebe Kasaye, Mohammad Hoseini, Sonali Kochhar, Van C. Lansingh, Ali Almasi, Amir Radfar, Till Bärnighausen, Marcia R. Weaver, Mowafa Househ, Arya Haj-Mirzaian, Gebremicheal Gebreslassie Kasahun, Arash Etemadi, Getahun Fentaw Mulaw, Zubair Kabir, Cuong Tat Nguyen, Chabila C Mapoma, Aubrey J. Levine, Solomon Gedlu Nigatu, Aslam Pervaiz, Muhammed Magdy Abd El Razek, Nataliya A. Foigt, Andrey Nikolaevich Briko, Sadaf Esteghamati, Chuanhua Yu, Pascual R. Valdez, Jennifer Rickard, Jennifer M. Ross, Ionut Negoi, Hailay Abrha Gesesew, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Sangram Kishor Patel, Vera Marisa Costa, Mostafa Hosseini, Hajer Elkout, Mika Shigematsu, Bryan L. Sykes, Afarin Rahimi-Movaghar, Nuworza Kugbey, Vijay Kumar Chattu, Payman Salamati, Mona M. Khater, Reta Tsegaye Gayesa, Ehsan Sadeghi, Andrew T Olagunju, Govinda Prasad Dhungana, Dina Nur Anggraini Ningrum, Yaschilal Muche Belayneh, Leonardo Roever, Luca Ronfani, Nathaniel J. Henry, Brijesh Sathian, Hamid Sharifi, Liliana Preotescu, Joshua Longbottom, Somayeh Bohlouli, Huong Lan Thi Nguyen, Khaled Khatab, Ziyad Al-Aly, Ghobad Moradi, Ruth W Kimokoti, Jalal Arabloo, Mariam Molokhia, Maciej Banach, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Mekdes Tigistu Yilma, Taweewat Wiangkham, Soewarta Kosen, Kovin Naidoo, Fernando de la Hoz, Mohammed Shannawaz, Berhe Etsay Tesfay I, Yogesh Sabde, Syed Mohamed Aljunid, Belay Tessema, Reza Malekzadeh, Tinuke O Olagunju, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Oladimeji M. Adebayo, Teshome Gebre, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Ismael R. Campos-Nonato, Alaa Badawi, Amir Hasanzadeh, Gebreamlak Gebremedhn Gebremeskel, Gessessew Bugssa Hailu, Dessalegn Ajema Berbada, Kate E. LeGrand, Azadeh Shafieesabet, Nikolay Ivanovich Briko, Robert S. Bernstein, Irfan Ullah, Isaac Oluwafemi Dipeolu, Hadi Hassankhani, Keyghobad Ghadiri, Local Burden of Disease Diarrhoea Collaborator, Violante FS, Wiens, KE, Lindstedt, PA, Blacker, BF, Johnson, KB, Yisma, E, Ahmed, Muktar Beshir, Reiner, Robert C, Duko, Bereket, Local Burden of Disease Diarrhoea Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, HUS Comprehensive Cancer Center, Clinicum, Institute for Molecular Medicine Finland, Department of Oncology, University of Helsinki, and Instituto de Saúde Pública da Universidade do Porto
Subjects: RJ101, medicine.medical_treatment, CHILDREN, ZINC, 0302 clinical medicine, 030212 general & internal medicine, media_common, Geography, lcsh:Public aspects of medicine, 1. No poverty, Low income and middle income countries, General Medicine, 3142 Public health care science, environmental and occupational health, 3. Good health, Child, Preschool, A990 Medicine and Dentistry not elsewhere classified, Geographical inequalities, 0605 Microbiology, Diarrhea, AFRICA, Inequality, DEATHS, media_common.quotation_subject, 030231 tropical medicine, Developing country, Article, RS, 1117 Public Health and Health Services, 03 medical and health sciences, MORBIDITY, Environmental health, DIARRHEAL DISEASE, medicine, Humans, Oral rehydration therapy, Healthcare Disparities, Developing Countries, Models, Statistical, CHOLERA, MORTALITY, Infant, Newborn, Infant, lcsh:RA1-1270, Bayes Theorem, Middle income, GLOBAL BURDEN, Child mortality, 0605 Microbiology, 1117 Public Health and Health Services, Health Care Surveys, ITC-ISI-JOURNAL-ARTICLE, Fluid Therapy, NA, Human medicine, ITC-GOLD
Abstract: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). L G Abreu has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado de Minas Gerais. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. H T Atalay acknowledges Aksum University. M Ausloos and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. P S Azzopardi was supported by an Australian National Health and Medical Research Council (NHMRC) early career fellowship. A Badawi is supported by the Public Health Agency of Canada. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; the EU; the Wellcome Trust; and from National Institute of Child Health and Human Development of National Institutes of Health (NIH; R01-HD084233), National Institute on Aging of NIH (P01-AG041710), National Institute of Allergy and Infectious Diseases of NIH (R01-AI124389 and R01-AI112339), as well as Fogarty International Center of NIH (D43-TW009775). G B Britton is supported by Sistema Nacional de Investigación (SNI) de la Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) of Panamá. A Barac is funded by the Project of Ministry of Education, Science and Technology of the Republic of Serbia (number III45005). D A Bennett was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/Ministério da Ciência, Tecnologia e Ensino Superior through national funds. K Deribe is supported by a Wellcome Trust grant (number 201900/Z/16/Z) as part of his International Intermediate Fellowship. C Herteliu is partially supported by a grant co-funded by European Fund for Regional Development through the Operational Program for Competitiveness (project ID P_40_382). P Hoogar thanks Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education, Manipal and Centre for Holistic Development and Research, Kalaghatgi-Karnataka. S M S Islam is funded by a Fellowship from National Heart Foundation of Australia and Deakin University. M Jakovljevic and the Serbian part of this GBD contribution was co-funded through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. A P Kengne is supported by the South African Medical Research Council. Y J Kim's work was supported by the Research Management Centre, Xiamen University Malaysia, grants number XMUMRF/2018-C2/ITCM/0001. K Krishan is supported by a DST PURSE grant and UGC Center of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar acknowledges K43 TW010716-03. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence, Oxford. P T N Memiah acknowledges the Council for the Development of Social Science Research in Africa. M Molokhia is supported by the NIHR Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London. I Moreno Velásquez is supported by the Sistema Nacional de Investigación (SENACYT, Panamá). G C Patton is funded by an NHMRC Fellowship. A M Samy received a fellowship from the Egyptian Fulbright Mission programme. M M Santric-Milicevic acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). A Sheikh acknowledges the support of Health Data Research UK. M R Sobhiyeh acknowledges the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences for their wise advice. R Tabarés-Seisdedos was supported in part by grant PI17/00719 from Instituto de Salud Carlos III–FEDER. B Unnikrishnan acknowledges Manipal Academy of Higher Education, Manipal. M R Weaver was supported by the Bill & Melinda Gates Foundation grant OPP1127433. C S Wiysonge was supported by the South African Medical Research Council.
Published: 2020

29. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. Undurraga, Oladimeji M. Adebayo, Simon Yadgir, Victor Aboyans, Justin J. Lang, Catherine O. Johnson, Soewarta Kosen, Carla Sofia e.Sá Farinha, Marcos Roberto Tovani-Palone, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Heather Orpana, Samuel B. Albertson, Mahdi Afshari, Nicholas J K Breitborde, Nelson J. Alvis-Zakzuk, Adrian Oţoiu, Iván Landires, Robert G. Weintraub, Kidanemaryam Berhe, André Faro, Sophia Emmons-Bell, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Yordanos Gizachew Yeshitila, Mehdi Hosseinzadeh, Arash Etemadi, Oleguer Plana-Ripoll, Theodore Patrick Younker, Joemer C. Maravilla, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayanaswamy Venketasubramanian, Seyed Mohammad Kazem Aghamir, Linda Morales, Amanda Deen, Noushin Mohammadifard, Obinna Onwujekwe, Ai Koyanagi, Michele Nguyen, Chieh Han, Kiana Ramezanzadeh, Mika Shigematsu, Mohammed Shannawaz, Khurshid Alam, Javad Nazari, Bryan L. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020

30. Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report

Author: Katia Rueda, Tania T. Herrera, Gabrielle B. Britton, and Honorina Espinosa
Subjects: Adult, medicine.medical_specialty, Twin pregnancy, Perforation (oil well), Twin reversed arterial perfusion, Prenatal diagnosis, lcsh:Medicine, Case Report, 030204 cardiovascular system & hematology, TRAP sequence, Fetoscopy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Fetal intervention, medicine, Humans, Twin Pregnancy, medicine.diagnostic_test, business.industry, Cesarean Section, lcsh:R, Infant, Newborn, Pregnancy Outcome, Gestational age, General Medicine, Fetofetal Transfusion, medicine.disease, Surgery, Perfusion, Fetal therapies, 030220 oncology & carcinogenesis, Intestinal volvulus, Pregnancy, Twin, Female, Laser Therapy, business, Premature rupture of membranes
Abstract: Background Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology. Conclusions The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancies.
Published: 2019

31. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Author: Mohsen Bayati, Arvin Haj-Mirzaian, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Nasir Salam, Mohamad-Hani Temsah, Fatemeh Heydarpour, Davide Rasella, Kavumpurathu Raman Thankappan, Ghulam Mustafa, Sergey Konstantinovitch Vladimirov, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Leonardo Roever, Oghenowede Eyawo, Koustuv Dalal, Ana-Laura Manda, Ritesh G. Menezes, Molly K. Miller-Petrie, Javad Yoosefi Lebni, Gebreamlak Gebremedhn Gebremeskel, Aziz Eftekhari, Oleguer Plana-Ripoll, Jon Wakefield, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Edris Hasanpoor, Brijesh Sathian, Kala M. Mehta, Moritz U. G. Kraemer, Saeed Amini, Hesham M. Al-Mekhlafi, Abbas Yadegar, João Pedro Silva, Desmond Kuupiel, Anvar Asadi, Hamid Sharifi, Ebrahim Babaee, Dessalegn Ajema Berbada, Taddese Alemu Zerfu, Ian Davis, Mostafa Qorbani, Fatemeh Rajati, Samer Hamidi, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Syed Mohamed Aljunid, Elias Merdassa Roro, Mihaela Hostiuc, Robert S. Bernstein, Vahid Yazdi-Feyzabadi, Gebre Teklemariam Demoz, Irina Filip, Mu'awiyyah Babale Sufiyan, Amir Khater, Lidia Morawska, Sangram Kishor Patel, Robert C. Reiner, Joshua O. Akinyemi, Telma Zahirian Moghadam, Ali Akbar Fazaeli, Reza Malekzadeh, Olatunde Aremu, Mohammad Reza Salahshoor, Irfan Ullah, Gabrielle B. Britton, Gelin Xu, Nathaniel J Henry, Thomas R. Hird, Ronny Westerman, Vera Marisa Costa, Reza Assadi, Tiffany K. Gill, Chhabi Lal Ranabhat, Meysam Olfatifar, Sezer Kisa, Grant Rodgers Kemp, Mahmoud Yousefifard, Aleksandra Barac, Simon I. Hay, Walter Mendoza, Mohammad Zamani, Nader Jafari Balalami, Mahdi Safdarian, Manfred S. Green, Mahesh P A, Nahid Neamati, Pallab K. Maulik, Ali H. Mokdad, Joshua Longbottom, Somayeh Bohlouli, Ahmad Daryani, Ibrahim Abdollahpour, Mostafa Hosseini, Deborah Carvalho Malta, Nick Golding, Sheikh Mohammed Shariful Islam, Shirin Nosratnejad, Haidong Wang, Shadi Rahimzadeh, Pushpendra Kumar, Mehdi Noroozi, Andre M. N. 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To, Ester Cerin, Martin Amogre Ayanore, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), Veritati - Repositório Institucional da Universidade Católica Portuguesa, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, UT-I-ITC-ACQUAL, GeoHealth, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, Clinicum, HUS Comprehensive Cancer Center, Staff Services, Department of Surgery, University of Helsinki, Islam, Nazrul [0000-0003-3982-4325], Apollo - University of Cambridge Repository, Burstein R., Henry N.J., Collison M.L., Marczak L.B., Sligar A., Watson S., Marquez N., Abbasalizad-Farhangi M., Abbasi M., Abd-Allah F., Abdoli A., Abdollahi M., Abdollahpour I., Abdulkader R.S., Abrigo M.R.M., Acharya D., Adebayo O.M., Adekanmbi V., Adham D., Afshari M., Aghaali M., Ahmadi K., Ahmadi M., Ahmadpour E., Ahmed R., Akal C.G., Akinyemi J.O., Alahdab F., Alam N., Alamene G.M., Alene K.A., Alijanzadeh M., Alinia C., Alipour V., Aljunid S.M., Almalki M.J., Al-Mekhlafi H.M., Altirkawi K., Alvis-Guzman N., Amegah A.K., Amini S., Amit A.M.L., Anbari Z., Androudi S., Anjomshoa M., Ansari F., Antonio C.A.T., Arabloo J., Arefi Z., Aremu O., Armoon B., Arora A., Artaman A., Asadi A., Asadi-Aliabadi M., Ashraf-Ganjouei A., Assadi R., Ataeinia B., Atre S.R., Quintanilla B.P.A., Ayanore M.A., Azari S., Babaee E., Babazadeh A., Badawi A., Bagheri S., Bagherzadeh M., Baheiraei N., Balouchi A., Barac A., Bassat Q., Baune B.T., Bayati M., Bedi N., Beghi E., Behzadifar M., Belay Y.B., Bell B., Bell M.L., Berbada D.A., Bernstein R.S., Bhattacharjee N.V., Bhattarai S., Bhutta Z.A., Bijani A., Bohlouli S., Breitborde N.J.K., Britton G., Browne A.J., Nagaraja S.B., Busse R., Butt Z.A., Car J., Cardenas R., Castaneda-Orjuela C.A., Cerin E., Chanie W.F., Chatterjee P., Chu D.-T., Cooper C., Costa V.M., Dalal K., Dandona L., Dandona R., Daoud F., Daryani A., Das Gupta R., Davis I., Davis Weaver N., Davitoiu D.V., De Neve J.-W., Demeke F.M., Demoz G.T., Deribe K., Desai R., Deshpande A., Desyibelew H.D., Dey S., Dharmaratne S.D., Dhimal M., Diaz D., Doshmangir L., Duraes A.R., Dwyer-Lindgren L., Earl L., Ebrahimi R., Ebrahimpour S., Effiong A., Eftekhari A., Ehsani-Chimeh E., El Sayed I., El Sayed Zaki M., El Tantawi M., El-Khatib Z., Emamian M.H., Enany S., Eskandarieh S., Eyawo O., Ezalarab M., Faramarzi M., Fareed M., Faridnia R., Faro A., Fazaeli A.A., Fazlzadeh M., Fentahun N., Fereshtehnejad S.-M., Fernandes J.C., Filip I., Fischer F., Foigt N.A., Foroutan M., Francis J.M., Fukumoto T., Fullman N., Gallus S., Gebre D.G., Gebrehiwot T.T., Gebremeskel G.G., Gessner B.D., Geta B., Gething P.W., Ghadimi R., Ghadiri K., Ghajarzadeh M., Ghashghaee A., Gill P.S., Gill T.K., Golding N., Gomes N.G.M., Gona P.N., Gopalani S.V., Gorini G., Goulart B.N.G., Graetz N., Greaves F., Green M.S., Guo Y., Haj-Mirzaian A., Hall B.J., Hamidi S., Haririan H., Haro J.M., Hasankhani M., Hasanpoor E., Hasanzadeh A., Hassankhani H., Hassen H.Y., Hegazy M.I., Hendrie D., Heydarpour F., Hird T.R., Hoang C.L., Hollerich G., Rad E.H., Hoseini-Ghahfarokhi M., Hossain N., Hosseini M., Hosseinzadeh M., Hostiuc M., Hostiuc S., Househ M., Hsairi M., Ilesanmi O.S., Imani-Nasab M.H., Iqbal U., Irvani S.S.N., Islam N., Islam S.M.S., Jurisson M., Balalami N.J., Jalali A., Javidnia J., Jayatilleke A.U., Jenabi E., Ji J.S., Jobanputra Y.B., Johnson K., Jonas J.B., Shushtari Z.J., Jozwiak J.J., Kabir A., Kahsay A., Kalani H., Kalhor R., Karami M., Karki S., Kasaeian A., Kassebaum N.J., Keiyoro P.N., Kemp G.R., Khabiri R., Khader Y.S., Khafaie M.A., Khan E.A., Khan J., Khan M.S., Khang Y.-H., Khatab K., Khater A., Khater M.M., Khatony A., Khazaei M., Khazaei S., Khazaei-Pool M., Khubchandani J., Kianipour N., Kim Y.J., Kimokoti R.W., Kinyoki D.K., Kisa A., Kisa S., Kolola T., Kosen S., Koul P.A., Koyanagi A., Kraemer M.U.G., Krishan K., Krohn K.J., Kugbey N., Kumar G.A., Kumar M., Kumar P., Kuupiel D., Lacey B., Lad S.D., Lami F.H., Larsson A.O., Lee P.H., Leili M., Levine A.J., Li S., Lim L.-L., Listl S., Longbottom J., Lopez J.C.F., Lorkowski S., Magdeldin S., Abd El Razek H.M., Abd El Razek M.M., Majeed A., Maleki A., Malekzadeh R., Malta D.C., Mamun A.A., Manafi N., Manda A.-L., Mansourian M., Martins-Melo F.R., Masaka A., Massenburg B.B., Maulik P.K., Mayala B.K., Mazidi M., McKee M., Mehrotra R., Mehta K.M., Meles G.G., Mendoza W., Menezes R.G., Meretoja A., Meretoja T.J., Mestrovic T., Miller T.R., Miller-Petrie M.K., Mills E.J., Milne G.J., Mini G.K., Mir S.M., Mirjalali H., Mirrakhimov E.M., Mohamadi E., Mohammad D.K., Darwesh A.M., Mezerji N.M.G., Mohammed A.S., Mohammed S., Mokdad A.H., Molokhia M., Monasta L., Moodley Y., Moosazadeh M., Moradi G., Moradi M., Moradi Y., Moradi-Lakeh M., Moradinazar M., Moraga P., Morawska L., Mosapour A., Mousavi S.M., Mueller U.O., Muluneh A.G., Mustafa G., Nabavizadeh B., Naderi M., Nagarajan A.J., Nahvijou A., Najafi F., Nangia V., Ndwandwe D.E., Neamati N., Negoi I., Negoi R.I., Ngunjiri J.W., Thi Nguyen H.L., Nguyen L.H., Nguyen S.H., Nielsen K.R., Ningrum D.N.A., Nirayo Y.L., Nixon M.R., Nnaji C.A., Nojomi M., Noroozi M., Nosratnejad S., Noubiap J.J., Motlagh S.N., Ofori-Asenso R., Ogbo F.A., Oladimeji K.E., Olagunju A.T., Olfatifar M., Olum S., Olusanya B.O., Oluwasanu M.M., Onwujekwe O.E., Oren E., Ortega-Altamirano D.D.V., Ortiz A., Osarenotor O., Osei F.B., Osgood-Zimmerman A.E., Otstavnov S.S., Owolabi M.O., Mahesh P.A., Pagheh A.S., Pakhale S., Panda-Jonas S., Pandey A., Park E.-K., Parsian H., Pashaei T., Patel S.K., Pepito V.C.F., Pereira A., Perkins S., Pickering B.V., Pilgrim T., Pirestani M., Piroozi B., Pirsaheb M., Plana-Ripoll O., Pourjafar H., Puri P., Qorbani M., Quintana H., Rabiee M., Rabiee N., Radfar A., Rafiei A., Rahim F., Rahimi Z., Rahimi-Movaghar V., Rahimzadeh S., Rajati F., Raju S.B., Ramezankhani A., Ranabhat C.L., Rasella D., Rashedi V., Rawal L., Reiner Jr R.C., Renzaho A.M.N., Rezaei S., Rezapour A., Riahi S.M., Ribeiro A.I., Roever L., Roro E.M., Roser M., Roshandel G., Roshani D., Rostami A., Rubagotti E., Rubino S., Sabour S., Sadat N., Sadeghi E., Saeedi R., Safari Y., Safari-Faramani R., Safdarian M., Sahebkar A., Salahshoor M.R., Salam N., Salamati P., Salehi F., Zahabi S.S., Salimi Y., Salimzadeh H., Salomon J.A., Sambala E.Z., Samy A.M., Santric Milicevic M.M., Jose B.P.S., Saraswathy S.Y.I., Sarmiento-Suarez R., Sartorius B., Sathian B., Saxena S., Sbarra A.N., Schaeffer L.E., Schwebel D.C., Sepanlou S.G., Seyedmousavi S., Shaahmadi F., Shaikh M.A., Shams-Beyranvand M., Shamshirian A., Shamsizadeh M., Sharafi K., Sharif M., Sharif-Alhoseini M., Sharifi H., Sharma J., Sharma R., Sheikh A., Shields C., Shigematsu M., Shiri R., Shiue I., Shuval K., Siddiqi T.J., Silva J.P., Singh J.A., Sinha D.N., Sisay M.M., Sisay S., Sliwa K., Smith D.L., Somayaji R., Soofi M., Soriano J.B., Sreeramareddy C.T., Sudaryanto A., Sufiyan M.B., Sykes B.L., Sylaja P.N., Tabares-Seisdedos R., Tabb K.M., Tabuchi T., Taveira N., Temsah M.-H., Terkawi A.S., Tessema Z.T., Thankappan K.R., Thirunavukkarasu S., To Q.G., Tovani-Palone M.R., Tran B.X., Tran K.B., Ullah I., Usman M.S., Uthman O.A., Vahedian-Azimi A., Valdez P.R., van Boven J.F.M., Vasankari T.J., Vasseghian Y., Veisani Y., Venketasubramanian N., Violante F.S., Vladimirov S.K., Vlassov V., Vos T., Vu G.T., Vujcic I.S., Waheed Y., Wakefield J., Wang H., Wang Y., Wang Y.-P., Ward J.L., Weintraub R.G., Weldegwergs K.G., Weldesamuel G.T., Westerman R., Wiysonge C.S., Wondafrash D.Z., Woyczynski L., Wu A.-M., Xu G., Yadegar A., Yamada T., Yazdi-Feyzabadi V., Yilgwan C.S., Yip P., Yonemoto N., Lebni J.Y., Younis M.Z., Yousefifard M., Yousof H.-A.S.A., Yu C., Yusefzadeh H., Zabeh E., Moghadam T.Z., Bin Zaman S., Zamani M., Zandian H., Zangeneh A., Zerfu T.A., Zhang Y., Ziapour A., Zodpey S., Murray C.J.L., and Hay S.I.
Subjects: Survival, RJ101, Mortalidad Infantil, HB, UNDER-5 MORTALITY, Global Health, Pediatrics, 0302 clinical medicine, 3123 Gynaecology and paediatrics, Child death, Infant Mortality, Epidemiology, Global health, Middle income country, Nacimiento vivo, 030212 general & internal medicine, 10. No inequality, Child, POPULATION, Developing world, education.field_of_study, Public health, Multidisciplinary, Geography, Mortality rate, wa_900, 1. No poverty, SUCCESS, Pediatrik, A900 Others in Medicine and Dentistry, 3142 Public health care science, environmental and occupational health, 3. Good health, Child Mortality, Death children, VACCINATION, HEALTH, ws_100, INTERVENTIONS, AFRICA, medicine.medical_specialty, United Nations, General Science & Technology, 030231 tropical medicine, Population, Developing country, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], ITC-HYBRID, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Social Justice, Recién nacido, Neonatal deaths, medicine, SYSTEMATIC ANALYSIS, Organizational Objectives, Humans, education, Developing Countries, business.industry, Infant, Newborn, Infant, CIVIL REGISTRATION, Paediatrics, Child survival, Newborn, PREVENTION, Infant mortality, wa_320, ws_200, Child mortality, Socioeconomic Factors, ITC-ISI-JOURNAL-ARTICLE, Human medicine, Paediatrics, Public health, Developing world, business, Demography
Abstract: Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations., A high-resolution, global atlas of mortality of children under five years of age between 2000 and 2017 highlights subnational geographical inequalities in the distribution, rates and absolute counts of child deaths by age.
Published: 2019

32. Vascular biomarkers and ApoE4 expression in mild cognitive impairment and Alzheimer’s disease

Author: Shantal Grajales, Maria B. Carreira, Gabrielle B Britton, Diana C Oviedo, Ana Frank, Hector Lezcano, Ambar Pérez, Sara Fernández, Baltasar Isaza, Alcibiades E. Villarreal, and Lavinia Wesley
Subjects: cognition, Apolipoprotein E, medicine.medical_specialty, aging| cognition| atherosclerosis| intima-media thickness| stenosis| Latin America| Panama, Panama, Disease, lcsh:RC321-571, Internal medicine, Medicine, intima-media thickness, Prospective cohort study, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, business.industry, General Neuroscience, aging, stenosis, Neuropsychology, Cognition, medicine.disease, Executive functions, Stenosis, Latin America, Intima-media thickness, atherosclerosis, business, Research Article
Abstract: Vascular pathology and genetic markers such as apolipoprotein E allele ε4 (ApoE ε4) are risk factors for the progression from mild cognitive impairment (MCI) to Alzheimer’s disease (AD). In Panama, a high prevalence of vascular risk factors and an increase in the aging population, generate the need to investigate biomarkers using specific, sensitive, non-invasive and cost-efficient methods that could be used in primary care. The main objective of this study was to explore the association between vascular biomarkers such as intima-media thickness (IMT) and stenosis, ApoΕ ε4 and cognitive function in a sample of older adults, including healthy controls (n = 41), MCI (n = 33), and AD (n = 12). A descriptive and cross-sectional study was conducted. Participants were part of the Panama Aging Research Initiative (PARI), the first prospective study in aging in Panama. Assessments included a neuropsychological battery, ApoΕ ε4 genotyping and a Doppler ultrasound of the left carotid artery to examine the presence of vascular risk factors. Neuropsychological tests were combined to form six cognitive domains: Global cognition, language, visuospatial abilities, learning and memory, attention and executive functions. Multivariable analyses (using age, education, and ApoE ε4 expression as covariates) were conducted. Participants with increased IMT showed poorer performance in memory and those with carotid stenosis showed poorer performance in language, visuospatial abilities and attention, independent of age, education or ApoΕ ε4 expression. The results support the use of vascular markers in cognitive assessments of aged individuals.
Published: 2018

33. Limitations in Activities of Daily Living among Dementia-Free Older Adults in Panama

Author: Vivian Vasquez, Astevia Montalván, Lineth López, Shantal Grajales, Lee Anne Gómez, Diana C Oviedo, Maria B. Carreira, Gabrielle B Britton, and Alcibiades E. Villarreal
Subjects: Gerontology, Panama, Population ageing, Health (social science), Activities of daily living, business.industry, Psychological intervention, Logistic regression, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Elderly population, medicine, Dementia, 030212 general & internal medicine, business, human activities, Stroke, 030217 neurology & neurosurgery
Abstract: The Latin America and Caribbean region is experiencing one of the fastest rates of population aging, but research on age-related disability is limited, particularly in Central America. The aim of this study was to examine limitations in the performance of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and their association with sociodemographic and health-related factors in a sample of adults aged 65 and older in Panama. Cross-sectional data are reported for 370 community-dwelling elderly outpatients (144 males, 226 females) without dementia. Self-reported BADL and IADL limitations were the outcomes. Logistic regression models were used to examine the association between sociodemographic and health characteristics and at least one limitation or severe (four or more) limitations. Approximately half (53.5%) and one-third (66.8%) of participants reported at least one BADL and IADL limitation, respectively. Increased age (≥ 80 years), being male, less education, and a history of stroke were independently and significantly associated with BADL limitations. The same variables, in addition to reporting four or more chronic illnesses, were independently and significantly associated with IADL limitations. The results are consistent with previous research in low and middle-income countries regarding the factors associated with BADL and IADL disability in older adults. Assessing the extent of disability among Panama’s elderly population is vital for identifying those at risk of transitioning to worse states of health over the course of aging and designing specific interventions to meet the needs of older adults.
Published: 2018

34. Blood-based biomarkers of adverse perinatal outcomes in maternal obesity

Author: Tania T. Herrera, Gabrielle B. Britton, and Jillian L. Garcia
Subjects: medicine.medical_specialty, 030209 endocrinology & metabolism, Prenatal diagnosis, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Prenatal Diagnosis, medicine, Humans, Obesity, Fetus, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Infant, Newborn, Pregnancy Outcome, Obstetrics and Gynecology, Prognosis, medicine.disease, Infant mortality, Pregnancy Complications, Relative risk, Pediatrics, Perinatology and Child Health, Biomarker (medicine), Female, business, Body mass index, Biomarkers, Blood Chemical Analysis
Abstract: Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity.Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes.It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfilled the criteria to be considered clinically useful.There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.
Published: 2017

35. The Panama Aging Research Initiative Longitudinal Study

Author: Shantal Grajales, Maria B. Carreira, Ambar R Pérez-Lao, Alcibiades E. Villarreal, Gabrielle B. Britton, and Diana C Oviedo
Subjects: Male, Gerontology, Longitudinal study, medicine.medical_specialty, Panama, Comorbidity, Body Mass Index, Apolipoproteins E, Risk Factors, Activities of Daily Living, Epidemiology, Humans, Medicine, Dementia, Longitudinal Studies, Cognitive decline, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, Hand Strength, Depression, business.industry, General Medicine, medicine.disease, Chronic Disease, Polypharmacy, Accidental Falls, Female, Cognition Disorders, business, Biomarkers, Cohort study, Blood drawing
Abstract: The Panama Aging Research Initiative is a cohort study of 423 adults aged ≥65 years recruited from an outpatient geriatric department of Panama's largest public hospital, the Social Security Fund's Dr Arnulfo Arias Madrid Hospital Complex (Complejo Hospitalario Dr Arnulfo Arias Madrid de la Caja de Seguro Social). The study provides the first reports of modifiable and non-modifiable risk factors of cognitive impairment and dementia, as well as various health conditions common among older adults in Panama, including chronic illnesses, polypharmacy and rates of comorbidity. The initial study, conducted September 2012-May 2016, included a clinical interview; physical assessments of body mass index and handgrip strength; and cognitive testing, plus non-fasting blood draws for measurements of genetic (Apolipoprotein E genotype) and blood-based biological markers. Information was collected regarding limitations in activities of daily living, symptoms of depression and fall incidents. A subsample of participants provided cerebrospinal fluid to measure proteins related to Alzheimer's disease; another subsample underwent ultrasonography and electroencephalography. This report describes the general study design and highlights lessons learned and future directions. In particular, drawing on lessons learned from this clinical research, a community-based prospective cohort study is currently under way among older adults in Panama to validate a blood-based biomarker profile for detecting mild cognitive impairment and Alzheimer's disease, as well as risk factors for cognitive decline. KEYWORDS: Dementia, biomarkers, Latin America, aging, cognition, chronic disease, Panama.
Published: 2019

36. Sex differences and estrous cycle effects on foreground contextual fear conditioning

Author: Gabrielle B. Britton, Maria B. Carreira, Carol E. Vásquez, and Ricardo Cossio
Subjects: Male, 0301 basic medicine, Estrous cycle phase, Gene Expression, Prefrontal Cortex, Physiology, Hippocampus, Estrous Cycle, Experimental and Cognitive Psychology, Amygdala, Developmental psychology, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Conditioning, Psychological, medicine, Animals, Fear conditioning, Rats, Wistar, Freezing Reaction, Cataleptic, Prefrontal cortex, Estrous cycle, Analysis of Variance, Sex Characteristics, Brain-Derived Neurotrophic Factor, Classical conditioning, Fear, Hormones, 030104 developmental biology, medicine.anatomical_structure, Mental Recall, Conditioning, Female, Psychology, 030217 neurology & neurosurgery
Abstract: Previous reports have suggested that the female estrous cycle modulates fear responses to contextual and discrete cue stimuli following fear conditioning, but conflicting results have been obtained across studies. We assessed sex differences between males and naturally cycling female rats using fear conditioning procedures that involve learning about a discrete cue (tone conditioned stimulus, CS) and either background (explicitly paired) or foreground (explicitly unpaired) contextual conditioning. We measured brain derived neurotrophic factor (BDNF) expression in amygdala, hippocampus, and medial prefrontal cortex, brain regions implicated in the fear circuitry. When comparing males to females without considering the estrous cycle phase, sex differences were found in unpaired conditioning only; females showed significantly less freezing than males during acquisition. Significant differences in unpaired but not paired conditioning were found between subgroups of females depending on the phase of the estrous cycle. Female rats that underwent unpaired conditioning in estrus showed significantly less freezing during acquisition and cued recall than males. In contrast, contextual recall in females that received unpaired training was not affected by estrous cycle phase. BDNF protein expression remained unchanged by fear conditioning but overall males expressed higher levels in all brain regions examined compared to females. Together, these results show that sex differences in fear behaviors following foreground contextual conditioning depend on the phase of the estrous cycle. These results are discussed in light of previous reports of sex and estrous cycle effects on fear learning and BDNF.
Published: 2016

37. A blood screening test for Alzheimer's disease

Author: Neill R. Graff-Radford, C. Munro Cullum, Melissa Edwards, Mary Quiceno, Leigh A. Johnson, Alcibiades E. Villarreal, Gabrielle B. Britton, James Hall, and Sid E. O'Bryant
Subjects: medicine.medical_specialty, Disease, Primary care, lcsh:Geriatrics, lcsh:RC346-429, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Positive predicative value, Diagnosis, medicine, Blood test, lcsh:Neurology. Diseases of the nervous system, medicine.diagnostic_test, business.industry, Blood Screening, Blood-Based Biomarkers, Alzheimer's disease, Test (assessment), lcsh:RC952-954.6, Psychiatry and Mental health, 030220 oncology & carcinogenesis, Predictive power, Physical therapy, Screening, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Introduction This study combined data across four independent cohorts to examine the positive and negative predictive values of an Alzheimer's disease (AD) blood test if implemented in primary care. Methods Blood samples from 1329 subjects from multiple independent, multiethnic, community‐based, and clinic‐based cohorts were analyzed. A “locked‐down” referent group of 1128 samples was generated with 201 samples randomly selected for validation purposes. Random forest analyses were used to create the AD blood screen. Positive (PPV) and negative (NPV) predictive values were calculated. Results In detecting AD, PPV was 0.81, and NPV was 0.95 while using the full AD blood test. When detecting mild cognitive impairment, PPV and NPV were 0.74 and 0.93, respectively. Preliminary analyses were conducted to detect any “neurodegenerative disease”. The full 21‐protein AD blood test yielded a PPV of 0.85 and NPV of 0.94. Discussion The present study creates the first‐ever multiethnic referent sample that spans community‐based and clinic‐based populations for implementation of an AD blood screen.
Published: 2016

38. Inflammatory Biomarkers, Depressive Symptoms and Falls Among the elderly in Panama

Author: Ambar R Pérez-Lao, Gabrielle B Britton, Alcibiades E. Villarreal, Maria B. Carreira, Leigh A. Johnson, Diana C Oviedo, James Hall, and Sid E. O'Bryant
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Aging, Activities of daily living, Panama, Hispanics, Poison control, Occupational safety and health, Article, 03 medical and health sciences, Chemokine CCL1, 0302 clinical medicine, Risk Factors, Internal medicine, Injury prevention, Medicine, Humans, 030212 general & internal medicine, Depression (differential diagnoses), Aged, Aged, 80 and over, Mini–Mental State Examination, biology, medicine.diagnostic_test, business.industry, Depression, Interleukin-6, Incidence, Interleukin-7, C-reactive protein, Hispanic or Latino, Interleukin-10, C-Reactive Protein, Latin America, disability, inflammation, Pediatrics, Perinatology and Child Health, depression, biology.protein, Geriatric Depression Scale, Accidental Falls, Female, Inflammation Mediators, business, 030217 neurology & neurosurgery, Biomarkers
Abstract: Background: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. Objective: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. Method: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. Results: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. Conclusion: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks. Background: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. Objective: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. Method: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. Results: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. Conclusion: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks.
Published: 2018

39. Cognitive Impairment, Depression, and Cooccurrence of Both among the Elderly in Panama: Differential Associations with Multimorbidity and Functional Limitations

Author: Alcibiades E. Villarreal, Shantal Grajales, Lineth Lopez, Gabrielle B. Britton, and Panama Aging Research Initiative
Subjects: Male, Gerontology, Activities of daily living, Article Subject, Panama, lcsh:Medicine, General Biochemistry, Genetics and Molecular Biology, Odds, Humans, Multimorbidity, Medicine, Depression (differential diagnoses), Aged, Multinomial logistic regression, Aged, 80 and over, General Immunology and Microbiology, Depression, business.industry, lcsh:R, Cognition, General Medicine, Mental health, Female, Geriatric Depression Scale, Cognition Disorders, business, human activities, Research Article
Abstract: Cognitive impairment and depression are common mental health problems among the elderly, although few studies have examined their cooccurrence in older adults in Latin America. The purpose of this study was to examine cognitive impairment, depression, and cooccurrence of the two conditions and associated factors in a sample of older adults in Panama. This study included 304 community-dwelling elderly (≥65 years) individuals. Participants underwent a clinical interview and assessments of cognitive function by the Minimental State Examination and depressive symptoms by the Geriatric Depression Scale. Limitations in basic (BADL) and instrumental (IADL) activities in daily living and the presence of chronic illnesses were recorded. Multinomial regression analysis revealed that cooccurrence of cognitive impairment and depressive symptoms was explained by increasing age (OR: 3.2, 95% CI: 1.20, 8.30), low education (OR: 3.3, 95% CI: 1.33, 8.38), having four or more chronic conditions (OR: 11.5, 95% CI: 2.84, 46.63), and BADL limitations (OR: 5.0, 95% CI: 1.26, 19.68). Less education and limitations in BADL and IADL increased the odds of cognitive impairment alone, while less education and three or more chronic conditions increased the odds of depression alone. These findings underscore the relevance of assessing cognitive impairment in the elderly as part of a long-term approach to managing depression and vice versa.
Published: 2015

40. Characterization of Alzheimer's Disease and Mild Cognitive Impairment in Older Adults in Panama

Author: Gabrielle B. Britton, Shantal Grajales, Astevia Montalván, Melissa Edwards, Alcibiades E. Villarreal, Lineth López, and Sid E. O'Bryant
Subjects: Apolipoprotein E, Male, Pediatrics, medicine.medical_specialty, Aging, Panama, Apolipoprotein E4, Disease, Neuropsychological Tests, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Genotype, medicine, Dementia, Humans, Cognitive Dysfunction, Cognitive impairment, Aged, Aged, 80 and over, 030214 geriatrics, business.industry, General Neuroscience, Cognition, General Medicine, medicine.disease, Psychiatry and Mental health, Clinical Psychology, Female, Geriatrics and Gerontology, Alzheimer's disease, business, 030217 neurology & neurosurgery
Abstract: Research on age-related cognitive impairment is scarce in Central America. We report factors associated with cognitive impairment among a sample of older adults in Panama diagnosed with Alzheimer's disease (AD, n = 31), mild cognitive impairment (MCI, n = 43), or no cognitive impairment (controls, n = 185). Apolipoprotein E (ApoE) genotype was assessed in a subset of cases (n = 135). Age (OR = 2.53, 95% CI = 1.03-6.17) and ApoE ɛ4 (OR = 5.14, 95% CI = 2.11-12.52) were significantly related to cognitive impairment (AD/MCI combined). Results underscore the potential of genetic screening in Panama for identifying those at risk of dementia.
Published: 2016

41. Individual and sex differences in high and low responder phenotypes

Author: Ricardo Cossio, Maria B. Carreira, and Gabrielle B. Britton
Subjects: Male, Elevated plus maze, Individuality, Physiology, Poison control, Context (language use), Anxiety, Motor Activity, Open field, Developmental psychology, 03 medical and health sciences, Behavioral Neuroscience, Mice, 0302 clinical medicine, Memory, Injury prevention, medicine, Animals, 0501 psychology and cognitive sciences, 050102 behavioral science & comparative psychology, Sex Characteristics, Behavior, Animal, Depression, 05 social sciences, General Medicine, Fear, Mice, Inbred C57BL, Phenotype, Animal Science and Zoology, Female, medicine.symptom, Psychology, 030217 neurology & neurosurgery, Sex characteristics, Behavioural despair test
Abstract: Individual differences in responses to a novel environment are an important tool to predict predisposition to neuropsychiatric disorders. One way to examine individual differences involves classifying animals based on locomotion in a novel context. In this study we focused on individual and sex differences by categorizing female and male mice as high (HR) or low responders (LR) on the basis of open field locomotion. We then assessed whether groups differed on behavioral measures of spontaneous alternations, anxiety, depression and contextual fear conditioning. In the Y-maze, we observed no differences across HR/LR or sex on spontaneous alternations, but HR displayed more locomotion. HR male mice showed less anxiety-like behavior in the light-dark test but not the elevated plus maze. We observed no differences in the forced swim test across HR/LR, although males exhibited greater depression-like behavior overall. HR mice exhibited less contextual fear memory compared to LR regardless of sex. Principal component analyses suggested sex-specific patterns of behaviors across tests, with female responses within individual tests tending to load together. In females anxiety- and depression-like behaviors explained a large part of the variance observed across tests in our battery, whereas male behavior was primarily explained by variables related to locomotion.
Published: 2016

42. Serum-based protein profiles of Alzheimer's disease and mild cognitive impairment in elderly Hispanics

Author: Gabrielle B. Britton, Shantal Grajales, Alcibiades E. Villarreal, Sid E. O'Bryant, and Melissa Edwards
Subjects: 0301 basic medicine, Oncology, Apolipoprotein E, Male, medicine.medical_specialty, Pathology, Aging, Disease, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Internal medicine, medicine, Dementia, Humans, Hispanic population, Cognitive impairment, Aged, Aged, 80 and over, Psychiatric Status Rating Scales, Analysis of Variance, Proteomic Profile, Chi-Square Distribution, Cognition, Blood Proteins, Hispanic or Latino, medicine.disease, 030104 developmental biology, Disease Progression, Biomarker (medicine), Cytokines, Female, Neurology (clinical), Psychology, Cognition Disorders, 030217 neurology & neurosurgery, Biomarkers, Research Article
Abstract: Aim: To describe the biomarker profiles in elderly Panamanians diagnosed with Alzheimer's disease (AD), mild cognitive impairment (MCI) or no impairment using serum-based biomarkers. Methods: Twenty-four proteins were analyzed using an electrochemiluminescence-based multiplex biomarker assay platform. A biomarker profile was generated using random forest analyses. Results: Two proteins differed among groups: IL-18 and T-lymphocyte-secreted protein I-309. The AD profile was highly accurate and independent of age, gender, education and Apolipoprotein E ε4 status. AD and MCI profiles had substantial overlap among the top markers, suggesting common functions in AD and MCI but differences in their relative importance. Conclusion: Our results underscore the potential influence of genetic and environmental differences within Hispanic populations on the proteomic profile of AD.
Published: 2016

43. Recent Advances in α-Synuclein Functions, Advanced Glycation, and Toxicity: Implications for Parkinson’s Disease

Author: Erika N. Guerrero, K.S.J. Rao, Muralidhar L. Hegde, Gabrielle B. Britton, and Padmaraju Vasudevaraju
Subjects: Glycation End Products, Advanced, Protein Folding, Glycosylation, Parkinson's disease, Amyloid beta, Neuroscience (miscellaneous), Cellular and Molecular Neuroscience, Glycation, mental disorders, medicine, Animals, Humans, Phosphorylation, chemistry.chemical_classification, Reactive oxygen species, Cell Death, Lewy body, biology, Neurodegeneration, Parkinson Disease, medicine.disease, nervous system diseases, nervous system, Neurology, chemistry, Biochemistry, alpha-Synuclein, biology.protein, Signal transduction, Protein Binding
Abstract: The toxicity of α-synuclein in the neuropathology of Parkinson's disease which includes its hallmark aggregation has been studied scrupulously in the last decade. Although little is known regarding the normal functions of α-synuclein, its association with membrane phospholipids suggests its potential role in signaling pathways. Following extensive evidences for its nuclear localization, we and others recently demonstrated DNA binding activity of α-synuclein that modulates its conformation as well as aggregation properties. Furthermore, we also underscored the similarities among various amyloidogenic proteins involved in neurodegenerative diseases including amyloid beta peptides and tau. Our more recent studies show that α-synuclein is glycated and glycosylated both in vitro and in neurons, significantly affecting its folding, oligomeric, and DNA binding properties. Glycated α-synuclein causes increased genome damage both via its direct interaction with DNA and by increased generation of reactive oxygen species as glycation byproduct. In this review, we discuss the mechanisms of glycation and other posttranslational modifications of α-synuclein, including phosphorylation and nitration, and their role in neuronal death in Parkinson's disease.
Published: 2012

44. New evidence on α-synuclein and Tau binding to conformation and sequence specific GCFNx01 rich DNA: Relevance to neurological disorders

Author: Erika N. Guerrero, Muralidhar L. Hegde, Gabrielle B. Britton, Padmaraju Vasudevaraju, KS Rao, and TB Collen
Subjects: HMG-box, Base pair, oligonucleotide-protein interaction, Parkinson′s disease, lcsh:Analytical chemistry, lcsh:RS1-441, Bioengineering, Biology, General Biochemistry, Genetics and Molecular Biology, Z-DNA, lcsh:Pharmacy and materia medica, chemistry.chemical_compound, General Pharmacology, Toxicology and Pharmaceutics, Gene, α-Synuclein, lcsh:QD71-142, Oligonucleotide, Promoter, Molecular biology, genomic DNA, Alzheimer′s disease, chemistry, Biophysics, Tau, DNA
Abstract: Background: Deoxyribonucleic acid (DNA) topology plays a critical role in maintaining the integrity of the genome and cellular functions. Although changes in DNA conformation and structural dynamics in the brain have been associated with various neurological disorders, its precise role in the pathogenesis is still unclear. Previous studies from our laboratory have shown that there is a conformational change in the genomic DNA of Parkinson's disease (PD) (B to altered B-DNA) and Alzheimer's disease brain (B to Z-DNA). However, there is limited information on the mechanism on DNA dynamics changes in brain. Objective: In the present study, we have investigated the DNA conformation and sequence specific binding ability of α-Synuclein and Tau with reference to B-DNA and Z-DNA using oligonucleotide (CGCGCGCG) 2 as a novel model DNA system. This sequence is predominantly present in the promoter region of the genes of biological relevance. Materials and Methods: Natively, (CGCGCGCG) 2 sequence exists in B-DNA conformation, but in the presence of high sodium concentration (4 M NaCl), the oligo converts into Z-DNA form. We used circular dichroism, melting temperature and fluorescence studies to understand protein-DNA interactions. Results: CD studies indicated that both α-Synuclein and Tau bind to B-DNA conformation of (CGCGCGCG) 2 and induce altered B-form. Further, these proteins increased the melting temperature and decreased the number of EtBr molecules bound per base pair of DNA in B-form indicating that DNA stability is favored to alter B-DNA conformation, which could be an intermediate form favoring Z-DNA conformation. Moreover, both α-Synuclein and Tau also bound to disease-linked Z-DNA conformation of (CGCGCGCG) 2 and further stabilized the Z-conformation. Conclusions: The present study provides vital mechanistic information on Synuclein and Tau binding to DNA in a conformation-specific manner causing conformational transition. Furthermore, both the proteins stabilize Z-DNA conformation. These have altered minor and major groove patterns and thus may have significant biological implications in relevance to gene expression pattern in neurodegeneration. We discuss the implications of α-Synuclein/Tau binding to DNA and stabilizing the altered conformations of DNA in neuronal cell dysfunction.
Published: 2012

45. Targeting Oligomers in Neurodegenerative Disorders: Lessons from α-Synuclein, Tau, and Amyloid-β Peptide

Author: Gabrielle B. Britton, Bharathi S. Gadad, and K.S.J. Rao
Subjects: Amyloid beta-Peptides, Mechanism (biology), Chemistry, General Neuroscience, Neurodegeneration, Neurodegenerative Diseases, tau Proteins, General Medicine, Brain damage, Protein aggregation, medicine.disease, Models, Biological, Cell biology, Pathogenesis, Psychiatry and Mental health, Clinical Psychology, alpha-Synuclein, medicine, Animals, Humans, Protein folding, Geriatrics and Gerontology, medicine.symptom, Amyotrophic lateral sclerosis, Function (biology)
Abstract: Neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, Prion disease, Huntington's disease, and amyotrophic lateral sclerosis are increasingly being realized to have common cellular and molecular mechanisms including protein aggregation and inclusion body formation in selected brain regions. The aggregates usually consist of insoluble fibrillar aggregates containing misfolded protein with β-sheet conformation. The most probable explanation is that inclusions and the aggregates symbolize an end stage of a molecular cascade of several events, and that earlier event in the cascade may be more directly tied up to pathogenesis than the inclusions themselves. Small intermediates termed as 'soluble oligomers' in the aggregation process might influence synaptic dysfunction, whereas large, insoluble deposits might function as reservoir of the bioactive oligomers. Compelling evidence suggests the role of misfolded proteins in the form of oligomers might lead to synaptic dysfunction, neuronal apoptosis and brain damage. However, the mechanism by which oligomers trigger neurodegeneration still remains mysterious. The aim of this article is to review the literature around the molecular mechanism and role of oligomers in neurodegeneration and leading approaches toward rational therapeutics.
Published: 2011

46. Exposure to oral methylphenidate from adolescence through young adulthood produces transient effects on hippocampal-sensitive memory in rats

Author: José A. Bethancourt, Zurislay Z. Camarena, and Gabrielle B. Britton
Subjects: Male, Conditioning, Classical, Hippocampus, Physiology, Affect (psychology), Open field, Developmental psychology, Random Allocation, Behavioral Neuroscience, Cognition, Memory, mental disorders, medicine, Animals, Learning, Rats, Wistar, Young adult, Freezing Reaction, Cataleptic, Analysis of Variance, Electroshock, Methylphenidate, Memoria, Body Weight, Recognition, Psychology, Fear, Rats, Exploratory Behavior, Central Nervous System Stimulants, Analysis of variance, Psychology, medicine.drug
Abstract: Methylphenidate (MPH) is the most commonly prescribed medication used to treat the symptoms associated with attention-deficit hyperactivity disorder (ADHD). The increase in ADHD diagnosis and MPH use has raised concerns regarding the long-term consequences of early exposure to psychostimulants. Animals studies indicate that early developmental MPH treatment produces enduring changes in hippocampal-sensitive tasks, including novel object recognition (NOR) and long-term retention of contextual fear. We administered oral MPH to male Wistar rats at a therapeutically relevant dose (2 or 5 mg/kg) twice daily for 7 weeks beginning on post-natal day (PN) 27 through PN 71 (i.e., periadolescence through young adulthood). Behavioral tests began 18 days following the last MPH administration. MPH (5 mg/kg) produced an increase in the latency to reach criterion for sample object exploration during the first of two NOR tests, but did not produce memory deficits at either dose. MPH (5 mg/kg) enhanced freezing during the 24 h retention test, but did not affect responding at 48 h. Taken together, the results of both tasks suggest that treatment with MPH in a manner that approximates clinical exposure patterns transiently modifies hippocampal-sensitive learning in rats but does not produce cognitive impairments. We suggest that the effects of prolonged exposure to MPH treatment on cognitive processes vary as a function of the duration and pattern of drug administration, as well as task complexity, which may account for differences among studies regarding its long-term behavioral effects. Future preclinical studies examining the effects of early psychostimulant treatment should include different periods of exposure and assessment, as well as clinically relevant doses and routes of drug administration, in order to better understand the impact of pediatric medications on adult cognition.
Published: 2009

47. Ascertaining fetal Zika virus infection based on IgM antibody test in endemic settings

Author: T. T. Herrera, Amador Goodridge, and Gabrielle B. Britton
Subjects: Fetus, Pregnancy, 030219 obstetrics & reproductive medicine, Radiological and Ultrasound Technology, biology, business.industry, Igm antibody, MEDLINE, Obstetrics and Gynecology, General Medicine, Prenatal care, biology.organism_classification, medicine.disease, Virology, Zika virus, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, Immunology, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, business
Published: 2017

48. La aplicación de biomarcadores a la búsqueda de nuevas farmacoterapias para el tratamiento de la enfermedad de Alzheimer

Author: Gabrielle B. Britton, Jagannatha Rao, Alcibiades E. Villarreal, Lee Anne Gómez, Rosa Arrue, Gabriela Carrillo-Pujol, Shantal Grajales, and Frank Ferro
Abstract: A la fecha, la poblacion mundial ha alcanzado 7000 millones de personas. Un reciente informe de la Organizacion Mundial de la Salud (2001) indica que los individuos mayores de 60 anos de edad son el grupo de mayor crecimiento en la tierra. En 2000, la poblacion de personas mayores de 60 anos fue de 600 millones; en el ano 2025 habra 1.2 billones y, para el ano 2050, casi 2 billones. Una de las condiciones que acompana el envejecimiento cerebral normal es un deterioro en la funcion cognitiva; una proporcion notable padecera de demencia, y de estas, la mayoria padecera de la enfermedad de Alzheimer (EA). Se estima que aproximadamente 5 millones de personas en Estados Unidos y 17 millones alrededor del mundo padecen demencia. Para las edades de 85 anos y mas, del 15% al 30% son afectadas, y las tasas de incidencias se incrementan aproximadamente 1% cada ano entre las personas de edades de 65 a 70 anos de edad y por 6% a 8% en personas de edades mayores de 85 anos. Si se suma a estas cifras la creciente poblacion de personas envejecidas, es evidente que el deterioro en la funcion cognitiva y la demencia representan un punto focal como problema de salud publica a nivel mundial. Un objetivo primordial de la investigacion relacionada a la EA es retardar o detener el progreso de la demencia. El diagnostico temprano es esencial, y se conoce que los procesos neurodegenerativos se manifiestan anos antes de que aparezcan sintomas conductuales. En el caso de la EA, el diagnostico se basa en la evaluacion clinica y neuropsicologica (a exclusion de otras causas de demencia), pero el diagnostico definitivo solo se obtiene post mortem. La neuropatologia de la EA se caracteriza por la presencia de conglomerados anormales de proteinas intracelulares (tau hiperfosforilado) y placas seniles (beta amiloide). La literatura sugiere que en pacientes de EA la precision del diagnostico oscila entre 60-90% y normalmente se realiza cuando el paciente esta en etapas avanzadas de deterioro funcional. Durante etapas tempranas de la EA, cuando la intervencion pudiera ser mas efectiva, el diagnostico preciso se dificulta debido a que los sintomas clinico patologicos son muy similares a otros tipos de demencia y los metodos existentes no son lo suficientemente sensibles. Por lo tanto, es necesario el descubrimiento de biomarcadores que permitan identificar pacientes en riesgo e intervenir en etapas tempranas de la demencia. Los biomarcadores son parametros (fisiologicos, bioquimicos, anatomicos, conductuales) que se pueden medir in vivo y que reflejan caracteristicas especificas de procesos patologicos de la enfermedad. El presente capitulo resumira diversas estrategias en la aplicacion de biomarcadores para detectar la EA y diagnosticar la patologia con mayor fiabilidad que los fenotipos cognitivos y conductuales tradicionales. Estas estrategias incluyen (1) la deteccion de las proteinas tau y beta amiloide en liquido cefalorraquideo (tau) y en plasma (tau y beta amiloide), (2) la aplicacion de tecnicas de neuroimagen (como la de imagen por resonancia magnetica, IRM) para la identificacion de lesiones, infarto y patrones de atrofia cerebral, (3) el uso de tomografia por emision de positrones (PET) y tomografia computarizada por emision de fotones individuales (SPECT) para visualizar depositos de beta amiloide, y (4) otras estrategias como la aplicacion de la electroencefalografia (EEG). Tambien se resumiran algunas pruebas neuropsicologicas comunmente utilizadas para registrar el grado de deterioro cognitivo durante la progresion de la EA, y se evaluara su validez, valor predictivo y relacion a biomarcadores anatomicos y bioquimicos. Una amplia literatura indica que el proceso de neurodegeneracion en la EA es multifactorial, i.e. multiples procesos bioquimicos en diferentes etapas de la enfermedad producen la constelacion de modificaciones estructurales y funcionales asociados a la EA. Por esta razon, la efectividad de biomarcadores depende de la capacidad de predecir la EA durante etapas tempranas y de monitorear la progresion de la EA. La disponibilidad de biomarcadores facilitara el diagnostico temprano y proporcionara criterios objetivos de valoracion. El capitulo propuesto resumira los avances en la busqueda de biomarcadores de la EA, y evaluara su capacidad de predecir el riesgo de padecer EA y guiar la eficacia de farmacoterapias para el tratamiento de la EA.
Published: 2014

49. NMDA receptor dysregulation in chronic state: a possible mechanism underlying depression with BDNF downregulation

Author: Elaine R. Reynolds, Gabrielle B. Britton, Carol E. Vásquez, and Romina M. Riener
Subjects: biology, Depression, Brain-Derived Neurotrophic Factor, Glutamate receptor, Down-Regulation, Cell Biology, CREB, Receptors, N-Methyl-D-Aspartate, Epigenesis, Genetic, Cellular and Molecular Neuroscience, Glutamatergic, nervous system, Neurotrophic factors, Ca2+/calmodulin-dependent protein kinase, Animal models of depression, biology.protein, Antidepressant, Animals, Humans, Chronic stress, Psychology, Neuroscience, Stress, Psychological
Abstract: Several lines of evidence indicate that chronic stress and downregulation of brain-derived neurotrophic factor (BNDF) are the key components of depression pathology. Evidence from animal models of depression demonstrates that chronic stress impairs hippocampal BDNF expression and that antidepressant drug effects correlate with increased BDNF synthesis and activity in the hippocampus. Studies with human carriers of BDNF Met-allele polymorphism link stress vulnerability and risk for depression. The mechanism by which chronic stress downregulates BDNF and promotes depressive-like responses is not established yet. It has been reported that chronic stress mediates alterations in several calcium-related components involved in BDNF synthesis, including CAMKII, CAMKIV and cAMP-response element-binding protein (CREB), and glutamatergic neurotransmission through N-Methyl-D-Aspartate receptors (NMDAR). Treatments with NMDAR antagonists like ketamine modulate glutamate signals, upregulate CREB and BDNF expression, and correct stress-induced cognitive and behavioral alterations. With the increasing interest to develop NMDAR modulators, it is crucial to understand the conditions that lead to depression pathology in order to develop rational therapies aimed at reestablishing proper neuronal function. We present here the current knowledge regarding the relation between chronic stress, BDNF and NMDARs and its implications in depression. We discuss a plausible mechanism where chronic stress induced NMDAR stimulation could lead to dysregulated calcium signaling and decreased BDNF activity. In these circumstances, neurons become vulnerable to the effects of stress, leading to dysfunctional neurotransmission and behavioral alterations. We propose that treatment with NMDAR antagonists may help to return the balance of calcium signaling, promote proper BDNF signaling and correct depressive symptoms.
Published: 2014

50. First trimester screening using ultrasound and serum markers in Panamanians: Factors associated with adverse pregnancy outcomes

Author: Tania T, Herrera, Scarlett, Sinisterra, Alcibiades, Solis, and Gabrielle B, Britton
Subjects: panama, pregnancy outcome, prenatal screening, Original Article, Fetal ultrasonography, nuchal translucency
Abstract: Background: There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians. Materials and Methods: This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG) and pregnancy associated plasma protein-A (PAPP-A), and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV), were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects. Results: A total of 454 (97%) pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50). Maternal age was significantly greater in cases of adverse outcome (P = 0.007). The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps < 0.001). No differences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A. Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.
Published: 2013

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