Browsing by Author "Meenakshi Sharma"

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Ayurvedic Management of Ekakushtha (Psoriasis): A case report
(Association of Ayurvedic Physicians of India, 2025) V. Varsha; Meenakshi Sharma; Sisir Kumar Mandal
Psoriasis is a chronic autoimmune dermatological disorder characterized by erythematous, scaly plaques that significantly impact a patient’s quality of life. Conventional treatment primarily focuses on immune suppressants and symptomatic relief, often leading to side effects. This case report presents a 61-year-old male patient with psoriasis managed through Ayurvedic interventions, incorporating Shodhana (~ purification) and Shamana (~palliative) therapies. The treatment included internal medications, Panchakarma procedures, and lifestyle modifications. A significant reduction in clinical features and Psoriasis Area Severity Index (PASI) score was observed, indicating the potential efficacy of Ayurvedic management of Psoriasis. © 2025, Association of Ayurvedic Physicians of India. All rights reserved.
Biochar Role in Soil Carbon Stabilization and Crop Productivity
(Springer Nature, 2021) Jitka Prichystalova; Jiri Holatko; Tereza Hammerschmiedt; Rahul Datta; Ram Swaroop Meena; Marek Sudoma; Lucie Bielska; Maja Radziemska; Zygmunt Mariusz Gusiatin; Antonin Kintl; Meenakshi Sharma; Subhan Danish; Muhammad Zafar-ul-Hye; Martin Brtnicky
In the presented chapter, various aspects related to carbon stabilization and storage in the form of biochar (an important soil amendment) are discussed. The following questions were considered: (i) what is the current general knowledge on biochar and its physicochemical composition, (ii) how manufacturing conditions affect biochar characteristics, including their role in carbon stabilization, (iii) how biochar contributes to soil carbon balance and storage, (iv) what are the effects of biochar on water retention in soil, soil erosion, production yields and economic productivity in agriculture, (iv) what are the effects of biochar on soil microbial community and activity, and (v) how biochar affects other soil amendments and their roles in soil. The present studies assess scientific outcomes and results which conclude that soil organic matter gained by organic residues can be used to enhance soil carbon storage. Following the published scientific results, the biochar amendment appears to be a promising way for increasing the stocks of recalcitrant carbon in the soil from a long-term perspective. Future research should focus on the designing, production, and use of enriched biochar, e.g. with nutrients, minerals, or microorganisms, to improve soil physicochemical properties, supply nutrients, and prevent their leaching. The fertilizer supplies accessible nutrients available to plants, and biochar can sequester depleted elements and prevent leaching of the added ones. © Springer Nature Singapore Pte Ltd. 2021.
Educational and Socioeconomic Correlates of Stroke Risk Behaviors: Findings from the SPRINT INDIA Trial
(Wolters Kluwer Medknow Publications, 2025) Shweta Jain Verma; Gurnoor Kaur; Arya Devi; Deepti Arora; Aneesh Dhasan; Padmavathyamma Narayanapillai Sylaja; Dheeraj Khurana; Vijaya Pamidimukkala; Biman Kanti Ray; Vivek Keshavan Nambiar; Sanjith Aaron; Gaurav Kumar Mittal; Sundarachary Nagarjunakonda; Aparna Ramakrishna Pai; Sankar Prasad Gorthi; Somasundaram Kumaravelu; Yerasu Muralidhar Reddy; Sunil K. Narayan; Nomal Chandra Borah; Rupjyoti Das; Girish Baburao Kulkarni; Vikram Huded; Thomas Mathew; Mv Padma Srivastava; Rohit Bhatia; Pawan Kumar Ojha; Jayanta Roy; Sherly Mary Abraham; Anand Girish Vaishnav; Arvind Kumar Sharma; Sheikh Jabeen; Abhishek Pathak; Sanjeev Kumar Bhoi; Sudhir Sharma; Sulena Sulena; Aralikatte Onkarappa Saroja; Neetu Ramrakhiani; Madhusudhan Byadarahalli Kempegowda; Mahesh Pundlik Kate; Tina K. George; Ivy Anne Sebastian; Meenakshi Sharma; Rupinder Singh Dhaliwal; Rahul Huilgol; Jeyaraj Durai Pandian
Background and Objectives: Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial was a randomized control trial that enrolled 4298 stroke patients and administered educational interventions at 31 centers across India, with the aim to reduce recurrent stroke through increased stroke knowledge. This SPRINT INDIA trial post hoc study aims to investigate the incidence of recurrent stroke, high-risk transient ischemic attack (TIA), acute coronary syndrome (ACS), death, and lifestyle behavioral factors at 1 year. In addition, it examines the relationship between patients' baseline characteristics and education levels, risk factors, and outcomes and performs subgroup analysis within the intervention and control groups. Methods: Participants were randomly assigned (1:1) to either intervention or control group through computer-based randomization on web. Intervention included stroke prevention Short Message Service messages, short-duration videos, and printed workbooks. Baseline assessments captured demographic and educational data, classifying patients into three categories: no schooling, less than high school, and high school or above. Primary outcome was a composite of recurrent stroke, high-risk TIA, ACS, and mortality at 1 year. Chi-square tests and analysis of variance were used to evaluate educational disparities across various variables. Results: The intervention did not reduce primary outcomes at 1 year among patients with different educational levels. Higher educational group was associated with enhanced medication adherence (94.3% vs 85.4%; P < 0.001), increased physical activity (5497.91 ± 4117.7 vs 6169.91±4828.8; P < 0.001), lower triglyceride levels, and decreased engagement in behavioral risk factors like alcohol intake (5.1% vs 6.8%; P = 0.013) and tobacco use (smoked and chewed) (4% vs 7.9%; P < 0.001 and 5.8% vs 11.6%; P = 0.020). Conclusions: Personalized secondary stroke prevention, tailored to educational levels, is crucial for effective stroke management. © 2025 Annals of Indian Academy of Neurology.
Enhanced corrosion resistance of low alloy steel in NaCl environment using 3-substituted chromone derivatives in epoxy coatings
(Elsevier B.V., 2025) Meenakshi Sharma; Meenakshi Thakran; Rakesh Kumar Tiwari; Gautam Kumar; Vinod Prasad Singh; Suman Lata; Sumit Kumar
This study investigates the corrosion-controlling impact of newly synthesized 3-substituted chromone derivatives incorporated as eco-friendly additives in epoxy coatings to improve the corrosion resistance of low alloy steel (LAS) exposed to a corrosive 3.5 % NaCl solution. This is the first time, as far as we know, that such a chromone-based compound has been investigated for use in coatings, marking a significant advancement from traditional toxic corrosion inhibitors to environmentally benign alternatives. The novel chromone derivates were characterized by 1H NMR, 13C NMR, and FT-IR. 3-substituted chromone derivates were applied to LAS substrates and evaluated for their corrosion protection using electrochemical impedance spectroscopy(EIS) and potentiodynamic polarization techniques(PDP) at 298 K at various concentrations (0.25 %, 0.50 %, and 1.00 %), where 0.25 wt% were identified as an optimized concentration for all compounds. Furthermore, EIS and potentiodynamic polarization studies of the various formed coatings also revealed that 0.25 % of (E)‑prop-2-yn-1-yl 3-(7‑hydroxy-4-oxo-4H-chromen-3-yl) acrylate (MSC-5) was the most optimized coating, with an outstanding protection efficacy of 96.91 % even after 336 h of immersion in a 3.5 % NaCl solution. An improvement attributed to the presence of phenolic -OH in MSC-5 enhanced the adhesion and barrier properties of the coating. Contact angle measurements demonstrated the hydrophobicity order of the BS < Epoxy < MSC < MSC-4 < MSC-5-containing coating and highlighted their efficacy as a moisture-resistant barrier. Atomic Force Microscopy (AFM) and FESEM analyses further illustrated the homogeneous dispersion of MSC-5 within the epoxy matrix, with minimal pores or microcracks, thus contributing to the coating's integrity and corrosion resistance. Furthermore, the protective properties of the coating were reinforced by the donor-acceptor interaction using density functional theory. © 2024 Elsevier B.V.
Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))
(Lancet Publishing Group, 2019) Jeffrey D. Stanaway; Ashkan Afshin; Emmanuela Gakidou; Stephen S. Lim; Degu Abate; Kalkidan Hassen Abate; Cristiana Abbafati; Nooshin Abbasi; Hedayat Abbastabar; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Ibrahim Abdollahpour; Rizwan Suliankatchi Abdulkader; Molla Abebe; Zegeye Abebe; Semaw F. Abera; Olifan Zewdie Abil; Haftom Niguse Abraha; Aklilu Roba Abrham; Laith Jamal Abu-Raddad; Niveen M.E. Abu-Rmeileh; Manfred Mario Kokou Accrombessi; Dilaram Acharya; Pawan Acharya; Abdu A. Adamu; Akilew Awoke Adane; Oladimeji M. Adebayo; Rufus Adesoji Adedoyin; Victor Adekanmbi; Zanfina Ademi; Olatunji O. Adetokunboh; Mina G. Adib; Amha Admasie; Jose C. Adsuar; Kossivi Agbelenko Afanvi; Mohsen Afarideh; Gina Agarwal; Anju Aggarwal; Sargis Aghasi Aghayan; Anurag Agrawal; Sutapa Agrawal; Alireza Ahmadi; Mehdi Ahmadi; Hamid Ahmadieh; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Mohammad Esmaeil Akbari; Tomi Akinyemiju; Nadia Akseer; Ziyad Al-Aly; Ayman Al-Eyadhy; Hesham M. Al-Mekhlafi; Fares Alahdab; Khurshid Alam; Samiah Alam; Tahiya Alam; Alaa Alashi; Seyed Moayed Alavian; Kefyalew Addis Alene; Komal Ali; Syed Mustafa Ali; Mehran Alijanzadeh; Reza Alizadeh-Navaei; Syed Mohamed Aljunid; Ala’a Alkerwi; François Alla; Ubai Alsharif; Khalid Altirkawi; Nelson Alvis-Guzman; Azmeraw T. Amare; Walid Ammar; Nahla Hamed Anber; Jason A. Anderson; Catalina Liliana Andrei; Sofia Androudi; Megbaru Debalkie Animut; Mina Anjomshoa; Mustafa Geleto Ansha; Josep M. Antó; Carl Abelardo T. Antonio; Palwasha Anwari; Lambert Tetteh Appiah; Seth Christopher Yaw Appiah; Jalal Arabloo; Olatunde Aremu; Johan Ärnlöv; Al Artaman; Krishna K. Aryal; Hamid Asayesh; Zerihun Ataro; Marcel Ausloos; Euripide F.G.A. Avokpaho; Ashish Awasthi; Beatriz Paulina Ayala Quintanilla; Rakesh Ayer; Tambe B. Ayuk; Peter S. Azzopardi; Arefeh Babazadeh; Hamid Badali; Alaa Badawi; Kalpana Balakrishnan; Ayele Geleto Bali; Kylie Ball; Shoshana H. Ballew; Maciej Banach; Joseph Adel Mattar Banoub; Aleksandra Barac; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Lope H. Barrero; Sanjay Basu; Bernhard T. Baune; Shahrzad Bazargan-Hejazi; Neeraj Bedi; Ettore Beghi; Masoud Behzadifar; Meysam Behzadifar; Yannick Béjot; Bayu Begashaw Bekele; Eyasu Tamru Bekru; Ezra Belay; Yihalem Abebe Belay; Michelle L. Bell; Aminu K. Bello; Derrick A. Bennett; Isabela M. Bensenor; Gilles Bergeron; Adugnaw Berhane; Eduardo Bernabe; Robert S. Bernstein; Mircea Beuran; Tina Beyranvand; Neeraj Bhala; Ashish Bhalla; Suraj Bhattarai; Zulfiqar A. Bhutta; Belete Biadgo; Ali Bijani; Boris Bikbov; Ver Bilano; Nigus Bililign; Muhammad Shahdaat Bin Sayeed; Donal Bisanzio; Tuhin Biswas; Tone Bjørge; Brigette F. Blacker; Archie Bleyer; Rohan Borschmann; Ibrahim R. Bou-Orm; Soufiane Boufous; Rupert Bourne; Oliver J. Brady; Michael Brauer; Alexandra Brazinova; Nicholas J.K. Breitborde; Hermann Brenner; Andrey Nikolaevich Briko; Gabrielle Britton; Traolach Brugha; Rachelle Buchbinder; Richard T. Burnett; Reinhard Busse; Zahid A. Butt; Leah E. Cahill; Lucero Cahuana-Hurtado; Ismael R. Campos-Nonato; Rosario Cárdenas; Giulia Carreras; Juan J. Carrero; Félix Carvalho; Carlos A. Castañeda-Orjuela; Jacqueline Castillo Rivas; Franz Castro; Ferrán Catalá-López; Kate Causey; Kelly M. Cercy; Ester Cerin; Yazan Chaiah; Hsing-Yi Chang; Jung-Chen Chang; Kai-Lan Chang; Fiona J. Charlson; Aparajita Chattopadhyay; Vijay Kumar Chattu; Miao Li Chee; Ching-Yu Cheng; Adrienne Chew; Peggy Pei-Chia Chiang; Odgerel Chimed-Ochir; Ken Lee Chin; Abdulaal Chitheer; Jee-Young J. Choi; Rajiv Chowdhury; Hanne Christensen; Devasahayam J. Christopher; Sheng-Chia Chung; Flavia M. Cicuttini; Massimo Cirillo; Aaron J. Cohen; Daniel Collado-Mateo; Cyrus Cooper; Owen R. Cooper; Josef Coresh; Leslie Cornaby; Paolo Angelo Cortesi; Monica Cortinovis; Megan Costa; Ewerton Cousin; Michael H. Criqui; Elizabeth A. Cromwell; David K. Cundiff; Alemneh Kabeta Daba; Berihun Assefa Dachew; Abel Fekadu Dadi; Albertino Antonio Moura Damasceno; Lalit Dandona; Rakhi Dandona; Sarah C. Darby; Paul I. Dargan; Ahmad Daryani; Rajat Das Gupta; José Das Neves; Tamirat Tesfaye Dasa; Aditya Prasad Dash; Dragos Virgil Davitoiu; Kairat Davletov; Vanessa De la Cruz-Góngora; Fernando Pio De La Hoz; Diego De Leo; Jan-Walter De Neve; Louisa Degenhardt; Selina Deiparine; Robert P. Dellavalle; Gebre Teklemariam Demoz; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Aniruddha Deshpande; Don C. Des Jarlais; Getenet Ayalew Dessie; Gabrielle Aline Deveber; Subhojit Dey; Samath Dhamminda Dharmaratne; Meghnath Dhimal; Mesfin Tadese Dinberu; Eric L. Ding; Helen Derara Diro; Shirin Djalalinia; Huyen Phuc Do; Klara Dokova; David Teye Doku; Kerrie E. Doyle; Tim R. Driscoll; Manisha Dubey; Eleonora Dubljanin; Eyasu Ejeta Duken; Bruce B. Duncan; Andre R. Duraes; Natalie Ebert; Hedyeh Ebrahimi; Soheil Ebrahimpour; David Edvardsson; Andem Effiong; Anne Elise Eggen; Charbel El Bcheraoui; Ziad El-Khatib; Iqbal Rf Elyazar; Ahmadali Enayati; Aman Yesuf Endries; Benjamin Er; Holly E. Erskine; Sharareh Eskandarieh; Alireza Esteghamati; Kara Estep; Hamed Fakhim; Mahbobeh Faramarzi; Mohammad Fareed; Talha A. Farid; Carla Sofia E. Sá Farinha; Andrea Farioli; Andre Faro; Maryam S. Farvid; Mohammad Hosein Farzaei; Batool Fatima; Kairsten A. Fay; Ali Akbar Fazaeli; Valery L. Feigin; Andrea B. Feigl; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; Joao C. Fernandes; Giannina Ferrara; Alize J. Ferrari; Manuela L. Ferreira; Irina Filip; Jonas David Finger; Florian Fischer; Nataliya A. Foigt; Kyle J. Foreman; Takeshi Fukumoto; Nancy Fullman; Thomas Fürst; João M. Furtado; Neal D. Futran; Seana Gall; Silvano Gallus; Amiran Gamkrelidze; Morsaleh Ganji; Alberto L. Garcia-Basteiro; William M. Gardner; Abadi Kahsu Gebre; Amanuel Tesfay Gebremedhin; Teklu Gebrehiwo Gebremichael; Tilayie Feto Gelano; Johanna M. Geleijnse; Yilma Chisha Dea Geramo; Peter W. Gething; Kebede Embaye Gezae; Reza Ghadimi; Keyghobad Ghadiri; Khalil Ghasemi Falavarjani; Maryam Ghasemi-Kasman; Mamata Ghimire; Rakesh Ghosh; Aloke Gopal Ghoshal; Simona Giampaoli; Paramjit Singh Gill; Tiffany K. Gill; Richard F. Gillum; Ibrahim Abdelmageed Ginawi; Giorgia Giussani; Elena V. Gnedovskaya; William W. Godwin; Srinivas Goli; Hector Gómez-Dantés; Philimon N. Gona; Sameer Vali Gopalani; Alessandra C. Goulart; Ayman Grada; Morgan E. Grams; Giuseppe Grosso; Harish Chander Gugnani; Yuming Guo; Rahul Gupta; Rajeev Gupta; Tanush Gupta; Reyna Alma Gutiérrez; Daniela S. Gutiérrez-Torres; Juanita A. Haagsma; Tesfa Dejenie Habtewold; Vladimir Hachinski; Nima Hafezi-Nejad; Tekleberhan B. Hagos; Tewodros Tesfa Hailegiyorgis; Gessessew Bugssa Hailu; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Randah R. Hamadeh; Samer Hamidi; Alexis J. Handal; Graeme J. Hankey; Yuantao Hao; Hilda L. Harb; Sivadasanpillai Harikrishnan; Josep Maria Haro; Hadi Hassankhani; Hamid Yimam Hassen; Rasmus Havmoeller; Caitlin N. Hawley; Simon I. Hay; Akbar Hedayatizadeh-Omran; Behzad Heibati; Behnam Heidari; Mohsen Heidari; Delia Hendrie; Andualem Henok; Ileana Heredia-Pi; Claudiu Herteliu; Fatemeh Heydarpour; Sousan Heydarpour; Desalegn T. Hibstu; Tarig B. Higazi; Esayas Haregot Hilawe; Hans W. Hoek; Howard J. Hoffman; Michael K. Hole; Enayatollah Homaie Rad; Praveen Hoogar; H. Dean Hosgood; Seyed Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Damian G. Hoy; Mohamed Hsairi; Thomas Hsiao; Guoqing Hu; Howard Hu; John J. Huang; Mamusha Aman Hussen; Chantal K. Huynh; Kim Moesgaard Iburg; Nayu Ikeda; Olayinka Stephen Ilesanmi; Usman Iqbal; Seyed Sina Naghibi Irvani; Caleb Mackay Salpeter Irvine; Sheikh Mohammed Shariful Islam; Farhad Islami; Maria D. Jackson; Kathryn H. Jacobsen; Leila Jahangiry; Nader Jahanmehr; Sudhir Kumar Jain; Mihajlo Jakovljevic; Spencer L. James; Simerjot K. Jassal; Achala Upendra Jayatilleke; Panniyammakal Jeemon; Ravi Prakash Jha; Vivekanand Jha; John S. Ji; Jost B. Jonas; Jitendra Jonnagaddala; Zahra Jorjoran Shushtari; Ankur Joshi; Jacek Jerzy Jozwiak; Mikk Jürisson; Zubair Kabir; Amaha Kahsay; Rizwan Kalani; Tanuj Kanchan; Surya Kant; Chittaranjan Kar; Manoochehr Karami; Behzad Karami Matin; André Karch; Corine Karema; Narges Karimi; Seyed M. Karimi; Amir Kasaeian; Dessalegn H. Kassa; Getachew Mullu Kassa; Tesfaye Dessale Kassa; Nicholas J. Kassebaum; Srinivasa Vittal Katikireddi; Anil Kaul; Norito Kawakami; Zhila Kazemi; Ali Kazemi Karyani; Adane Teshome Kefale; Peter Njenga Keiyoro; Grant Rodgers Kemp; Andre Pascal Kengne; Andre Keren; Chandrasekharan Nair Kesavachandran; Yousef Saleh Khader; Behzad Khafaei; Morteza Abdullatif Khafaie; Alireza Khajavi; Nauman Khalid; Ibrahim A. Khalil; Gulfaraz Khan; Muhammad Shahzeb Khan; Muhammad Ali Khan; Young-Ho Khang; Mona M. Khater; Mohammad Khazaei; Habibolah Khazaie; Abdullah T. Khoja; Ardeshir Khosravi; Mohammad Hossein Khosravi; Aliasghar A. Kiadaliri; Daniel N. Kiirithio; Cho-Il Kim; Daniel Kim; Young-Eun Kim; Yun Jin Kim; Ruth W. Kimokoti; Yohannes Kinfu; Adnan Kisa; Katarzyna Kissimova-Skarbek; Mika Kivimäki; Luke D. Knibbs; Ann Kristin Skrindo Knudsen; Sonali Kochhar; Yoshihiro Kokubo; Tufa Kolola; Jacek A. Kopec; Soewarta Kosen; Parvaiz A. Koul; Ai Koyanagi; Michael A. Kravchenko; Kewal Krishan; Kristopher J. Krohn; Hans Kromhout; Barthelemy Kuate Defo; Burcu Kucuk Bicer; G. Anil Kumar; Manasi Kumar; Igor Kuzin; Hmwe Hmwe Kyu; Carl Lachat; Deepesh P. Lad; Sheetal D. Lad; Alessandra Lafranconi; Ratilal Lalloo; Tea Lallukka; Faris Hasan Lami; Justin J. Lang; Van C. Lansingh; Samantha Leigh Larson; Arman Latifi; Jeffrey V. Lazarus; Paul H. Lee; James Leigh; Mostafa Leili; Cheru Tesema Leshargie; Janni Leung; Miriam Levi; Sonia Lewycka; Shanshan Li; Yichong Li; Juan Liang; Xiaofeng Liang; Yu Liao; Misgan Legesse Liben; Lee-Ling Lim; Shai Linn; Shiwei Liu; Rakesh Lodha; Giancarlo Logroscino; Alan D. Lopez; Stefan Lorkowski; Paulo A. Lotufo; Rafael Lozano; Tim C.D. Lucas; Raimundas Lunevicius; Stefan Ma; Erlyn Rachelle King Macarayan; Ísis Eloah Machado; Fabiana Madotto; Hue Thi Mai; Marek Majdan; Reza Majdzadeh; Azeem Majeed; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A. Mamun; Ana-Laura Manda; Helena Manguerra; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Joemer C. Maravilla; Wagner Marcenes; Ashley Marks; Randall V. Martin; Sheila C.O. Martins; Francisco Rogerlândio Martins-Melo; Winfried März; Melvin B. Marzan; Benjamin Ballard Massenburg; Manu Raj Mathur; Prashant Mathur; Kunihiro Matsushita; Pallab K. Maulik; Mohsen Mazidi; Colm McAlinden; John J. McGrath; Martin McKee; Ravi Mehrotra; Kala M. Mehta; Varshil Mehta; Toni Meier; Fantahun Ayenew Mekonnen; Yohannes A. Melaku; Addisu Melese; Mulugeta Melku; Peter T.N. Memiah; Ziad A. Memish; Walter Mendoza; Desalegn Tadese Mengistu; George A. Mensah; Gert B.M. Mensink; Seid Tiku Mereta; Atte Meretoja; Tuomo J. Meretoja; Tomislav Mestrovic; Haftay Berhane Mezgebe; Bartosz Miazgowski; Tomasz Miazgowski; Anoushka I. Millear; Ted R. Miller; Molly Katherine Miller-Petrie; G.K. Mini; Mojde Mirarefin; Andreea Mirica; Erkin M. Mirrakhimov; Awoke Temesgen Misganaw; Habtamu Mitiku; Babak Moazen; Bahram Mohajer; Karzan Abdulmuhsin Mohammad; Moslem Mohammadi; Noushin Mohammadifard; Mousa Mohammadnia-Afrouzi; Shafiu Mohammed; Farnam Mohebi; Ali H. Mokdad; Mariam Molokhia; Fatemeh Momeniha; Lorenzo Monasta; Yoshan Moodley; Ghobad Moradi; Maziar Moradi-Lakeh; Mehdi Moradinazar; Paula Moraga; Lidia Morawska; Joana Morgado-Da-Costa; Shane Douglas Morrison; Marilita M. Moschos; Simin Mouodi; Seyyed Meysam Mousavi; Dariush Mozaffarian; Kalayu Brhane Mruts; Achenef Asmamaw Muche; Kindie Fentahun Muchie; Ulrich Otto Mueller; Oumer Sada Muhammed; Satinath Mukhopadhyay; Kate Muller; Kamarul Imran Musa; Ghulam Mustafa; Ashraf F. Nabhan; Mohsen Naghavi; Aliya Naheed; Azin Nahvijou; Gurudatta Naik; Nitish Naik; Farid Najafi; Vinay Nangia; Jobert Richie Nansseu; Bruno Ramos Nascimento; Bruce Neal; Nahid Neamati; Ionut Negoi; Ruxandra Irina Negoi; Subas Neupane; Charles Richard James Newton; Josephine W. Ngunjiri; Anh Quynh Nguyen; Grant Nguyen; Ha Thu Nguyen; Huong Lan Thi Nguyen; Huong Thanh Nguyen; Minh Nguyen; Nam Ba Nguyen; Emma Nichols; Jing Nie; Dina Nur Anggraini Ningrum; Yirga Legesse Nirayo; Nobuo Nishi; Molly R. Nixon; Marzieh Nojomi; Shuhei Nomura; Ole F. Norheim; Mehdi Noroozi; Bo Norrving; Jean Jacques Noubiap; Hamid Reza Nouri; Malihe Nourollahpour Shiadeh; Mohammad Reza Nowroozi; Elaine O. Nsoesie; Peter S. Nyasulu; Carla M. Obermeyer; Christopher M. Odell; Richard Ofori-Asenso; Felix Akpojene Ogbo; In-Hwan Oh; Olanrewaju Oladimeji; Andrew T. Olagunju; Tinuke O. Olagunju; Pedro R. Olivares; Helen Elizabeth Olsen; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Kanyin L. Ong; Sok King Ong; Eyal Oren; Heather M. Orpana; Alberto Ortiz; Erika Ota; Stanislav S. Otstavnov; Simon Øverland; Mayowa Ojo Owolabi; P.A. Mahesh; Rosana Pacella; Abhijit P. Pakhare; Amir H. Pakpour; Adrian Pana; Songhomitra Panda-Jonas; Eun-Kee Park; Charles D.H. Parry; Hadi Parsian; Shanti Patel; Sanghamitra Pati; Snehal T. Patil; Ajay Patle; George C. Patton; Deepak Paudel; Katherine R. Paulson; Wayra Citlali Paz Ballesteros; Neil Pearce; Alexandre Pereira; David M. Pereira; Norberto Perico; Konrad Pesudovs; Max Petzold; Hai Quang Pham; Michael R. Phillips; Julian David Pillay; Michael A. Piradov; Meghdad Pirsaheb; Tobias Pischon; Farhad Pishgar; Oleguer Plana-Ripoll; Dietrich Plass; Suzanne Polinder; Kevan R. Polkinghorne; Maarten J. Postma; Richie Poulton; Akram Pourshams; Hossein Poustchi; Dorairaj Prabhakaran; Swayam Prakash; Narayan Prasad; Caroline A. Purcell; Manorama B. Purwar; Mostafa Qorbani; Amir Radfar; Anwar Rafay; Alireza Rafiei; Fakher Rahim; Zohreh Rahimi; Afarin Rahimi-Movaghar; Vafa Rahimi-Movaghar; Mahfuzar Rahman; Mohammad Hifz Ur Rahman; Muhammad Aziz Rahman; Rajesh Kumar Rai; Fatemeh Rajati; Sasa Rajsic; Sree Bhushan Raju; Usha Ram; Chhabi Lal Ranabhat; Prabhat Ranjan; Goura Kishor Rath; David Laith Rawaf; Salman Rawaf; K. Srinath Reddy; Colin D. Rehm; Jürgen Rehm; Robert C. Reiner; Marissa B. Reitsma; Giuseppe Remuzzi; Andre M.N. Renzaho; Serge Resnikoff; Luz Myriam Reynales-Shigematsu; Satar Rezaei; Antonio Luiz P. Ribeiro; Juan A. Rivera; Kedir Teji Roba; Sonia Rodríguez-Ramírez; Leonardo Roever; Yesenia Román; Luca Ronfani; Gholamreza Roshandel; Ali Rostami; Gregory A. Roth; Dietrich Rothenbacher; Ambuj Roy; Enrico Rubagotti; Lesley Rushton; Charumathi Sabanayagam; Perminder S. Sachdev; Basema Saddik; Ehsan Sadeghi; Sahar Saeedi Moghaddam; Hosein Safari; Yahya Safari; Roya Safari-Faramani; Mahdi Safdarian; Sare Safi; Saeid Safiri; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; Haniye Sadat Sajadi; Nasir Salam; Payman Salamati; Zikria Saleem; Yahya Salimi; Hamideh Salimzadeh; Joshua A. Salomon; Devashri Digvijay Salvi; Inbal Salz; Abdallah M. Samy; Juan Sanabria; Maria Dolores Sanchez-Niño; Tania G. Sánchez-Pimienta; Taren Sanders; Yingying Sang; Damian Francesco Santomauro; Itamar S. Santos; João Vasco Santos; Milena M. Santric Milicevic; Bruno Piassi Sao Jose; Mayank Sardana; Abdur Razzaque Sarker; Rodrigo Sarmiento-Suárez; Nizal Sarrafzadegan; Benn Sartorius; Shahabeddin Sarvi; Brijesh Sathian; Maheswar Satpathy; Arundhati R. Sawant; Monika Sawhney; Mete Saylan; Mehdi Sayyah; Elke Schaeffner; Maria Inês Schmidt; Ione J.C. Schneider; Ben Schöttker; Aletta Elisabeth Schutte; David C. Schwebel; Falk Schwendicke; James G. Scott; Soraya Seedat; Mario Sekerija; Sadaf G. Sepanlou; Marc L. Serre; Edson Serván-Mori; Seyedmojtaba Seyedmousavi; Hosein Shabaninejad; Gavin Shaddick; Azadeh Shafieesabet; Mehdi Shahbazi; Amira A. Shaheen; Masood Ali Shaikh; Teresa Shamah Levy; Mehran Shams-Beyranvand; Mohammadbagher Shamsi; Heidar Sharafi; Kiomars Sharafi; Mehdi Sharif; Mahdi Sharif-Alhoseini; Hamid Sharifi; Jayendra Sharma; Meenakshi Sharma; Rajesh Sharma; Jun She; Aziz Sheikh; Peilin Shi; Kenji Shibuya; Mekonnen Sisay Shiferaw; Mika Shigematsu; Min-Jeong Shin; Rahman Shiri; Reza Shirkoohi; Ivy Shiue; Farhad Shokraneh; Haitham Shoman; Mark G. Shrime; Matthew S. Shupler; Si Si; Soraya Siabani; Abla Mehio Sibai; Tariq J. Siddiqi; Inga Dora Sigfusdottir; Rannveig Sigurvinsdottir; Diego Augusto Santos Silva; João Pedro Silva; Dayane Gabriele Alves Silveira; Jasvinder A. Singh; Narinder Pal Singh; Virendra Singh; Dhirendra Narain Sinha; Eirini Skiadaresi; Vegard Skirbekk; David L. Smith; Mari Smith; Badr Hasan Sobaih; Soheila Sobhani; Ranjani Somayaji; Moslem Soofi; Reed J.D. Sorensen; Joan B. Soriano; Ireneous N. Soyiri; Angela Spinelli; Luciano A. Sposato; Chandrashekhar T. Sreeramareddy; Vinay Srinivasan; Vladimir I. Starodubov; Nadine Steckling; Dan J. Stein; Murray B. Stein; Goran Stevanovic; Leo Stockfelt; Mark A. Stokes; Lela Sturua; Michelle L. Subart; Agus Sudaryanto; Mu’awiyyah Babale Sufiyan; Gerhard Sulo; Bruno F. Sunguya; Patrick John Sur; Bryan L. Sykes; Cassandra E.I. Szoeke; Rafael Tabarés-Seisdedos; Takahiro Tabuchi; Santosh Kumar Tadakamadla; Ken Takahashi; Nikhil Tandon; Segen Gebremeskel Tassew; Mohammad Tavakkoli; Nuno Taveira; Arash Tehrani-Banihashemi; Tigist Gashaw Tekalign; Shishay Wahdey Tekelemedhin; Merhawi Gebremedhin Tekle; Habtamu Temesgen; Mohamad-Hani Temsah; Omar Temsah; Abdullah Sulieman Terkawi; Belay Tessema; Mebrahtu Teweldemedhin; Kavumpurathu Raman Thankappan; Andrew Theis; Sathish Thirunavukkarasu; Hannah J. Thomas; Matthew Lloyd Thomas; Nihal Thomas; George D. Thurston; Binyam Tilahun; Taavi Tillmann; Quyen G. To; Myriam Tobollik; Marcello Tonelli; Roman Topor-Madry; Anna E. Torre; Miguel Tortajada-Girbés; Mathilde Touvier; Marcos Roberto Tovani-Palone; Jeffrey A. Towbin; Bach Xuan Tran; Khanh Bao Tran; Thomas Clement Truelsen; Nu Thi Truong; Afewerki Gebremeskel Tsadik; Lorainne Tudor Car; E. Murat Tuzcu; Hayley D. Tymeson; Stefanos Tyrovolas; Kingsley N. Ukwaja; Irfan Ullah; Rachel L. Updike; Muhammad Shariq Usman; Olalekan A. Uthman; Muthiah Vaduganathan; Afsane Vaezi; Pascual R. Valdez; Aaron Van Donkelaar; Elena Varavikova; Santosh Varughese; Tommi Juhani Vasankari; Vidhya Venkateswaran; Narayanaswamy Venketasubramanian; Santos Villafaina; Francesco S. Violante
Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: A systematic analysis for the Global Burden of Disease Study 2017
(Lancet Publishing Group, 2018) Daniel Dicker; Grant Nguyen; Degu Abate; Kalkidan Hassen Abate; Solomon M. Abay; Cristiana Abbafati; Nooshin Abbasi; Hedayat Abbastabar; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Omar Abdel-Rahman; Alireza Abdi; Ibrahim Abdollahpour; Rizwan Suliankatchi Abdulkader; Ahmed Abdulahi Abdurahman; Haftom Temesgen Abebe; Molla Abebe; Zegeye Abebe; Teshome Abuka Abebo; Victor Aboyans; Haftom Niguse Abraha; Aklilu Roba Abrham; Laith Jamal Abu-Raddad; Niveen ME Abu-Rmeileh; Manfred Mario Kokou Accrombessi; Pawan Acharya; Oladimeji M. Adebayo; Isaac Akinkunmi Adedeji; Rufus Adesoji Adedoyin; Victor Adekanmbi; Olatunji O. Adetokunboh; Beyene Meressa Adhena; Tara Ballav Adhikari; Mina G. Adib; ArsÃ¨ne Kouablan Adou; Jose C. Adsuar; Mohsen Afarideh; Ashkan Afshin; Gina Agarwal; Rakesh Aggarwal; Sargis Aghasi Aghayan; Sutapa Agrawal; Anurag Agrawal; Mehdi Ahmadi; Alireza Ahmadi; Hamid Ahmadieh; Mohamed Lemine Cheikh Brahim Ahmed; Sayem Ahmed; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Ali S. Akanda; Mohammad Esmaeil Akbari; Mohammed Akibu; Rufus Olusola Akinyemi; Tomi Akinyemiju; Nadia Akseer; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Animut Alebel; Alicia V. Aleman; Kefyalew Addis Alene; Ayman Al-Eyadhy; Raghib Ali; Mehran Alijanzadeh; Reza Alizadeh-Navaei; Syed Mohamed Aljunid; Alaâ€™A Alkerwi; FranÃ§ois Alla; Peter Allebeck; Christine A. Allen; Jordi Alonso; Rajaa M. Al-Raddadi; Ubai Alsharif; Khalid Altirkawi; Nelson Alvis-Guzman; Azmeraw T. 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Brant; Alexandra Brazinova; Nicholas J K. Breitborde; Hermann Brenner; Gabrielle Britton; Traolach Brugha; Kristin E. Burke; Reinhard Busse; Zahid A. Butt; Lucero Cahuana-Hurtado; Charlton S K H. Callender; Ismael R. Campos-Nonato; Julio Cesar Campuzano Rincon; Jorge Cano; Mate Car; Rosario CÃ¡rdenas; Giulia Carreras; Juan J. Carrero; Austin Carter; FÃ©lix Carvalho; Carlos A. CastaÃ±eda-Orjuela; Jacqueline Castillo Rivas; Franz Castro; FerrÃ¡n CatalÃ¡-LÃ³pez; Alanur Ã‡avlin; Ester Cerin; Yazan Chaiah; Ana Paula Champs; Hsing-Yi Chang; Jung-Chen Chang; Aparajita Chattopadhyay; Pankaj Chaturvedi; Wanqing Chen; Peggy Pei-Chia Chiang; Odgerel Chimed-Ochir; Ken Lee Chin; Vesper Hichilombwe Chisumpa; Abdulaal Chitheer; Jee-Young J. Choi; Hanne Christensen; Devasahayam J. Christopher; Sheng-Chia Chung; Flavia M. Cicuttini; Liliana G. Ciobanu; Massimo Cirillo; Rafael M. Claro; Aaron J. 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Igumbor; Chad Thomas Ikeda; Olayinka Stephen Ilesanmi; Usman Iqbal; Seyed Sina Naghibi Irvani; Oluwaseyi Oluwakemi Isehunwa; Sheikh Mohammed Shariful Islam; Farhad Islami; Leila Jahangiry; Nader Jahanmehr; Rajesh Jain; Sudhir Kumar Jain; Mihajlo Jakovljevic; Spencer L. James; Mehdi Javanbakht; Sudha Jayaraman; Achala Upendra Jayatilleke; Sun Ha Jee; Panniyammakal Jeemon; Ravi Prakash Jha; Vivekanand Jha; John S. Ji; Sarah Charlotte Johnson; Jost B. Jonas; Ankur Joshi; Jacek Jerzy Jozwiak; Suresh Banayya Jungari; Mikk JÃ¼risson; K. Madhanraj; Zubair Kabir; Rajendra Kadel; Amaha Kahsay; Molla Kahssay; Rizwan Kalani; Umesh Kapil; Manoochehr Karami; Behzad Karami Matin; AndrÃ© Karch; Corine Karema; Narges Karimi; Seyed M. Karimi; Hamidreza Karimi-Sari; Amir Kasaeian; Getachew Mullu Kassa; Tesfaye Dessale Kassa; Zemenu Yohannes Kassa; Nicholas J. Kassebaum; Marzieh Katibeh; Srinivasa Vittal Katikireddi; Anil Kaul; Norito Kawakami; Hossein Kazemeini; Zhila Kazemi; Ali Kazemi Karyani; K.C. Prakash; Seifu Kebede; Peter Njenga Keiyoro; Grant Rodgers Kemp; Andre Pascal Kengne; Andre Keren; Maia Kereselidze; Yousef Saleh Khader; Morteza Abdullatif Khafaie; Alireza Khajavi; Nauman Khalid; Ibrahim A. Khalil; Ejaz Ahmad Khan; Gulfaraz Khan; Muhammad Shahzeb Khan; Muhammad Ali Khan; Young-Ho Khang; Tripti Khanna; Mona M. Khater; Alireza Khatony; Habibolah Khazaie; Abdullah T. Khoja; Ardeshir Khosravi; Mohammad Hossein Khosravi; Jagdish Khubchandani; Aliasghar A. Kiadaliri; Getiye D Dejenu Kibret; Cho-Il Kim; Daniel Kim; Jun Y. Kim; Young-Eun Kim; Ruth W. Kimokoti; Yohannes Kinfu; Sanjay Kinra; Adnan Kisa; Katarzyna Kissimova-Skarbek; Niranjan Kissoon; Mika KivimÃ¤ki; Marcus E. Kleber; Luke D. Knibbs; Ann Kristin Skrindo Knudsen; Sonali Kochhar; Yoshihiro Kokubo; Tufa Kolola; Jacek A. Kopec; Margaret N. Kosek; Soewarta Kosen; Parvaiz A. Koul; Ai Koyanagi; Michael A. Kravchenko; Kewal Krishan; Sanjay Krishnaswami; Barthelemy Kuate Defo; Burcu Kucuk Bicer; Andreas A. Kudom; Ernst J. Kuipers; Xie Rachel Kulikoff; G Anil Kumar; Manasi Kumar; Pushpendra Kumar; Fekede Asefa Kumsa; Michael J. Kutz; Sheetal D. Lad; Alessandra Lafranconi; Dharmesh Kumar Lal; Ratilal Lalloo; Hilton Lam; Faris Hasan Lami; Qing Lan; SinÃ©ad M. Langan; Van C. Lansingh; Sonia Lansky; Heidi Jane Larson; Dennis Odai Laryea; Zohra S. Lassi; Arman Latifi; Pablo M. Lavados; Avula Laxmaiah; Jeffrey V. Lazarus; Georgy Lebedev; Paul H. Lee; James Leigh; Cheru Tesema Leshargie; Samson Leta; Miriam Levi; Shanshan Li; Yichong Li; Xiaohong Li; Juan Liang; Xiaofeng Liang; Misgan Legesse Liben; Lee-Ling Lim; Stephen S. Lim; Miteku Andualem Limenih; Shai Linn; Shiwei Liu; Yang Liu; Rakesh Lodha; Giancarlo Logroscino; Chris Lonsdale; Scott A. Lorch; Stefan Lorkowski; Paulo A. Lotufo; Rafael Lozano; Tim C D. Lucas; Raimundas Lunevicius; Ronan A. Lyons; Stefan Ma; Crispin Mabika; Erlyn Rachelle King Macarayan; Mark T. Mackay; Emilie R. Maddison; Ralph Maddison; Fabiana Madotto; Hassan Magdy Abd El Razek; Muhammed Magdy Abd El Razek; Dhaval P. Maghavani; Marek Majdan; Reza Majdzadeh; Azeem Majeed; Reza Malekzadeh; Manzoor Ahmad Malik; Deborah Carvalho Malta; Abdullah A. Mamun; Wondimu Ayele Manamo; Ana-Laura Manda; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Chabila Christopher Mapoma; Dadi Marami; Joemer C. Maravilla; Wagner Marcenes; Shakhnazarova Marina; Jose Martinez-Raga; Sheila C O. Martins; Francisco RogerlÃ¢ndio Martins-Melo; Winfried MÃ¤rz; Melvin B. Marzan; Tivani Phosa Mashamba-Thompson; Felix Masiye; Benjamin Ballard Massenburg; Pallab K. Maulik; Mohsen Mazidi; John J. McGrath; Martin McKee; Suresh Mehata; Sanjay Madhav Mehendale; Man Mohan Mehndiratta; Ravi Mehrotra; Kala M. Mehta; Varshil Mehta; Tesfa Mekonen; Tefera Chane Mekonnen; Hagazi Gebre Meles; Kidanu Gebremariam Meles; Addisu Melese; Mulugeta Melku; Peter T N. Memiah; Ziad A. Memish; Walter Mendoza; Desalegn Tadese Mengistu; Getnet Mengistu; George A. Mensah; Seid Tiku Mereta; Atte Meretoja; Tuomo J. Meretoja; Tomislav Mestrovic; Haftay Berhane Mezgebe; Yode Miangotar; Bartosz Miazgowski; Tomasz Miazgowski; Ted R. Miller; G.K. Mini; Andreea Mirica; Erkin M. Mirrakhimov; Awoke Temesgen Misganaw; Babak Moazen; Nurilign Abebe Moges; Karzan Abdulmuhsin Mohammad; Moslem Mohammadi; Noushin Mohammadifard; Maryam Mohammadi-Khanaposhtani; Mousa Mohammadnia-Afrouzi; Shafiu Mohammed; Mohammed A. Mohammed; Viswanathan Mohan; Ali H. Mokdad; Mariam Molokhia; Lorenzo Monasta; Ghobad Moradi; Mahmoudreza Moradi; Maziar Moradi-Lakeh; Mehdi Moradinazar; Paula Moraga; Lidia Morawska; Ilais Moreno VelÃ¡squez; Joana Morgado-Da-costa; Shane Douglas Morrison; Abbas Mosapour; Marilita M. Moschos; Seyyed Meysam Mousavi; Achenef Asmamaw Muche; Kindie Fentahun Muchie; Ulrich Otto Mueller; Satinath Mukhopadhyay; Erin C. Mullany; Kate Muller; Manoj Murhekar; Tasha B. Murphy; G.V.S. Murthy; Srinivas Murthy; Jonah Musa; Kamarul Imran Musa; Ghulam Mustafa; Saravanan Muthupandian; Jean B. Nachega; Gabriele Nagel; Mohsen Naghavi; Aliya Naheed; Azin Nahvijou; Gurudatta Naik; Sanjeev Nair; Farid Najafi; Vinay Nangia; Jobert Richie Nansseu; Bruno Ramos Nascimento; Haseeb Nawaz; Busisiwe P. Ncama; Nahid Neamati; Ionut Negoi; Ruxandra Irina Negoi; Subas Neupane; Charles Richard James Newton; Frida N. Ngalesoni; Josephine W. Ngunjiri; Ha Thu Nguyen; Huong Thanh Nguyen; Long Hoang Nguyen; Michele Nguyen; Trang Huyen Nguyen; Dina Nur Anggraini Ningrum; Yirga Legesse Nirayo; Muhammad Imran Nisar; Molly R. Nixon; Nomonde Nolutshungu; Shuhei Nomura; Ole F. Norheim; Mehdi Noroozi; Bo Norrving; Jean Jacques Noubiap; Hamid Reza Nouri; Malihe Nourollahpour Shiadeh; Mohammad Reza Nowroozi; Elaine O. Nsoesie; Peter S. Nyasulu; Richard Ofori-Asenso; Okechukwu Samuel Ogah; Felix Akpojene Ogbo; In-Hwan Oh; Anselm Okoro; Olanrewaju Oladimeji; Andrew T. Olagunju; Tinuke O. Olagunju; Pedro R. Olivares; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Sok King Ong; John Nelson Opio; Eyal Oren; Justin R. Ortiz; Alberto Ortiz; Erika Ota; Stanislav S. Otstavnov; Simon Ã˜verland; Mayowa Ojo Owolabi; Abayomi Samuel Oyekale; P.A. Mahesh; Rosana Pacella; Smita Pakhale; Abhijit P. Pakhare; Adrian Pana; Basant Kumar Panda; Songhomitra Panda-Jonas; Achyut Raj Pandey; Jeyaraj Durai Pandian; Andrea Parisi; Eun-Kee Park; Charles D H. Parry; Hadi Parsian; Shanti Patel; Ajay Patle; Scott B. Patten; George C. Patton; Deepak Paudel; Neil Pearce; Emmanuel K. Peprah; Alexandre Pereira; David M. Pereira; Krystle M. Perez; Norberto Perico; Aslam Pervaiz; Konrad Pesudovs; William A. Petri; Max Petzold; Michael R. Phillips; David M. Pigott; Julian David Pillay; Meghdad Pirsaheb; Farhad Pishgar; Dietrich Plass; Suzanne Polinder; Constance Dimity Pond; Svetlana Popova; Maarten J. Postma; Farshad Pourmalek; Akram Pourshams; Hossein Poustchi; Dorairaj Prabhakaran; V. Prakash; Swayam Prakash; Narayan Prasad; Mostafa Qorbani; D Alex Quistberg; Amir Radfar; Anwar Rafay; Alireza Rafiei; Fakher Rahim; Kazem Rahimi; Afarin Rahimi-Movaghar; Vafa Rahimi-Movaghar; Mahfuzar Rahman; Mohammad Hifz Ur Rahman; Muhammad Aziz Rahman; Sajjad Ur Rahman; Rajesh Kumar Rai; Fatemeh Rajati; Sasa Rajsic; Sree Bhushan Raju; Usha Ram; Chhabi Lal Ranabhat; Prabhat Ranjan; Anna Ranta; Davide Rasella; David Laith Rawaf; Salman Rawaf; Sarah E. Ray; Christian Razo-GarcÃa; Maria Albertina Santiago Rego; JÃ¼rgen Rehm; Robert C. Reiner; Nickolas Reinig; Cesar Reis; Giuseppe Remuzzi; Andre M N. Renzaho; Serge Resnikoff; Satar Rezaei; Shahab Rezaeian; Mohammad Sadegh Rezai; Seyed Mohammad Riahi; Antonio Luiz P. Ribeiro; Horacio Riojas; Maria Jesus Rios-Blancas; Kedir Teji Roba; Stephen R. Robinson; Leonardo Roever; Luca Ronfani; Gholamreza Roshandel; Denis O. Roshchin; Ali Rostami; Dietrich Rothenbacher; Enrico Rubagotti; George Mugambage Ruhago; Soheil Saadat; Yogesh Damodar Sabde; Perminder S. Sachdev; Basema Saddik; Ehsan Sadeghi; Sahar Saeedi Moghaddam; Hosein Safari; Yahya Safari; Roya Safari-Faramani; Mahdi Safdarian; Sare Safi; Saeid Safiri; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; Haniye Sadat Sajadi; Mohamadreza Salahshoor; Nasir Salam; Joseph S. Salama; Payman Salamati; Raphael de Freitas Saldanha; Yahya Salimi; Hamideh Salimzadeh; Inbal Salz; Evanson Zondani Sambala; Abdallah M. Samy; Juan Sanabria; Maria Dolores Sanchez-NiÃ±o; Itamar S. Santos; JoÃ£o Vasco Santos; Milena M. Santric Milicevic; Bruno Piassi Sao Jose; Mayank Sardana; Abdur Razzaque Sarker; Nizal Sarrafzadegan; Benn Sartorius; Shahabeddin Sarvi; Brijesh Sathian; Maheswar Satpathy; Miloje Savic; Arundhati R. Sawant; Monika Sawhney; Sonia Saxena; Mehdi Sayyah; Vinod Scaria; Elke Schaeffner; Kathryn Schelonka; Maria InÃªs Schmidt; Ione J C. Schneider; Ben SchÃ¶ttker; Aletta Elisabeth Schutte; David C. Schwebel; Falk Schwendicke; James G. Scott; Mario Sekerija; Sadaf G. Sepanlou; Edson ServÃ¡n-Mori; Hosein Shabaninejad; Katya Anne Shackelford; Azadeh Shafieesabet; Amira A. Shaheen; Masood Ali Shaikh; Raad A. Shakir; Mehran Shams-Beyranvand; Mohammadbagher Shamsi; Morteza Shamsizadeh; Heidar Sharafi; Kiomars Sharafi; Mehdi Sharif; Mahdi Sharif-Alhoseini; Meenakshi Sharma; Jayendra Sharma; Rajesh Sharma; Jun She; Aziz Sheikh; Kevin N. Sheth; Peilin Shi; Kenji Shibuya; Girma Temam Shifa; Mekonnen Sisay Shiferaw; Mika Shigematsu; Rahman Shiri; Reza Shirkoohi; Ivy Shiue; Farhad Shokraneh; Mark G. Shrime; Sharvari Rahul Shukla; Si Si
Background: Assessments of age-specifc mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Afairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specifc mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in diferent components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specifc mortality shows that there are remarkably complex patterns in population mortality across countries. The fndings of this study highlight global successes, such as the large decline in under-5 mortality, which refects signifcant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. © 2018 The Author(s).
Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
(Lancet Publishing Group, 2018) Spencer L. James; Degu Abate; Kalkidan Hassen Abate; Solomon M. Abay; Cristiana Abbafati; Nooshin Abbasi; Hedayat Abbastabar; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Ibrahim Abdollahpour; Rizwan Suliankatchi Abdulkader; Zegeye Abebe; Semaw F. Abera; Olifan Zewdie Abil; Haftom Niguse Abraha; Laith Jamal Abu-Raddad; Niveen M.E. Abu-Rmeileh; Manfred Mario Kokou Accrombessi; Dilaram Acharya; Pawan Acharya; Ilana N. Ackerman; Abdu A. Adamu; Oladimeji M. Adebayo; Victor Adekanmbi; Olatunji O. Adetokunboh; Mina G. Adib; Jose C. Adsuar; Kossivi Agbelenko Afanvi; Mohsen Afarideh; Ashkan Afshin; Gina Agarwal; Kareha M. Agesa; Rakesh Aggarwal; Sargis Aghasi Aghayan; Sutapa Agrawal; Alireza Ahmadi; Mehdi Ahmadi; Hamid Ahmadieh; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Tomi Akinyemiju; Nadia Akseer; Ziyad Al-Aly; Ayman Al-Eyadhy; Hesham M. Al-Mekhlafi; Rajaa M. Al-Raddadi; Fares Alahdab; Khurshid Alam; Tahiya Alam; Alaa Alashi; Seyed Moayed Alavian; Kefyalew Addis Alene; Mehran Alijanzadeh; Reza Alizadeh-Navaei; Syed Mohamed Aljunid; Ala'a Alkerwi; François Alla; Peter Allebeck; Mohamed M.L. Alouani; Khalid Altirkawi; Nelson Alvis-Guzman; Azmeraw T. Amare; Leopold N. Aminde; Walid Ammar; Yaw Ampem Amoako; Nahla Hamed Anber; Catalina Liliana Andrei; Sofia Androudi; Megbaru Debalkie Animut; Mina Anjomshoa; Mustafa Geleto Ansha; Carl Abelardo T. Antonio; Palwasha Anwari; Jalal Arabloo; Antonio Arauz; Olatunde Aremu; Filippo Ariani; Bahram Armoon; Johan Ärnlöv; Amit Arora; Al Artaman; Krishna K. Aryal; Hamid Asayesh; Rana Jawad Asghar; Zerihun Ataro; Sachin R. Atre; Marcel Ausloos; Leticia Avila-Burgos; Euripide F.G.A. Avokpaho; Ashish Awasthi; Beatriz Paulina Ayala Quintanilla; Rakesh Ayer; Peter S. Azzopardi; Arefeh Babazadeh; Hamid Badali; Alaa Badawi; Ayele Geleto Bali; Katherine E. Ballesteros; Shoshana H. Ballew; Maciej Banach; Joseph Adel Mattar Banoub; Amrit Banstola; Aleksandra Barac; Miguel A. Barboza; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Lope H. Barrero; Bernhard T. Baune; Shahrzad Bazargan-Hejazi; Neeraj Bedi; Ettore Beghi; Masoud Behzadifar; Meysam Behzadifar; Yannick Béjot; Abate Bekele Belachew; Yihalem Abebe Belay; Michelle L. Bell; Aminu K. Bello; Isabela M. Bensenor; Eduardo Bernabe; Robert S. Bernstein; Mircea Beuran; Tina Beyranvand; Neeraj Bhala; Suraj Bhattarai; Soumyadeep Bhaumik; Zulfiqar A. Bhutta; Belete Biadgo; Ali Bijani; Boris Bikbov; Ver Bilano; Nigus Bililign; Muhammad Shahdaat Bin Sayeed; Donal Bisanzio; Brigette F. Blacker; Fiona M. Blyth; Ibrahim R. Bou-Orm; Soufiane Boufous; Rupert Bourne; Oliver J. Brady; Michael Brainin; Luisa C. Brant; Alexandra Brazinova; Nicholas J.K. Breitborde; Hermann Brenner; Paul Svitil Briant; Andrew M. Briggs; Andrey Nikolaevich Briko; Gabrielle Britton; Traolach Brugha; Rachelle Buchbinder; Reinhard Busse; Zahid A. Butt; Lucero Cahuana-Hurtado; Jorge Cano; Rosario Cárdenas; Juan J. Carrero; Austin Carter; Félix Carvalho; Carlos A. Castañeda-Orjuela; Jacqueline Castillo Rivas; Franz Castro; Ferrán Catalá-López; Kelly M. Cercy; Ester Cerin; Yazan Chaiah; Alex R. Chang; Hsing-Yi Chang; Jung-Chen Chang; Fiona J. Charlson; Aparajita Chattopadhyay; Vijay Kumar Chattu; Pankaj Chaturvedi; Peggy Pei-Chia Chiang; Ken Lee Chin; Abdulaal Chitheer; Jee-Young J. Choi; Rajiv Chowdhury; Hanne Christensen; Devasahayam J. Christopher; Flavia M. Cicuttini; Liliana G. Ciobanu; Massimo Cirillo; Rafael M. Claro; Daniel Collado-Mateo; Cyrus Cooper; Josef Coresh; Paolo Angelo Cortesi; Monica Cortinovis; Megan Costa; Ewerton Cousin; Michael H. Criqui; Elizabeth A. Cromwell; Marita Cross; John A. Crump; Abel Fekadu Dadi; Lalit Dandona; Rakhi Dandona; Paul I. Dargan; Ahmad Daryani; Rajat Das Gupta; José Das Neves; Tamirat Tesfaye Dasa; Gail Davey; Adrian C. Davis; Dragos Virgil Davitoiu; Barbora De Courten; Fernando Pio De La Hoz; Diego De Leo; Jan-Walter De Neve; Meaza Girma Degefa; Louisa Degenhardt; Selina Deiparine; Robert P. Dellavalle; Gebre Teklemariam Demoz; Kebede Deribe; Nikolaos Dervenis; Don C. Des Jarlais; Getenet Ayalew Dessie; Subhojit Dey; Samath Dhamminda Dharmaratne; Mesfin Tadese Dinberu; M. Ashworth Dirac; Shirin Djalalinia; Linh Doan; Klara Dokova; David Teye Doku; E. Ray Dorsey; Kerrie E. Doyle; Tim Robert Driscoll; Manisha Dubey; Eleonora Dubljanin; Eyasu Ejeta Duken; Bruce B. Duncan; Andre R. Duraes; Hedyeh Ebrahimi; Soheil Ebrahimpour; Michelle Marie Echko; David Edvardsson; Andem Effiong; Joshua R. Ehrlich; Charbel El Bcheraoui; Maysaa El Sayed Zaki; Ziad El-Khatib; Hajer Elkout; Iqbal R.F. Elyazar; Ahmadali Enayati; Aman Yesuf Endries; Benjamin Er; Holly E. Erskine; Babak Eshrati; Sharareh Eskandarieh; Alireza Esteghamati; Sadaf Esteghamati; Hamed Fakhim; Vahid Fallah Omrani; Mahbobeh Faramarzi; Mohammad Fareed; Farzaneh Farhadi; Talha A. Farid; Carla Sofia Esá Farinha; Andrea Farioli; Andre Faro; Maryam S. Farvid; Farshad Farzadfar; Valery L. Feigin; Netsanet Fentahun; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; Joao C. Fernandes; Alize J. Ferrari; Garumma Tolu Feyissa; Irina Filip; Florian Fischer; Christina Fitzmaurice; Nataliya A. Foigt; Kyle J. Foreman; Jack Fox; Tahvi D. Frank; Takeshi Fukumoto; Nancy Fullman; Thomas Fürst; João M. Furtado; Neal D. Futran; Seana Gall; Morsaleh Ganji; Fortune Gbetoho Gankpe; Alberto L. Garcia-Basteiro; William M. Gardner; Abadi Kahsu Gebre; Amanuel Tesfay Gebremedhin; Teklu Gebrehiwo Gebremichael; Tilayie Feto Gelano; Johanna M. Geleijnse; Ricard Genova-Maleras; Yilma Chisha Dea Geramo; Peter W. Gething; Kebede Embaye Gezae; Keyghobad Ghadiri; Khalil Ghasemi Falavarjani; Maryam Ghasemi-Kasman; Mamata Ghimire; Rakesh Ghosh; Aloke Gopal Ghoshal; Simona Giampaoli; Paramjit Singh Gill; Tiffany K. Gill; Ibrahim Abdelmageed Ginawi; Giorgia Giussani; Elena V. Gnedovskaya; Ellen M. Goldberg; Srinivas Goli; Hector Gómez-Dantés; Philimon N. Gona; Sameer Vali Gopalani; Taren M. Gorman; Alessandra C. Goulart; Bárbara Niegia Garcia Goulart; Ayman Grada; Morgan E. Grams; Giuseppe Grosso; Harish Chander Gugnani; Yuming Guo; Prakash C. Gupta; Rahul Gupta; Rajeev Gupta; Tanush Gupta; Bishal Gyawali; Juanita A. Haagsma; Vladimir Hachinski; Nima Hafezi-Nejad; Hassan Haghparast Bidgoli; Tekleberhan B. Hagos; Gessessew Bugssa Hailu; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Randah R. Hamadeh; Samer Hamidi; Alexis J. Handal; Graeme J. Hankey; Yuantao Hao; Hilda L. Harb; Sivadasanpillai Harikrishnan; Josep Maria Haro; Mehedi Hasan; Hadi Hassankhani; Hamid Yimam Hassen; Rasmus Havmoeller; Caitlin N. Hawley; Roderick J. Hay; Simon I. Hay; Akbar Hedayatizadeh-Omran; Behzad Heibati; Delia Hendrie; Andualem Henok; Claudiu Herteliu; Sousan Heydarpour; Desalegn Tsegaw Hibstu; Huong Thanh Hoang; Hans W. Hoek; Howard J. Hoffman; Michael K. Hole; Enayatollah Homaie Rad; Praveen Hoogar; H. Dean Hosgood; Seyed Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Peter J. Hotez; Damian G. Hoy; Mohamed Hsairi; Aung Soe Htet; Guoqing Hu; John J. Huang; Chantal K. Huynh; Kim Moesgaard Iburg; Chad Thomas Ikeda; Bogdan Ileanu; Olayinka Stephen Ilesanmi; Usman Iqbal; Seyed Sina Naghibi Irvani; Caleb Mackay Salpeter Irvine; Sheikh Mohammed; Shariful Islam; Farhad Islami; Kathryn H. Jacobsen; Leila Jahangiry; Nader Jahanmehr; Sudhir Kumar Jain; Mihajlo Jakovljevic; Mehdi Javanbakht; Achala Upendra Jayatilleke; Panniyammakal Jeemon; Ravi Prakash Jha; Vivekanand Jha; John S. Ji; Catherine O. Johnson; Jost B. Jonas; Jacek Jerzy Jozwiak; Suresh Banayya Jungari; Mikk Jürisson; Zubair Kabir; Rajendra Kadel; Amaha Kahsay; Rizwan Kalani; Tanuj Kanchan; Manoochehr Karami; Behzad Karami Matin; André Karch; Corine Karema; Narges Karimi; Seyed M. Karimi; Amir Kasaeian; Dessalegn H. Kassa; Getachew Mullu Kassa; Tesfaye Dessale Kassa; Nicholas J. Kassebaum; Srinivasa Vittal Katikireddi; Norito Kawakami; Ali Kazemi Karyani; Masoud Masoud Keighobadi; Peter Njenga Keiyoro; Laura Kemmer; Grant Rodgers Kemp; Andre Pascal Kengne; Andre Keren; Yousef Saleh Khader; Behzad Khafaei; Morteza Abdullatif Khafaie; Alireza Khajavi; Ibrahim A. Khalil; Ejaz Ahmad Khan; Muhammad Shahzeb Khan; Muhammad Ali Khan; Young-Ho Khang; Mohammad Khazaei; Abdullah T. Khoja; Ardeshir Khosravi; Mohammad Hossein Khosravi; Aliasghar A. Kiadaliri; Daniel N. Kiirithio; Cho-Il Kim; Daniel Kim; Pauline Kim; Young-Eun Kim; Yun Jin Kim; Ruth W. Kimokoti; Yohannes Kinfu; Adnan Kisa; Katarzyna Kissimova-Skarbek; Mika Kivimäki; Ann Kristin Skrindo Knudsen; Jonathan M. Kocarnik; Sonali Kochhar; Yoshihiro Kokubo; Tufa Kolola; Jacek A. Kopec; Soewarta Kosen; Georgios A. Kotsakis; Parvaiz A. Koul; Ai Koyanagi; Michael A. Kravchenko; Kewal Krishan; Kristopher J. Krohn; Barthelemy Kuate Defo; Burcu Kucuk Bicer; G. Anil Kumar; Manasi Kumar; Hmwe Hmwe Kyu; Deepesh P. Lad; Sheetal D. Lad; Alessandra Lafranconi; Ratilal Lalloo; Tea Lallukka; Faris Hasan Lami; Van C. Lansingh; Arman Latifi; Kathryn Mei-Ming Lau; Jeffrey V. Lazarus; Janet L. Leasher; Jorge R. Ledesma; Paul H. Lee; James Leigh; Janni Leung; Miriam Levi; Sonia Lewycka; Shanshan Li; Yichong Li; Yu Liao; Misgan Legesse Liben; Lee-Ling Lim; Stephen S. Lim; Shiwei Liu; Rakesh Lodha; Katharine J. Looker; Alan D. Lopez; Stefan Lorkowski; Paulo A. Lotufo; Nicola Low; Rafael Lozano; Tim C.D. Lucas; Lydia R. Lucchesi; Raimundas Lunevicius; Ronan A. Lyons; Stefan Ma; Erlyn Rachelle King Macarayan; Mark T. Mackay; Fabiana Madotto; Hassan Magdy Abd El Razek; Muhammed Magdy Abd El Razek; Dhaval P. Maghavani; Narayan Bahadur Mahotra; Hue Thi Mai; Marek Majdan; Reza Majdzadeh; Azeem Majeed; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A. Mamun; Ana-Laura Manda; Helena Manguerra; Treh Manhertz; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Chabila Christopher Mapoma; Joemer C. Maravilla; Wagner Marcenes; Ashley Marks; Francisco Rogerlândio Martins-Melo; Ira Martopullo; Winfried März; Melvin B. Marzan; Tivani Phosa Mashamba-Thompson; Benjamin Ballard Massenburg; Manu Raj Mathur; Kunihiro Matsushita; Pallab K. Maulik; Mohsen Mazidi; Colm McAlinden; John J. McGrath; Martin McKee; Man Mohan Mehndiratta; Ravi Mehrotra; Kala M. Mehta; Varshil Mehta; Fabiola Mejia-Rodriguez; Tesfa Mekonen; Addisu Melese; Mulugeta Melku; Michele Meltzer; Peter T.N. Memiah; Ziad A. Memish; Walter Mendoza; Desalegn Tadese Mengistu; Getnet Mengistu; George A. Mensah; Seid Tiku Mereta; Atte Meretoja; Tuomo J. Meretoja; Tomislav Mestrovic; Naser Mohammad Gholi Mezerji; Bartosz Miazgowski; Tomasz Miazgowski; Anoushka I. Millear; Ted R. Miller; Benjamin Miltz; G.K. Mini; Mojde Mirarefin; Erkin M. Mirrakhimov; Awoke Temesgen Misganaw; Philip B. Mitchell; Habtamu Mitiku; Babak Moazen; Bahram Mohajer; Karzan Abdulmuhsin Mohammad; Noushin Mohammadifard; Mousa Mohammadnia-Afrouzi; Mohammed A. Mohammed; Shafiu Mohammed; Farnam Mohebi; Modhurima Moitra; Ali H. Mokdad; Mariam Molokhia; Lorenzo Monasta; Yoshan Moodley; Mahmood Moosazadeh; Ghobad Moradi; Maziar Moradi-Lakeh; Mehdi Moradinazar; Paula Moraga; Lidia Morawska; Ilais Moreno Velásquez; Joana Morgado-Da-Costa; Shane Douglas Morrison; Marilita M. Moschos; Seyyed Meysam Mousavi; Kalayu Brhane Mruts; Achenef Asmamaw Muche; Kindie Fentahun Muchie; Ulrich Otto Mueller; Oumer Sada Muhammed; Satinath Mukhopadhyay; Kate Muller; John Everett Mumford; Manoj Murhekar; Jonah Musa; Kamarul Imran Musa; Ghulam Mustafa; Ashraf F. Nabhan; Chie Nagata; Mohsen Naghavi; Aliya Naheed; Azin Nahvijou; Gurudatta Naik; Nitish Naik; Farid Najafi; Luigi Naldi; Hae Sung Nam; Vinay Nangia; Jobert Richie Nansseu; Bruno Ramos Nascimento; Gopalakrishnan Natarajan; Nahid Neamati; Ionut Negoi; Ruxandra Irina Negoi; Subas Neupane; Charles Richard James Newton; Josephine W. Ngunjiri; Anh Quynh Nguyen; Ha Thu Nguyen; Huong Lan Thi Nguyen; Huong Thanh Nguyen; Long Hoang Nguyen; Minh Nguyen; Nam Ba Nguyen; Son Hoang Nguyen; Emma Nichols; Dina Nur Anggraini Ningrum; Molly R. Nixon; Nomonde Nolutshungu; Shuhei Nomura; Ole F. Norheim; Mehdi Noroozi; Bo Norrving; Jean Jacques Noubiap; Hamid Reza Nouri; Malihe Nourollahpour Shiadeh; Mohammad Reza Nowroozi; Elaine O. Nsoesie; Peter S. Nyasulu; Christopher M. Odell; Richard Ofori-Asenso; Felix Akpojene Ogbo; In-Hwan Oh; Olanrewaju Oladimeji; Andrew T. Olagunju; Tinuke O. Olagunju; Pedro R. Olivares; Helen Elizabeth Olsen; Bolajoko Olubukunola Olusanya; Kanyin L. Ong; Sok King Ong; Eyal Oren; Alberto Ortiz; Erika Ota; Stanislav S. Otstavnov; Simon øverland; Mayowa Ojo Owolabi; P.A. Mahesh; Rosana Pacella; Amir H. Pakpour; Adrian Pana; Songhomitra Panda-Jonas; Andrea Parisi; Eun-Kee Park; Charles D.H. Parry; Shanti Patel; Sanghamitra Pati; Snehal T. Patil; Ajay Patle; George C. Patton; Vishnupriya Rao Paturi; Katherine R. Paulson; Neil Pearce; David M. Pereira; Norberto Perico; Konrad Pesudovs; Hai Quang Pham; Michael R. Phillips; David M. Pigott; Julian David Pillay; Michael A. Piradov; Meghdad Pirsaheb; Farhad Pishgar; Oleguer Plana-Ripoll; Dietrich Plass; Suzanne Polinder; Svetlana Popova; Maarten J. Postma; Akram Pourshams; Hossein Poustchi; Dorairaj Prabhakaran; Swayam Prakash; V. Prakash; Caroline A. Purcell; Manorama B. Purwar; Mostafa Qorbani; D. Alex Quistberg; Amir Radfar; Anwar Rafay; Alireza Rafiei; Fakher Rahim; Kazem Rahimi; Afarin Rahimi-Movaghar; Vafa Rahimi-Movaghar; Mahfuzar Rahman; Mohammad Hifz Ur Rahman; Muhammad Aziz Rahman; Sajjad Ur Rahman; Rajesh Kumar Rai; Fatemeh Rajati; Usha Ram; Prabhat Ranjan; Anna Ranta; Puja C. Rao; David Laith Rawaf; Salman Rawaf; K. Srinath Reddy; Robert C. Reiner; Nickolas Reinig; Marissa Bettay Reitsma; Giuseppe Remuzzi; Andre M.N. Renzaho; Serge Resnikoff; Satar Rezaei; Mohammad Sadegh Rezai; Antonio Luiz P. Ribeiro; Stephen R. Robinson; Leonardo Roever; Luca Ronfani; Gholamreza Roshandel; Ali Rostami; Gregory A. Roth; Ambuj Roy; Enrico Rubagotti; Perminder S. Sachdev; Nafis Sadat; Basema Saddik; Ehsan Sadeghi; Sahar Saeedi Moghaddam; Hosein Safari; Yahya Safari; Roya Safari-Faramani; Mahdi Safdarian; Sare Safi; Saeid Safiri; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; Haniye Sadat Sajadi; Nasir Salam; Joseph S. Salama; Payman Salamati; Komal Saleem; Zikria Saleem; Yahya Salimi; Joshua A. Salomon; Sundeep Santosh Salvi; Inbal Salz; Abdallah M. Samy; Juan Sanabria; Yingying Sang; Damian Francesco Santomauro; Itamar S. Santos; João Vasco Santos; Milena M. Santric Milicevic; Bruno Piassi Sao Jose; Mayank Sardana; Abdur Razzaque Sarker; Nizal Sarrafzadegan; Benn Sartorius; Shahabeddin Sarvi; Brijesh Sathian; Maheswar Satpathy; Arundhati R. Sawant; Monika Sawhney; Sonia Saxena; Mete Saylan; Elke Schaeffner; Maria Inês Schmidt; Ione J.C. Schneider; Ben Schöttker; David C. Schwebel; Falk Schwendicke; James G. Scott; Mario Sekerija; Sadaf G. Sepanlou; Edson Serván-Mori; Seyedmojtaba Seyedmousavi; Hosein Shabaninejad; Azadeh Shafieesabet; Mehdi Shahbazi; Amira A. Shaheen; Masood Ali Shaikh; Mehran Shams-Beyranvand; Mohammadbagher Shamsi; Morteza Shamsizadeh; Heidar Sharafi; Kiomars Sharafi; Mehdi Sharif; Mahdi Sharif-Alhoseini; Meenakshi Sharma; Rajesh Sharma; Jun She; Aziz Sheikh; Peilin Shi; Kenji Shibuya; Mika Shigematsu; Rahman Shiri; Reza Shirkoohi; Kawkab Shishani; Ivy Shiue; Farhad Shokraneh; Haitham Shoman; Mark G. Shrime; Si Si; Soraya Siabani; Tariq J. Siddiqi; Inga Dora Sigfusdottir; Rannveig Sigurvinsdottir; João Pedro Silva; Dayane Gabriele Alves Silveira; Narayana Sarma Venkata Singam; Jasvinder A. Singh; Narinder Pal Singh; Virendra Singh; Dhirendra Narain Sinha; Eirini Skiadaresi; Erica Leigh N. Slepak; Karen Sliwa; David L. Smith; Mari Smith; Adauto Martins Soares Filho; Badr Hasan Sobaih; Soheila Sobhani; Eugène Sobngwi; Samir S. Soneji; Moslem Soofi; Masoud Soosaraei; Reed J.D. Sorensen; Joan B. Soriano; Ireneous N. Soyiri; Luciano A. Sposato; Chandrashekhar T. Sreeramareddy; Vinay Srinivasan; Jeffrey D. Stanaway; Dan J. Stein; Caitlyn Steiner; Timothy J. Steiner; Mark A. Stokes; Lars Jacob Stovner; Michelle L. Subart; Agus Sudaryanto; Mu'awiyyah Babale Sufiyan; Bruno F. Sunguya; Patrick John Sur; Ipsita Sutradhar; Bryan L. Sykes; Dillon O. Sylte; Rafael Tabarés-Seisdedos; Santosh Kumar Tadakamadla; Birkneh Tilahun Tadesse; Nikhil Tandon; Segen Gebremeskel Tassew; Mohammad Tavakkoli; Nuno Taveira; Hugh R. Taylor; Arash Tehrani-Banihashemi; Tigist Gashaw Tekalign; Shishay Wahdey Tekelemedhin; Merhawi Gebremedhin Tekle; Habtamu Temesgen; Mohamad-Hani Temsah; Omar Temsah; Abdullah Sulieman Terkawi; Mebrahtu Teweldemedhin; Kavumpurathu Raman Thankappan; Nihal Thomas; Binyam Tilahun; Quyen G. To; Marcello Tonelli; Roman Topor-Madry; Fotis Topouzis; Anna E. Torre; Miguel Tortajada-Girbés; Mathilde Touvier; Marcos Roberto Tovani-Palone; Jeffrey A. Towbin; Bach Xuan Tran; Khanh Bao Tran; Christopher E. Troeger; Thomas Clement Truelsen; Miltiadis K. Tsilimbaris; Derrick Tsoi; Lorainne Tudor Car; E. Murat Tuzcu; Kingsley N. Ukwaja; Irfan Ullah; Eduardo A. Undurraga; Jurgen Unutzer; Rachel L. Updike; Muhammad Shariq Usman; Olalekan A. Uthman; Muthiah Vaduganathan; Afsane Vaezi; Pascual R. Valdez; Santosh Varughese; Tommi Juhani Vasankari; Narayanaswamy Venketasubramanian; Santos Villafaina; Francesco S. Violante; Sergey Konstantinovitch Vladimirov; Vasily Vlassov; Stein Emil Vollset; Kia Vosoughi; Isidora S. Vujcic; Fasil Shiferaw Wagnew; Yasir Waheed; Stephen G. Waller; Yafeng Wang; Yuan-Pang Wang; Elisabete Weiderpass; Robert G. Weintraub; Daniel J. Weiss; Fitsum Weldegebreal; Kidu Gidey Weldegwergs; Andrea Werdecker; T. Eoin West; Harvey A. Whiteford; Justyna Widecka; Tissa Wijeratne; Lauren B. Wilner; Shadrach Wilson; Andrea Sylvia Winkler; Alison B. Wiyeh; Charles Shey Wiysonge; Charles D.A. Wolfe; Anthony D. Woolf; Shouling Wu; Yun-Chun Wu; Grant M.A. Wyper; Denis Xavier; Gelin Xu; Simon Yadgir; Ali Yadollahpour; Seyed Hossein Yahyazadeh Jabbari; Tomohide Yamada; Lijing L. Yan; Yuichiro Yano; Mehdi Yaseri; Yasin Jemal Yasin; Alex Yeshaneh; Ebrahim M. Yimer; Paul Yip; Engida Yisma; Naohiro Yonemoto; Seok-Jun Yoon; Marcel Yotebieng; Mustafa Z. Younis; Mahmoud Yousefifard; Chuanhua Yu; Vesna Zadnik; Zoubida Zaidi; Sojib Bin Zaman; Mohammad Zamani; Zohreh Zare; Ayalew Jejaw Zeleke
Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Indian Trial of Tranexamic acid in Spontaneous Intracerebral Hemorrhage study protocol
(SAGE Publications Inc., 2025) Jeyaraj Durai Pandian; Atul Phillips; Shweta Jain Verma; Deepti Arora; Aneesh Dhasan; Pheba Susan Raju; Padmavathyamma Narayanapillai Sylaja; Biman Kanti Ray; Uddalak Chakraborty; Jacob Johnson; Praveen Kumar Sharma; Sanjeev Kumar Bhoi; Menka Jha; Thomas Iype; Chithra P; Dheeraj Khurana; Sucharita Ray; Dwijen Das; Naurima Kalita; Sweekriti Adhikari; Ashish K. Sharma; Jayanta Roy; Rajeshwar Sahonta; Sulena Singh; Vikram Chaudhary; Girish Ramachandran Menon; Sanjith Aaron; Deepti Bal; Rajinder Kumar Dhamija; Monali Chaturvedi; Siddharth Maheshwari; Aralikatte Onkarappa Saroja; Karkal Ravishankar Naik; Neeraj Bhutani; Kailash Dhankhar; Dinesh Sharma; Rohit Bhatia; Sankar Prasad Gorthi; Binod Sarmah; Vijaya Pamidimukkala; Sankaralingam Saravanan; Sunil K. Narayan; Lakshya Jyoti Basumatary; Nagarjunakonda Venkata Sundarachary; Aruna K. Upputuri; Ummer Karadan; Vayyattu Govindankutty Pradeep Kumar; Rajsrinivas Parthasarathy; Darshan Doshi; Satish Wagh; Tirppur C.R. Ramakrishnan; Saleem Akhtar; Soaham Dilip Desai; Nomal Chandra Borah; Rupjyoti Das; Gaurav Kumar Mittal; Agam Jain; Paul J. Alapatt; Girish Baburao Kulkarni; Deepak Menon; Pritam Raja; Inder Puri; Vivek Keshavan Nambiar; Muralidhar Reddy Yerasu; Shyam Krishnakumar Jaiswal; Kapil Gangadhar Zirpe; Sushma Kirtikumar Gurav; Sudheer Sharma; Somasundaram Kumaravelu; M. Bk; Vicky V. Thakkar; Abhishek Pathak; Madhusudhan Byadarahalli Kempegowda; Praveen Chander; Neetu Ramrakhiani; Arya Devi Ks; Prabhakaran Sankara Sarma; Rahul Huilgol; Meenakshi Sharma; Rupinder Singh Dhaliwal
Rationale: Early mortality in intracerebral hemorrhage (ICH) is due to hematoma volume (HV) expansion, and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug that is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Hypothesis: Administration of TXA in ICH patients when given within 4.5 h of symptom onset will reduce early mortality at 30 days. Design: Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 h of symptom onset or when last seen well. Study participants received 2 g of TXA administered within 45 min while control group received standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed is done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction in HV at 24 h from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90. Summary: If proven to be beneficial, TXA will have a major impact on medical management of ICH. Trial registration: Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831). © 2025 World Stroke Organization
INSTRuCT: Protocol, Infrastructure, and Governance
(Wolters Kluwer Health, 2021) Jeyaraj Durai Pandian; Shweta Jain Verma; Deepti Arora; Meenakshi Sharma; Rupinder Dhaliwal; Himani Khatter; Rahul Huilgol; P.N. Sylaja; Aneesh Dhasan; Vishnu Renjith; Abhishek Pathak; Aparna Pai; Arvind Sharma; Anand Vaishnav; Biman Ray; Dheeraj Khurana; Gaurav Mittal; Girish Kulkarni; Ivy Sebastian; Jayanta Roy; Somasundaram Kumaravelu; Lydia John; Mahesh Kate; M.V. Srivastava; Madhusudhan Byadarahalli Kempegowda; Nomal Borah; Neetu Ramrakhiani; Nirendra Rai; Pawan Ojha; Rohit Bhatia; Rupjyoti Das; Sachin Sureshbabu; Shaikh Afshan Jabeen; Sanjeev Bhoi; Sanjith Aaron; Prabhakaran Sarma; Aralikatte Onkarappa Saroja; Sherly Abraham; Sudhir Sharma; Sulena Sulena; Sankar Gorthi; Sundarachary Nagarjunakonda; Sunil Narayan; Thomas Mathew; Tina George; Pamidimukkala Vijaya; Vikram Huded; Vivek Nambiar; Y. Muralidhar Reddy
Background and Purpose: Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India. Methods: Multiple expert group meetings were conducted by Indian Council of Medical Research to understand the scope of network to perform stroke clinical trials in the country. Established stroke centers with annual volume of 200 patients with stroke with prior experience of conducting clinical trials were included. Central coordinating center, standard operating procedures, data and safety monitoring board were formed. Discussion: In first phase, 2 trials were initiated namely, SPRINT (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India) and Ayurveda treatment in the rehabilitation of patients with ischemic stroke in India (RESTORE [Rehabilitation of Ischemic stroke Patients in India: A Randomized controlled trial]). In second phase, 4 trials have been approved. SPRINT trial was the first to be initiated. SPRINT trial randomized first patient on April 28, 2018; recruited 3048 patients with an average of 128.5 per month so far. The first follow-up was completed on May 27, 2019. RESTORE trial randomized first patient on May 22, 2019; recruited 49 patients with an average of 3.7 per month so far. The first follow-up was completed on August 30, 2019. Conclusions: In next 5 years, INSTRuCT will be able to complete high-quality large scale stroke trials which are relevant globally. © 2021 American Heart Association, Inc.
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016
(Lancet Publishing Group, 2018) Nancy Fullman; Jamal Yearwood; Solomon M. Abay; Cristiana Abbafati; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Zegeye Abebe; Teshome Abuka Abebo; Victor Aboyans; Haftom Niguse Abraha; Daisy M.X. Abreu; Laith J. Abu-Raddad; Akilew Awoke Adane; Rufus Adesoji Adedoyin; Olatunji Adetokunboh; Tara Ballav Adhikari; Mohsen Afarideh; Ashkan Afshin; Gina Agarwal; Dominic Agius; Anurag Agrawal; Sutapa Agrawal; Aliasghar Ahmad Kiadaliri; Miloud Taki Eddine Aichour; Mohammed Akibu; Rufus Olusola Akinyemi; Tomi F. Akinyemiju; Nadia Akseer; Faris Hasan Al Lami; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Tahiya Alam; Deena Alasfoor; Mohammed I. Albittar; Kefyalew Addis Alene; Ayman Al-Eyadhy; Syed Danish Ali; Mehran Alijanzadeh; Syed M. Aljunid; Ala'a Alkerwi; François Alla; Peter Allebeck; Christine Allen; Mahmoud A. Alomari; Rajaa Al-Raddadi; Ubai Alsharif; Khalid A. Altirkawi; Nelson Alvis-Guzman; Azmeraw T. Amare; Kebede Amenu; Walid Ammar; Yaw Ampem Amoako; Nahla Anber; Catalina Liliana Andrei; Sofia Androudi; Carl Abelardo T. Antonio; Valdelaine E.M. Araújo; Olatunde Aremu; Johan Ärnlöv; Al Artaman; Krishna Kumar Aryal; Hamid Asayesh; Ephrem Tsegay Asfaw; Solomon Weldegebreal Asgedom; Rana Jawad Asghar; Mengistu Mitiku Ashebir; Netsanet Abera Asseffa; Tesfay Mehari Atey; Sachin R. Atre; Madhu S. Atteraya; Leticia Avila-Burgos; Euripide Frinel G. Arthur Avokpaho; Ashish Awasthi; Beatriz Paulina Ayala Quintanilla; Animut Alebel Ayalew; Henok Tadesse Ayele; Rakesh Ayer; Tambe Betrand Ayuk; Peter Azzopardi; Natasha Azzopardi-Muscat; Tesleem Kayode Babalola; Hamid Badali; Alaa Badawi; Maciej Banach; Amitava Banerjee; Amrit Banstola; Ryan M. Barber; Miguel A. Barboza; Suzanne L. Barker-Collo; Till Bärnighausen; Simon Barquera; Lope H. Barrero; Quique Bassat; Sanjay Basu; Bernhard T. Baune; Shahrzad Bazargan-Hejazi; Neeraj Bedi; Ettore Beghi; Masoud Behzadifar; Meysam Behzadifar; Bayu Begashaw Bekele; Abate Bekele Belachew; Saba Abraham Belay; Yihalem Abebe Belay; Michelle L. Bell; Aminu K. Bello; Derrick A. Bennett; James R. Bennett; Isabela M. Bensenor; Derbew Fikadu Berhe; Eduardo Bernabé; Robert Steven Bernstein; Mircea Beuran; Ashish Bhalla; Paurvi Bhatt; Soumyadeep Bhaumik; Zulfiqar A. Bhutta; Belete Biadgo; Ali Bijani; Boris Bikbov; Charles Birungi; Stan Biryukov; Hailemichael Bizuneh; Ian W. Bolliger; Kaylin Bolt; Ibrahim R. Bou-Orm; Kayvan Bozorgmehr; Oliver Jerome Brady; Alexandra Brazinova; Nicholas J.K. Breitborde; Hermann Brenner; Gabrielle Britton; Traolach S. Brugha; Zahid A. Butt; Lucero Cahuana-Hurtado; Ismael Ricardo Campos-Nonato; Julio Cesar Campuzano; Josip Car; Mate Car; Rosario Cárdenas; Juan Jesus Carrero; Felix Carvalho; Carlos A. Castañeda-Orjuela; Jacqueline Castillo Rivas; Ferrán Catalá-López; Kelly Cercy; Julian Chalek; Hsing-Yi Chang; Jung-Chen Chang; Aparajita Chattopadhyay; Pankaj Chaturvedi; Peggy Pei-Chia Chiang; Vesper Hichilombwe Chisumpa; Jee-Young J. Choi; Hanne Christensen; Devasahayam Jesudas Christopher; Sheng-Chia Chung; Liliana G. Ciobanu; Massimo Cirillo; Danny Colombara; Sara Conti; Cyrus Cooper; Leslie Cornaby; Paolo Angelo Cortesi; Monica Cortinovis; Alexandre Costa Pereira; Ewerton Cousin; Michael H. Criqui; Elizabeth A. Cromwell; Christopher Stephen Crowe; John A. Crump; Alemneh Kabeta Daba; Berihun Assefa Dachew; Abel Fekadu Dadi; Lalit Dandona; Rakhi Dandona; Paul I. Dargan; Ahmad Daryani; Maryam Daryani; Jai Das; Siddharth Kumar Das; José Das Neves; Nicole Davis Weaver; Kairat Davletov; Barbora De Courten; Diego De Leo; Jan-Walter De Neve; Robert P. Dellavalle; Gebre Demoz; Kebede Deribe; Don C. Des Jarlais; Subhojit Dey; Samath D. Dharmaratne; Meghnath Dhimal; Shirin Djalalinia; David Teye Doku; Kate Dolan; E. Ray Dorsey; Kadine Priscila Bender Dos Santos; Kerrie E. Doyle; Tim R. Driscoll; Manisha Dubey; Eleonora Dubljanin; Bruce Bartholow Duncan; Michelle Echko; Dumessa Edessa; David Edvardsson; Joshua R. Ehrlich; Erika Eldrenkamp; Ziad El-Khatib; Matthias Endres; Aman Yesuf Endries; Babak Eshrati; Sharareh Eskandarieh; Alireza Esteghamati; Mahdi Fakhar; Tamer Farag; Mahbobeh Faramarzi; Emerito Jose Aquino Faraon; André Faro; Farshad Farzadfar; Adesegun Fatusi; Mir Sohail Fazeli; Valery L. Feigin; Andrea B. Feigl; Netsanet Fentahun; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; João C. Fernandes; Daniel Obadare Fijabi; Irina Filip; Florian Fischer; Christina Fitzmaurice; Abraham D. Flaxman; Luisa Sorio Flor; Nataliya Foigt; Kyle J. Foreman; Joseph J. Frostad; Thomas Fürst; Neal D. Futran; Emmanuela Gakidou; Silvano Gallus; Ketevan Gambashidze; Amiran Gamkrelidze; Morsaleh Ganji; Abadi Kahsu Gebre; Tsegaye Tewelde Gebrehiwot; Amanuel Tesfay Gebremedhin; Yalemzewod Assefa Gelaw; Johanna M. Geleijnse; Demeke Geremew; Peter W. Gething; Reza Ghadimi; Khalil Ghasemi Falavarjani; Maryam Ghasemi-Kasman; Paramjit Singh Gill; Ababi Zergaw Giref; Maurice Giroud; Melkamu Dedefo Gishu; Giorgia Giussani; William W. Godwin; Srinivas Goli; Hector Gomez-Dantes; Philimon N. Gona; Amador Goodridge; Sameer Vali Gopalani; Yevgeniy Goryakin; Alessandra Carvalho Goulart; Ayman Grada; Max Griswold; Giuseppe Grosso; Harish Chander Gugnani; Yuming Guo; Rahul Gupta; Rajeev Gupta; Tanush Gupta; Tarun Gupta; Vipin Gupta; Juanita A. Haagsma; Vladimir Hachinski; Nima Hafezi-Nejad; Gessessew Bugssa Hailu; Randah Ribhi Hamadeh; Samer Hamidi; Graeme J. Hankey; Hilda L. Harb; Heather C. 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Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations. Copyright © 2018 The Author(s). Published by Elsevier Ltd.
SPRINT INDIA: Regional Variations in Primary and Secondary Stroke Outcomes Based on Baseline Characteristics in North and South Indian Sites
(Wolters Kluwer Medknow Publications, 2025) Somasundaram Kumaravelu; Shweta Jain Verma; Rimpi Arora; Deepti Arora; K. S. Arya Devi; Aneesh Dhasan; Padmavathyamma Narayanapillai Sylaja; Dheeraj Khurana; Pamidimukkala Vijaya; Biman Kanti Ray; Vivek Keshavan Nambiar; Sanjith Aaron; Gaurav Kumar Mittal; Sundarachary Nagarjunakonda; Aparna Ramakrishna Pai; Yerasu Muralidhar Reddy; Sunil K. Narayan; Nomal Chandra Borah; Rupjyoti Das; Girish Baburao Kulkarni; Vikram Huded; Thomas Mathew; Madakasira Vasantha Padma Srivastava; Rohit Bhatia; Pawan T. Ojha; Jayanta Roy; Sherly Mary Abraham; Anand Girish Vaishnav; Arvind Kumar Sharma; Shaikh Afshan Jabeen; Abhishek Pathak; Sanjeev Kumar Bhoi; Sudhir Sharma; Sulena Sulena; Aralikatte Onkarappa Saroja; Neetu Ramrakhiani; Madhusudhan Byadarahalli Kempegowda; Sankar Prasad Gorthi; Mahesh Pundlik Kate; Tina K. George; Ivy Anne Sebastian; Meenakshi Sharma; Rupinder Singh Dhaliwal; Rahul Huilgol; Jeyaraj Durai Pandian
Background and Objectives: Regional differences in stroke prevalence and outcomes in India, driven by demographic and risk factors, are crucial for guiding effective prevention and management strategies. This subanalysis of Secondary prevention with a structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA) randomized controlled trial compared the demographics, risk factors, and clinical outcomes of stroke patients from North and South India to identify regional differences and inform targeted interventions for stroke prevention. Methods: The study analyzed data of 4298 participants from 31 stroke centers across India, focusing on demographics, stroke types, and risk factors. In this study, Mumbai, located at 19.07°N in western India, serves as the dividing line between North and South India. One-year follow-up data from 3038 patients were utilized to examine regional disparities between North and South India. Results: South Indian stroke patients were predominantly rural (60.1%) and less educated (58.2%), while North Indian patients were mostly urban (64.2%). South Indian patients had higher incidence of ischemic stroke (91.1% vs. 73.5%, P = 0.001) and higher rates of large artery atherosclerosis (33.6% vs. 19.7%, P = 0.001), hypertension, type 2 diabetes, smoking, and alcohol consumption, but better medication adherence. In contrast, North Indian patients had higher high-density lipoprotein, drug use, and tobacco use. At 1-year follow-up, North Indian patients had more high-risk transient ischemic attacks and poorer lifestyle-related outcomes, despite South Indians having higher systolic blood pressure and fasting glucose levels. Conclusion: Region-specific strategies are crucial. Block randomization may help. South India needs better lifestyle modification programs, while North India requires improved health education and medication adherence strategies. © 2025 Annals of Indian Academy of Neurology.