The economic burden of non-communicable disease mortality in the South Pacific: Evidence from Fiji.

Non-communicable diseases (NCDs) have emerged as one of the major endemics in Fiji which is responsible for more than 80 percent of deaths annually. In this study, we estimate the economic burden of non-communicable disease mortality in Fiji. The specific impact of diabetes, cardiovascular disease, chronic respiratory disease and cancer-related mortality on Fiji's output is also investigated using the autoregressive distributed lag bounds tests approach to cointegration. The data used is compiled from Fiji Ministry of Health and Medical Services and World Health Organization's Mortality database. Overall, the study finds that NCD mortality rate together with cardiovascular disease, diabetes, chronic respiratory disease and cancer have a significant negative effect on output per capita of Fiji between 1972 and 2016. A one percentage point increase in NCD-mortality rate reduced output per capita by 0.012 percent. In addition, a percentage point increase in the mortality rates of cardiovascular disease, diabetes, chronic respiratory disease and cancer decreased output per capita by 0.018, 0.01, 0.031, and 0.035 percent, respectively. The findings conclude that NCD poses significant economic burden in Fiji and recommend policy innovations in lessening the high risk of NCD among the Fijian population.

Creation of a Smoke-free Environment for Children: An Assessment of Compliance to COTPA 2003 Legislation in an Urban Area.

OBJECTIVE: To ascertain the compliance to Cigarette and Other Tobacco Products Act (COTPA) 2003 which ensures the protection of children from the adverse health effects of second hand smoke. METHODS: This cross-sectional study assessed the compliance of 32 educational institutions and 157 points of sale of Shimla city. RESULTS: About 88% of the educational institutions and mere 7.6% points of sale were found having good compliance to the key indicators. No point of sale was found within the premises of educational institutions; however, 26% were found selling tobacco products within 100 metres radius of an educational institution. 7.6% points of sale were found selling a tobacco product to children. CONCLUSIONS: Despite having the status of a smoke-free city, lapses were observed in compliance to the Act. Strict adherence to the provisions of the Act would ultimately lead to a smoke-free environment for our children.

Vascular Burden Score Impacts Cognition Independent of Amyloid PET and MRI Measures of Alzheimer's Disease and Vascular Brain Injury.

BACKGROUND/OBJECTIVE: To determine the impact of vascular burden on rates of decline in episodic memory and executive function. We hypothesize that greater vascular burden will have an additive negative impact on cognition after accounting for baseline cognitive impairment, positron emission tomography (PET) amyloid burden, and magnetic resonance imaging (MRI) measures. METHODS: Individuals were followed an average of 5 years with serial cognitive assessments. Predictor variables include vascular burden score (VBS), quantitative brain MRI assessment, and amyloid imaging. Subjects consisted of 65 individuals, 53% of whom were male, aged 73.2±7.2 years on average with an average of 15.5±3.3 years of educational achievement. RESULTS: Baseline cognitive impairment was significantly associated poorer episodic memory (p < 0.0001), smaller hippocampal volume (p < 0.0001), smaller brain volume (p = 0.0026), and greater global Pittsburg Imaging Compound B (PiB) index (p = 0.0008). Greater amyloid burden was associated with greater decline in episodic memory over time (ß= -0.20±0.07, p < 0.005). VBS was significantly associated with the level of executive function performance (ß= -0.14±0.05, p < 0.005) and there was a significant negative interaction between VBS, cognitive impairment, and PiB index (ß= -0.065±0.03, p = 0.03). CONCLUSIONS: Our results find a significant influence of VBS independent of standard MRI measures and cerebral amyloid burden on executive function. In addition, VBS reduced the amount of cerebral amyloid burden needed to result in cognitive impairment. We conclude that the systemic effects of vascular disease as reflected by the VBS independently influence cognitive ability.

Most edges in Markov random fields for white matter hyperintensity segmentation are worthless.

The time and space complexities of Markov random field (MRF) algorithms for image segmentation increase with the number of edges that represent statistical dependencies between adjacent pixels. This has made MRFs too computationally complex for cutting-edge applications such as joint segmentation of longitudinal sequences of many high-resolution magnetic resonance images (MRIs). Here, we show that simply removing edges from full MRFs can reduce the computational complexity of MRF parameter estimation and inference with no notable decrease in segmentation performance. In particular, we show that for segmentation of white matter hyperintensities in 88 brain MRI scans of elderly individuals, as many as 66% of MRF edges can be removed without substantially degrading segmentation accuracy. We then show that removing edges from MRFs makes MRF parameter estimation and inference computationally tractable enough to enable modeling statistical dependencies within and across a larger number of brain MRI scans in a longitudinal series; this improves segmentation performance compared to separate segmentations of each individual scan in the series.

Impact of Markov Random Field optimizer on MRI-based tissue segmentation in the aging brain.

Automatically segmenting brain magnetic resonance images into grey matter, white matter, and cerebrospinal fluid compartments is a fundamentally important neuroimaging problem whose difficulty is heightened in the presence of aging and neurodegenerative disease. Current methods overlap greatly in terms of identifiable algorithmic components, and the impact of specific components on performance is generally unclear in important real-world scenarios involving serial scanning, multiple scanners, and neurodegenerative disease. Therefore we evaluated the impact that one such component, the Markov Random Field (MRF) optimizer that encourages spatially-smooth tissue labelings, has on brain tissue segmentation performance. Two challenging elderly data sets were used to test segmentation consistency across scanners and biological plausibility of tissue change estimates; and a simulated young brain data set was used to test accuracy against ground truth. Belief propagation (BP) and graph cuts (GC), used as the MRF optimizer component of a standardized segmentation system, provide high segmentation performance on aggregate that is competitive with end-to-end systems provided by SPM and FSL (FAST) as well as the more traditional MRF optimizer iterated conditional modes (ICM). However, the relative performance of each method varied strongly by performance criterion and differed between young and old brains. The findings emphasize the unique difficulties involved in segmenting the aging brain, and suggest that optimal algorithm components may depend in part on performance criteria.