Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study.

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.

The increasing significance of disease severity in a burden of disease framework.

Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease.

Population vulnerability to COVID-19 in Europe: a burden of disease analysis.

BACKGROUND: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. METHODS: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. RESULTS: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. CONCLUSION: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.

Correction to: Population vulnerability to COVID-19 in Europe: a burden of disease analysis.

[This corrects the article DOI: 10.1186/s13690-020-00433-y.].

Trends in Glaucoma Surgical Procedures in Portugal: A 16-Year Nationwide Study (2000-2015).

PURPOSE: Glaucoma leads as the first cause of irreversible blindness. The number of patients will greatly increase in upcoming years and changes will have to be accomplished to cope with those numbers. As such, data are important to understand the effect of new policies introduced in glaucoma management. Only few countries have described their glaucoma surgical profile and, in Europe, only the United Kingdom described the last 15 years. The aim of this study is to assess the glaucoma surgical profile and its changes in mainland Portugal from 2000 to 2015. METHODS: Retrospective database analysis of inpatient and surgical outpatients' episodes of all public hospitals in mainland Portugal was performed. The annual absolute numbers of ophthalmic procedures, as well as their surgical rate (per 100,000 inhabitants) were calculated. RESULTS: Glaucoma patients undergoing glaucoma procedures were 67±14 years old and 50% were female. During the study period there was an increase in the number and surgical rate of glaucoma procedures. Trabeculectomy showed a stable surgical rate (7 per 100,000 inhabitants) despite a reduction in terms of relative weight among glaucoma procedures. At the same time, the surgical rate of glaucoma drainage devices and cyclophotoablation increased, while remaining stable for cyclocryoablation. CONCLUSIONS: In Portugal, trabeculectomy had a stable surgical rate throughout the study period, being the most performed glaucoma surgical procedure. Other surgeries, like glaucoma drainage devices and cyclophotoablation are gaining ground among glaucoma specialists. Our results match what has been published by other countries worldwide and can be used to achieve a better health planning.

Paediatric burn unit in Portugal: Beds needed using a bed-day approach.

INTRODUCTION: Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. METHODS: We performed a nation-wide retrospective study, between 2009 and 2013, among less than 16 years-old inpatients with burns that met the transfer criteria to a burn unit in Portugal. A bed-day approach was used, targeting an occupancy rate of 70-75%, and possible locations were studied. The primary outcome was the number of beds needed, and secondary outcomes were the overload and revenue for each possible number of beds in a PBU. RESULTS: A total of 1155 children met the transfer criteria to a burn unit, representing a total of 17,371 bed-days. Occupancy rates of 11-bed, 12-bed, 13-bed and 14-bed PBU were, respectively, 79.7%, 75.3%, 71.0% and 66.8%. The 13-bed PBU scenario would represent an overload of 523 bed-days, revenue of more than 5 million Euros and a ratio of 1 PBU bed per 123,409 children. CONCLUSIONS: Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed.

PGen: large-scale genomic variations analysis workflow and browser in SoyKB.

BACKGROUND: With the advances in next-generation sequencing (NGS) technology and significant reductions in sequencing costs, it is now possible to sequence large collections of germplasm in crops for detecting genome-scale genetic variations and to apply the knowledge towards improvements in traits. To efficiently facilitate large-scale NGS resequencing data analysis of genomic variations, we have developed "PGen", an integrated and optimized workflow using the Extreme Science and Engineering Discovery Environment (XSEDE) high-performance computing (HPC) virtual system, iPlant cloud data storage resources and Pegasus workflow management system (Pegasus-WMS). The workflow allows users to identify single nucleotide polymorphisms (SNPs) and insertion-deletions (indels), perform SNP annotations and conduct copy number variation analyses on multiple resequencing datasets in a user-friendly and seamless way. RESULTS: We have developed both a Linux version in GitHub ( https://github.com/pegasus-isi/PGen-GenomicVariations-Workflow ) and a web-based implementation of the PGen workflow integrated within the Soybean Knowledge Base (SoyKB), ( http://soykb.org/Pegasus/index.php ). Using PGen, we identified 10,218,140 single-nucleotide polymorphisms (SNPs) and 1,398,982 indels from analysis of 106 soybean lines sequenced at 15X coverage. 297,245 non-synonymous SNPs and 3330 copy number variation (CNV) regions were identified from this analysis. SNPs identified using PGen from additional soybean resequencing projects adding to 500+ soybean germplasm lines in total have been integrated. These SNPs are being utilized for trait improvement using genotype to phenotype prediction approaches developed in-house. In order to browse and access NGS data easily, we have also developed an NGS resequencing data browser ( http://soykb.org/NGS_Resequence/NGS_index.php ) within SoyKB to provide easy access to SNP and downstream analysis results for soybean researchers. CONCLUSION: PGen workflow has been optimized for the most efficient analysis of soybean data using thorough testing and validation. This research serves as an example of best practices for development of genomics data analysis workflows by integrating remote HPC resources and efficient data management with ease of use for biological users. PGen workflow can also be easily customized for analysis of data in other species.

The impact of a liberalisation law on legally induced abortion hospitalisations.

OBJECTIVES: Legal abortion based purely in maternal option without fetal/maternal pathology was liberalised in Portugal in 2007 and since then abortion rates have increased substantially. The aim of this paper was to study the impact of the liberalisation of abortion by maternal request on total legal abortion related hospitalisation trends. STUDY DESIGN: We considered hospitalisations of legal abortion (ICD-9-CM codes 635.x) with discharges from 2000 to 2014. Data was obtained from a Portuguese administrative database, which contains all registered public hospitalisations in mainland Portugal. Performed legal abortions during the same period were obtained from INE (National Statistics Institute). Hospitalisations per abortion were calculated by dividing the number of legal abortions hospitalisations per the number of legal abortions, mean ages, number of hospitalisations per age group, complications, admission type and length of stay were also analysed, throughout the study period. RESULTS: Hospitalisations rose during the study period, (from 618 episodes in 2000 to 1,259 in 2014, with a peak of 1,603 in 2010). Since the liberalisation law was passed there was a significant decrease in the number of hospitalisations per abortion: from 1.07 in 2000 to 0.11 in 2014 (p<0.001). Furthermore, the mean age maintained stable since liberalisation (30.8 years before 2007 and 31.0 after). Abortion related hospitalisations are more frequent in women aged 25-39. A significant decrease from the emergent to the scheduled type of admission occurred from 2000 to 2014 (from 83.5% to 56.7% of emergent admissions) (p<0.001). Complications remained stable between 2000 and 2014 and delayed or excessive haemorrhage was the most frequent (4.6%). CONCLUSIONS: Since the liberalisation, hospitalisations per abortion have decreased, reflecting the major impact that the liberalisation of legal abortion by maternal request had on abortion trends nationwide. Before the liberalisation, each abortion led to approximately one hospitalisation while after the liberalisation this trend shifted to approximately 10% of the number of abortions. Legal abortion related hospitalisations are more frequent in women aged between 25 and 39 years old, an older age group when compared to the one registered in all cases of legal abortions, reflecting the differences between those hospitalised and those who are not. Our study shows the impact that legal abortion by maternal request liberalisation law can bring to abortion and to hospitalisation trends.

Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations.

INTRODUCTION: There is a lack of recent and nation-wide epidemiological studies of burns in Europe, mainly in southern Europe. There are no recent studies describing the clinical and economic burden of burns in this European area. Hence, this research aimed to describe the clinical and economic burden of burn hospitalisations in Portugal. METHODS: A retrospective observational study was performed and the Portuguese hospitalisation database of public hospitals was used; all inpatients, discharged between 2000 and 2013, with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx) were taken into account. Furthermore, admissions to hospitals with and without burn centres were compared. RESULTS: A total of 26,447 burn hospitalisations were registered (mean of 1889burn admissions/year). The total hospitalisation rate was of 18.9hospitalisations/100,000inhabitants/year, and there was a higher incidence of male patients. Burn hospitalisations and hospitalisation rates are significantly decreasing - mostly in 0-14-year-old patients - and children below the age of 5 years represented a fifth of all admissions. Besides the important morbidity, the in-hospital mortality rate was of 4.4%. With a total annual charge of almost 13million Euros, the average cost per burn admission is increasing, and reached 8032Euros in 2013. Additionally, more than half of the patients admitted to hospitals without burn centres were not transferred to hospitals with burn centres, not following the European Burns Association transferral criteria. CONCLUSIONS: As the largest southern European nation-wide epidemiological study of burn patients, this research highlights that burn admissions, as well as hospitalisation rates, are decreasing significantly. This was particularly obvious among the youngest patients despite the fact that the numbers still remain very high. Moreover, the in-hospital mortality rate is still excessively high and the burn transferral criteria are not being followed. Thus, it is important to improve preventive measures, reach out to and educate providers about the burn transferral criteria, and develop specific health care strategies for children with these injuries.

Genome-wide transcriptome analysis of soybean primary root under varying water-deficit conditions.

BACKGROUND: Soybean is a major crop that provides an important source of protein and oil to humans and animals, but its production can be dramatically decreased by the occurrence of drought stress. Soybeans can survive drought stress if there is a robust and deep root system at the early vegetative growth stage. However, little is known about the genome-wide molecular mechanisms contributing to soybean root system architecture. This study was performed to gain knowledge on transcriptome changes and related molecular mechanisms contributing to soybean root development under water limited conditions. RESULTS: The soybean Williams 82 genotype was subjected to very mild stress (VMS), mild stress (MS) and severe stress (SS) conditions, as well as recovery from the severe stress after re-watering (SR). In total, 6,609 genes in the roots showed differential expression patterns in response to different water-deficit stress levels. Genes involved in hormone (Auxin/Ethylene), carbohydrate, and cell wall-related metabolism (XTH/lipid/flavonoids/lignin) pathways were differentially regulated in the soybean root system. Several transcription factors (TFs) regulating root growth and responses under varying water-deficit conditions were identified and the expression patterns of six TFs were found to be common across the stress levels. Further analysis on the whole plant level led to the finding of tissue-specific or water-deficit levels specific regulation of transcription factors. Analysis of the over-represented motif of different gene groups revealed several new cis-elements associated with different levels of water deficit. The expression patterns of 18 genes were confirmed byquantitative reverse transcription polymerase chain reaction method and demonstrated the accuracy and effectiveness of RNA-Seq. CONCLUSIONS: The primary root specific transcriptome in soybean can enable a better understanding of the root response to water deficit conditions. The genes detected in root tissues that were associated with key hormones, carbohydrates, and cell wall-related metabolism could play a vital role in achieving drought tolerance and could be promising candidates for future functional characterization. TFs involved in the soybean root and at the whole plant level could be used for future network analysis between TFs and cis-elements. All of these findings will be helpful in elucidating the molecular mechanisms associated with water stress responses in soybean roots.

Genetic variants in root architecture-related genes in a Glycine soja accession, a potential resource to improve cultivated soybean.

BACKGROUND: Root system architecture is important for water acquisition and nutrient acquisition for all crops. In soybean breeding programs, wild soybean alleles have been used successfully to enhance yield and seed composition traits, but have never been investigated to improve root system architecture. Therefore, in this study, high-density single-feature polymorphic markers and simple sequence repeats were used to map quantitative trait loci (QTLs) governing root system architecture in an inter-specific soybean mapping population developed from a cross between Glycine max and Glycine soja. RESULTS: Wild and cultivated soybean both contributed alleles towards significant additive large effect QTLs on chromosome 6 and 7 for a longer total root length and root distribution, respectively. Epistatic effect QTLs were also identified for taproot length, average diameter, and root distribution. These root traits will influence the water and nutrient uptake in soybean. Two cell division-related genes (D type cyclin and auxin efflux carrier protein) with insertion/deletion variations might contribute to the shorter root phenotypes observed in G. soja compared with cultivated soybean. Based on the location of the QTLs and sequence information from a second G. soja accession, three genes (slow anion channel associated 1 like, Auxin responsive NEDD8-activating complex and peroxidase), each with a non-synonymous single nucleotide polymorphism mutation were identified, which may also contribute to changes in root architecture in the cultivated soybean. In addition, Apoptosis inhibitor 5-like on chromosome 7 and slow anion channel associated 1-like on chromosome 15 had epistatic interactions for taproot length QTLs in soybean. CONCLUSION: Rare alleles from a G. soja accession are expected to enhance our understanding of the genetic components involved in root architecture traits, and could be combined to improve root system and drought adaptation in soybean.

Should European perinatal indicators be revisited?

OBJECTIVES: Our study presents the results of a survey of physicians and/or researchers working in 21 European countries, on their opinion about the relevance of perinatal indicators, in order to compare it with the EURO-PERISTAT recommendations. STUDY DESIGN: In this cross-sectional study, we selected 21 out of the initial set of 34 indicators of the national data supply on the European Perinatal Health Report, and added four other indicators based on expert opinion. The relative relevance of these 25 perinatal indicators was then rated by 134 respondents--expert physicians and/or researchers who have published in perinatal medicine--through a web-based survey. We summarized our data using descriptive statistics. RESULTS: The top five perinatal indicators, according to the respondents' rating were: neonatal mortality rate by gestational age, birth weight and plurality; percentage of highly preterm babies delivered in units without a NICU; prevalence of severe maternal morbidity; severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy. Of these top five indicators, however, only neonatal mortality rate by gestational age, birth weight and plurality was considered a core indicator, in 2003. Moreover, severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy, that were considered in 2003 as requiring further development, were now considered by the respondents as highly relevant. CONCLUSIONS: Current views of European physicians and/or researchers working in the perinatal field may not be in agreement with the EURO-PERISTAT recommendations. A revision of the set of perinatal indicators is, therefore, mandatory if a more comprehensive view of health care systems performance across Europe is to be achieved.

A comprehensive and suitable method for determining major ions from atmospheric particulate matter matrices.

The present study proposes an analytical methodology that employs ion chromatography-conductivity detection for simultaneous quantification of inorganic (F(-), Cl(-), NO(3)(-), SO(4)(2-), and PO(3)(-)), monocarboxylate (HCOO(-), CH(3)COO(-), propionate, n-butyrate, lactate, and pyruvate), dicarboxylate (oxalate and succinate), and tricarboxylate anions (citrate), as well as crustal cations (Li(+), Na(+), K(+), NH(4)(+), Ca(2+), Mg(2+)) at low pgm(-3) range in airborne particle samples in one single run. The optimized conditions for anions were as follows: 0.6 mmol L(-1) KOH for 0-14 min, 0.6-15 mmol L(-1) KOH 14-20 min, 15-38 mmol L(-1) KOH during 20-32 min and finally returned to 0.6 mmol L(-1) for a period of 3 min, thereafter the eluent flow rate was 0.38 mL min(-1). Similarly, for cations, isocratic elution was adjusted to 0.36 mL min(-1) at 17.5 mmol L(-1) H(2)SO(4). LOD ranged 3.0-130 pgm(-3) and LOQ was within 10-400 pgm(-3) (Li(+) and PO(4)(3-), respectively) as well as recoveries ranged 89% (Ca(2+)) to 120% (Li(+)). Major ions were successfully determined in real PM1 and PM2.5 samples. The method used here was found to be a comprehensive, simple, cheap and reliable procedure for studying ions in particulate matter (PM) samples even those from remote areas or near ecosystem natural conditions.

Development of method for the speciation of inorganic iron in wine samples.

In this paper, we proposed a procedure for the determination of iron(II) and total iron in wine samples employing molecular absorption spectrophotometry. The ligand used is 2-(5-bromo-2-pyridylazo)-5-(diethylamino)-phenol (Br-PADAP) and the chromogenic reaction in absence or presence of ascorbic acid (reducing agent) allows the determination of iron(II) or total iron, respectively. The optimization step was performed using a multivariate technique (Box Behnken design) involving the factors pH, acid ascorbic concentration and reaction time. The method allows the determination of iron(II) and iron(III) in wine samples, with limits of detection and quantification 0.22 and 0.72 microg L(-1), respectively. The precision expressed as relative standard deviation (R.S.D.) was 1.43 and 0.56% (both, n=11) for content of iron(II) in wine samples of 1.68 and 4.65 mg L(-1), and 1.66 and 0.87% (both, n=11) for content of total iron in wine samples of 1.72 and 5.48 mg L(-1). This method was applied for determination of iron(II) and total iron in six different wine samples. In these, the iron(II) content varied from 0.76 to 4.65 mg L(-1) and from 1.01 to 5.48 mg L(-1) for total iron. The results obtained in the determination of total iron by Br-PADAP method were compared with those that were performed after complete acid digestion in open system and determination of total iron employing FAAS. The method of regression linear was used for comparison of these results and demonstrated that there is no significant difference between the results obtained with these two procedures.