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4.
MMWR Morb Mortal Wkly Rep ; 68(48): 1105-1111, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31805033

RESUMO

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Sarampo/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Programas de Imunização , Incidência , Lactente , Sarampo/epidemiologia , Sarampo/mortalidade , Vacina contra Sarampo/administração & dosagem , Adulto Jovem
6.
MMWR Morb Mortal Wkly Rep ; 68(47): 1089, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31851652

RESUMO

World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1).


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Saúde Global/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Aniversários e Eventos Especiais , Humanos
7.
MMWR Morb Mortal Wkly Rep ; 68(43): 979-984, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671082

RESUMO

Dracunculiasis (also known as Guinea worm disease) is caused by the parasite Dracunculus medinensis and is acquired by drinking water containing copepods (water fleas) infected with D. medinensis larvae. The worm typically emerges through the skin on a lower limb approximately 1 year after infection, resulting in pain and disability (1). There is no vaccine or medicine to treat the disease; eradication efforts rely on case containment* to prevent water contamination and other interventions to prevent infection, including health education, water filtration, chemical treatment of unsafe water with temephos (an organophosphate larvicide to kill copepods), and provision of safe drinking water (1,2). In 1986, with an estimated 3.5 million cases† occurring each year in 20 African and Asian countries§ (3), the World Health Assembly called for dracunculiasis elimination (4). The global Guinea Worm Eradication Program (GWEP), led by The Carter Center and supported by the World Health Organization (WHO), CDC, the United Nations Children's Fund, and other partners, began assisting ministries of health in countries with dracunculiasis. This report, based on updated health ministry data, describes progress to eradicate dracunculiasis during January 2018-June 2019 and updates previous reports (2,4,5). With only five countries currently affected by dracunculiasis (Angola, Chad, Ethiopia, Mali, and South Sudan), achievement of eradication is within reach, but it is challenged by civil unrest, insecurity, and lingering epidemiologic and zoologic questions.


Assuntos
Erradicação de Doenças , Dracunculíase/prevenção & controle , Saúde Global/estatística & dados numéricos , Dracunculíase/epidemiologia , Humanos
8.
BMJ ; 367: l5873, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672760

RESUMO

OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS: These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.


Assuntos
Saúde Global/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Nefrologia/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Humanos
9.
Psychiatr Danub ; 31(4): 457-464, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698402

RESUMO

AIMS: National mental health policies must be grounded in accurate assessments of diseases. In the current article we used the Global Burden of Disease Study 2016 to examine burden due to mental and substance use disorders in Romania. METHODS: For each mental and substance use disorder included in the GBD 2016 we reported the yearly estimates for YLL (as a measure for non-fatal burden), YLD (fatal burden) and DALY (summing years lived with disability and years of life lost to give a measure of total burden). RESULTS: Mental and substance use disorders were the third leading cause of non-fatal burden in Romania in 2016, explaining 13.53% of total years lived with disability, the ninth leading cause for fatal burden explaining 0.84% of total years of life lost, and were the fifth leading cause of total burden, accounting for 5.52% of total disability-adjusted life years. Among MSDs, depression, anxiety and alcohol use disorders have the highest rate. Starting 1997 there has been a slow decrease of age-standardized disability-adjusted life year rates, with no significant change in the last 5 years. CONCLUSION: Global Burden of Disease Study 2016 found that mental and substance use disorders were the fifth leading contributors to disease burden in Romania, with anxiety and depressive being the most prevalent. Despite national programs and strategies in the area of mental health initiated especially after 1990, the mental health system does not fully meet the needs of the patients. Effective population-level strategic measures are still required in order to reduce the burden of disease.


Assuntos
Carga Global da Doença/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Pessoas com Deficiência , Humanos , Prevalência , Romênia/epidemiologia
10.
Presse Med ; 48(10): 1076-1084, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31706896

RESUMO

The breast is the leading cancer site in women throughout the world. That said, breast cancer incidence varies widely, ranging from 27/100,0002 (Central-East Asia and Africa) to 85-94/100,0002 (Australia, North America and Western Europe). Its frequency in France is among the highest in Europe. While in most countries, its incidence has been increasing for more than 40 years, in a few other countries (USA, Canada, Australia, France…), it has been decreasing since 2000-2005. Possibly due to a substantial reduction of hormone-based treatments at menopause, the decrease may be transient. It is also the leading cause of female cancer deaths in almost all countries, with the exception of the most economically developed, in which it is currently second to lung cancer. That much said, for thirty years in highly industrialized countries such as France, breast cancer mortality has been declining. Taken together, early diagnosis and improved treatment explain this success. In France, 5-year survival and 10-year survival approximate 88 % and 78 % respectively; these rates are among the most elevated in Western Europe. Excess mortality due to breast cancer is consequently low (<5 %) but variable according to age, and maximal during the first two years of follow-up. Several thousand epidemiological studies on risk factors for breast cancer have been carried out worldwide; it is difficult to draw up an overall assessment, especially insofar as the identified factors interact and vary according to whether the cancers occur before or after menopause and depending on their histological, biological (receptors) or molecular characteristics. Moreover, their prevalence varies in time and from one region to another. For the majority of these factors, the level of relative risk is≤2. Genetic particularities: presence of proliferative mastopathy, a first child after 35 years of age and thoracic irradiation are the sole factors entailing relative risk from 2 to 5 (comparatively speaking, the risk levels associated with tobacco consumption reach values from 10 to 20, and in some cases even higher). However, exposure to risk factors≤2 may be relatively frequent and consequently favorable to development of a substantial number of breast cancers. Estimation (based on degree of risk and frequency of exposure) of the proportion of risk attributable to a given factor facilitates decision-making aimed at determining the most effective primary prevention actions. Taking into consideration the identified factors pertaining to post-menopausal cancers, only 35 % [23 to 45 %] of the attributable proportions could be reduced by primary prevention. In view of achieving this level of reduction, it is possible to put forward the following recommendations: for the women themselves: have a first child before the age of 30, breastfeed for several months, engage in sufficiently intense and regular physical activity, avoid or reduce excess weight after turning thirty, avoid exposure to active or passive smoking, limit alcohol consumption; for their physicians: do not prescribe pointless thoracic irradiations (unnecessary mammography in particular) or unjustified hormonal treatments. *persons/years.


Assuntos
Neoplasias da Mama/epidemiologia , Distribuição por Idade , Fatores Etários , Neoplasias da Mama/etiologia , Neoplasias da Mama/mortalidade , Feminino , França/epidemiologia , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Fatores de Risco
11.
MMWR Morb Mortal Wkly Rep ; 68(45): 1024-1028, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31725706

RESUMO

Certification of global eradication of indigenous wild poliovirus type 2 occurred in 2015 and of type 3 in 2019. Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 and broad use of live, attenuated oral poliovirus vaccine (OPV), the number of wild poliovirus cases has declined >99.99% (1). Genetically divergent vaccine-derived poliovirus* (VDPV) strains can emerge during vaccine use and spread in underimmunized populations, becoming circulating VDPV (cVDPV) strains, and resulting in outbreaks of paralytic poliomyelitis.† In April 2016, all oral polio vaccination switched from trivalent OPV (tOPV; containing vaccine virus types 1, 2, and 3) to bivalent OPV (bOPV; containing types 1 and 3) (2). Monovalent type 2 OPV (mOPV2) is used in response campaigns to control type 2 cVDPV (cVDPV2) outbreaks. This report presents data on cVDPV outbreaks detected during January 2018-June 2019 (as of September 30, 2019). Compared with January 2017-June 2018 (3), the number of reported cVDPV outbreaks more than tripled, from nine to 29; 25 (86%) of the outbreaks were caused by cVDPV2. The increase in the number of outbreaks in 2019 resulted from VDPV2 both inside and outside of mOPV2 response areas. GPEI is planning future use of a novel type 2 OPV, stabilized to decrease the likelihood of reversion to neurovirulence. However, all countries must maintain high population immunity to decrease the risk for cVDPV emergence. Cessation of all OPV use after certification of polio eradication will eliminate the risk for VDPV emergence.


Assuntos
Surtos de Doenças , Saúde Global/estatística & dados numéricos , Poliomielite/epidemiologia , Vacina Antipólio Oral/efeitos adversos , Poliovirus/isolamento & purificação , Humanos , Poliomielite/etiologia , Poliomielite/prevenção & controle , Poliovirus/classificação , Vacina Antipólio Oral/administração & dosagem , Sorotipagem
12.
BMC Public Health ; 19(1): 1391, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660919

RESUMO

BACKGROUND: This study assessed international variations in changes in drowning mortality rates and the quality of reporting specific information in death certificates over the past decade. METHODS: Drowning mortality data of 61 countries were extracted from the World Health Organization Mortality Database. We calculated the percentage change (PC) in age-standardized drowning mortality rates and percentage of drowning deaths reported with unspecified codes between 2004 and 2005 and 2014-2015. RESULTS: Of the 61 countries studied, 50 exhibited a reduction in drowning mortality rates from 2004 to 2005 to 2014-2015. Additionally, five countries-Lithuania, Moldova, Kyrgyzstan, Romania, and El Salvador-with a high mortality rate in 2004-2005 (> 40 deaths per 100,000) showed improvement (PC < - 32%). By contrast, four countries-South Africa, Guyana, Morocco, and Guatemala-exhibited a more than twofold increase in mortality rates. Regarding the quality of reporting, 34 countries exhibited a decrease in the percentage of unspecified codes. Additionally, three countries-Paraguay, Serbia, and Croatia-with moderate and high percentages of unspecified codes (> 40%) exhibited a marked reduction (PC < - 60%), whereas three countries-Malaysia, Belgium, and Nicaragua-exhibited a notable increase. CONCLUSIONS: Large international variations in the extent of changes in drowning mortality rates and the quality of reporting specific information on the death certificate were observed during the study period.


Assuntos
Atestado de Óbito , Afogamento/mortalidade , Saúde Global/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Humanos , Lactente , Pessoa de Meia-Idade , Organização Mundial da Saúde , Adulto Jovem
13.
Lancet Haematol ; 6(12): e606-e615, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31631023

RESUMO

BACKGROUND: Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS: We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS: In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION: Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING: National Institutes of Health.


Assuntos
Bancos de Sangue/provisão & distribução , Transfusão de Sangue , Saúde Global , Acesso aos Serviços de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Bancos de Sangue/economia , Bancos de Sangue/normas , Bancos de Sangue/estatística & dados numéricos , Segurança do Sangue/normas , Segurança do Sangue/estatística & dados numéricos , Transfusão de Sangue/economia , Transfusão de Sangue/normas , Transfusão de Sangue/estatística & dados numéricos , Geografia , Carga Global da Doença , Saúde Global/economia , Saúde Global/normas , Saúde Global/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Modelos Teóricos , Determinação de Necessidades de Cuidados de Saúde/economia , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/normas , Áreas de Pobreza , Prevalência
14.
MMWR Morb Mortal Wkly Rep ; 68(40): 880-884, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600182

RESUMO

During May 19-September 28, 2019,* low levels of influenza activity were reported in the United States, with cocirculation of influenza A and influenza B viruses. In the Southern Hemisphere seasonal influenza viruses circulated widely, with influenza A(H3) predominating in many regions; however, influenza A(H1N1)pdm09 and influenza B viruses were predominant in some countries. In late September, the World Health Organization (WHO) recommended components for the 2020 Southern Hemisphere influenza vaccine and included an update to the A(H3N2) and B/Victoria-lineage components. Annual influenza vaccination is the best means for preventing influenza illness and its complications, and vaccination before influenza activity increases is optimal. Health care providers should recommend vaccination for all persons aged ≥6 months who do not have contraindications to vaccination (1).


Assuntos
Saúde Global/estatística & dados numéricos , Vacinas contra Influenza/química , Influenza Humana/epidemiologia , Vigilância da População , Farmacorresistência Viral , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/efeitos dos fármacos , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vírus da Influenza B/efeitos dos fármacos , Vírus da Influenza B/genética , Vírus da Influenza B/isolamento & purificação , Influenza Humana/virologia , Estações do Ano , Estados Unidos/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 68(41): 928-933, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31622286

RESUMO

Each year, tobacco use is responsible for approximately 8 million deaths worldwide, including 7 million deaths among persons who use tobacco and 1.2 million deaths among nonsmokers exposed to secondhand smoke (SHS) (1). Approximately 80% of the 1.1 billion persons who smoke tobacco worldwide reside in low- and middle-income countries (2,3). The World Health Organization's (WHO's) Framework Convention on Tobacco Control (FCTC) provides the foundation for countries to implement and manage tobacco control through the MPOWER policy package,* which includes monitoring tobacco use, protecting persons from SHS, warning them about the danger of tobacco, and enforcing bans on tobacco advertising, promotion, or sponsorship (tobacco advertising) (4). CDC analyzed data from 11 countries that completed two or more rounds of the Global Adult Tobacco Survey (GATS) during 2008-2017. Tobacco use and tobacco-related behaviors that were assessed included current tobacco use, SHS exposure, thinking about quitting because of warning labels, and exposure to tobacco advertising. Across the assessed countries, the estimated percentage change in tobacco use from the first round to the most recent round ranged from -21.5% in Russia to 1.1% in Turkey. Estimated percentage change in SHS exposure ranged from -71.5% in Turkey to 72.9% in Thailand. Estimated percentage change in thinking about quitting because of warning labels ranged from 77.4% in India to -33.0% in Turkey. Estimated percentage change in exposure to tobacco advertising ranged from -66.1% in Russia to 44.2% in Thailand. Continued implementation and enforcement of proven tobacco control interventions and strategies at the country level, as outlined in MPOWER, can help reduce tobacco-related morbidity and mortality worldwide (3,5,6).


Assuntos
Saúde Global/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/psicologia , Adulto , Inquéritos Epidemiológicos , Humanos
16.
MMWR Morb Mortal Wkly Rep ; 68(39): 855-859, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581161

RESUMO

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Vigilância da População , Síndrome da Rubéola Congênita/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Rubéola (Sarampo Alemão)/epidemiologia , Síndrome da Rubéola Congênita/epidemiologia , Vacina contra Rubéola/administração & dosagem
17.
BMC Med ; 17(1): 191, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647003

RESUMO

BACKGROUND: Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. METHODS: We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017. RESULTS: Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries. CONCLUSIONS: Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.


Assuntos
Carga Global da Doença , Classe Social , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Pré-Escolar , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Carga Global da Doença/métodos , Carga Global da Doença/estatística & dados numéricos , Carga Global da Doença/tendências , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Humanos , Incidência , Masculino , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Taxa de Sobrevida
18.
MMWR Morb Mortal Wkly Rep ; 68(38): 825-829, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557146

RESUMO

Among the three wild poliovirus (WPV) types, type 2 (WPV2) was declared eradicated globally by the Global Commission for the Certification of Poliomyelitis Eradication (GCC) in 2015. Subsequently, in 2016, a global withdrawal of Sabin type 2 oral poliovirus vaccine (OPV2) from routine use, through a synchronized switch from the trivalent formulation of oral poliovirus vaccine (tOPV, containing vaccine virus types 1, 2, and 3) to the bivalent form (bOPV, containing types 1 and 3), was implemented. WPV type 3 (WPV3), last detected in 2012 (1), will possibly be declared eradicated in late 2019.* To ensure that polioviruses are not reintroduced to the human population after eradication, World Health Organization (WHO) Member States committed in 2015 to containing all polioviruses in poliovirus-essential facilities (PEFs) that are certified to meet stringent containment criteria; implementation of containment activities began that year for facilities retaining type 2 polioviruses (PV2), including type 2 oral poliovirus vaccine (OPV) materials (2). As of August 1, 2019, 26 countries have nominated 74 PEFs to retain PV2 materials. Twenty-five of these countries have established national authorities for containment (NACs), which are institutions nominated by ministries of health or equivalent bodies to be responsible for poliovirus containment certification. All designated PEFs are required to be enrolled in the certification process by December 31, 2019 (3). When GCC certifies WPV3 eradication, WPV3 and vaccine-derived poliovirus (VDPV) type 3 materials will also be required to be contained, leading to a temporary increase in the number of designated PEFs. When safer alternatives to wild and OPV/Sabin strains that do not require containment conditions are available for diagnostic and serologic testing, the number of PEFs will decrease. Facilities continuing to work with polioviruses after global eradication must minimize the risk for reintroduction into communities by adopting effective biorisk management practices.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Poliomielite/prevenção & controle , Humanos , Poliomielite/epidemiologia
19.
BMC Public Health ; 19(1): 1212, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481044

RESUMO

BACKGROUND: To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries. METHODS: Data from World Health Survey conducted in 2002-2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede's cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants' sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede's cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable. RESULTS: A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI. CONCLUSION: National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.


Assuntos
Índice de Massa Corporal , Comparação Transcultural , Saúde Global/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível
20.
Artigo em Inglês | MEDLINE | ID: mdl-31370266

RESUMO

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2-38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety-a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.


Assuntos
Ansiedade/epidemiologia , Saúde Global/estatística & dados numéricos , Estudantes de Medicina/psicologia , Ansiedade/etiologia , Humanos , Modelos Estatísticos , Razão de Chances , Prevalência , Fatores de Risco , Estudantes de Medicina/estatística & dados numéricos
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