| 1. |
- Abbafati, Cristiana, et al.
(författare)
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- 2020
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of stroke and its risk factors, 1990-2019 : a systematic analysis for the Global Burden of Disease Study 2019
- 2021
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 20:10, s. 795-820
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Tidskriftsartikel (refereegranskat)abstract
- Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.
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| 3. |
- Micah, Angela E., et al.
(författare)
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Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050
- 2021
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 398:10308, s. 1317-1343
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Forskningsöversikt (refereegranskat)abstract
- Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
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| 4. |
- Khan, Asif, et al.
(författare)
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Multivariate statistical analysis of heavy metals and physico-chemical parameters in the groundwater of Karak District, Khyber Pakhtunkhwa, Pakistan
- 2021
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Ingår i: Proceedings of the Estonian Academy of Sciences. - : Estonian Academy Publishers. - 1736-6046 .- 1736-7530. ; 70:3, s. 297-306
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Tidskriftsartikel (refereegranskat)abstract
- Groundwater heavy metal pollution is a major concern all around the world. For the assessment of heavy metals and physico-chemical characteristics. groundwater samples were collected from different locations of the Karak District, Pakistan. With the help of the global information system device (GIS), groundwater samples were collected and studied from 47 locations. The present study focused on the water table (WT), water source depth (WSD), pH, electrical conductivity (EC), dissolved oxygen (DO), total dissolved solids (TDS), lead (Pb(II)), silver (Ag(I)), iron (Fe(II)) and chromium (Cr(VI)) parameters. Heavy metals were analyzed by the Atomic Absorption Spectrophotometer (AAS). The Pearson's matrix of correlation showed relationships between several parameters, such as the EC and the TDS which had close interactions between all the three different groundwater samples (collected by hand pump (HP), bore holes (BH) and tube wells (TW)). The strong correlation was detected in all the sources of water between the TDS and the EC, the regression coefficient (r) of which was 1. In the hierarchical clustering (by dendrograms) the HP samples show two clusters: Cluster 1 contains seven parameters and Cluster 2 has four parameters. The BH samples have two clusters: Cluster 1 contains three parameters and Cluster 2 has eight parameters. The TW dendrogram also shows two clusters: Cluster 1 contains six parameters while Cluster 2 has five parameters.
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| 5. |
- Khan, Kifayatullah, et al.
(författare)
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Heavy Metal Occurrence, Pathways, and Associated Socio-ecological Risks in Riverine Water : Application of Geographic Information System, Multivariate Statistics, and Risk Assessment Models
- 2023
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Ingår i: Water, Air and Soil Pollution. - 0049-6979 .- 1573-2932. ; 234:7
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Tidskriftsartikel (refereegranskat)abstract
- Heavy metal (HM) pollution is one of the major issues of concern in the world due to its serious health consequences on humans and ecology. In this study, riverine water from the River Kabul in Pakistan was studied using inductively coupled plasma mass spectrometry (ICP-MS) to determine the variation, routes, and possible socio-ecological hazards of chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn) cadmium (Cd), mercury (Hg), and lead (Pb). The results revealed significant HMs variation (p < 0.05) in the sequence of Cr > Zn > Ni > Cu > Cd > Pb > Mn > Co > Hg, indicating prevalent metal contaminations in the river. Multivariate statistics showed significant strong positive correlations (p ≤ 0.01) between the individual HMs contents along the monitoring sites. The strong-moderate levels of Cu, Co, Zn, Mn, Pb, and Cd in riverine systems were observed to be caused by surrounding industrial, agrochemicals, mining, and domestic wastewater discharges along with geogenic sources, the weak levels of Cr and Ni could be induced by erosion of mafic and ultramafic rocks, and mining activities, whereas the low contamination of Hg suggests minimal atmospheric deposition with fewer industrial discharges in the environment. The overall mass flux of the ∑HMs was estimated to be around 164.10 kg/year, with significant HM pollution index (HPI) and pollution index (PI) variations along the river characterizing the potential risk of HMs in decreasing order of Cd > Hg > Cr > Ni > Co > Pb > Mn > Cu > Zn and Cd > Hg > Ni > Pb > Cr > Co > Cu > Mn > Zn, respectively. Individual HM contamination was within the ecological risk threshold (ERI < 110), where, the chronic daily intake (CDIs), hazard quotients (HQs), health indices (HIs), and cancer risks (CRs) of Cd, Ni, Co, Cr, and Pb by daily riverine water ingestion and dermal contact posing considerable human health concerns. To protect the environment and public health, our findings suggest that untreated anthropogenic wastewater discharge into the river system be strictly controlled and regulated through public awareness campaigns and legislation prohibiting the use of herbicides and fertilizers containing high levels of Cr, Ni, Co, Cd, and Pb.
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| 6. |
- Muhammad, Noor, et al.
(författare)
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Novel mutations in MPT64 secretory protein of Mycobacterium tuberculosis complex
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:3
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Tidskriftsartikel (refereegranskat)abstract
- Tuberculosis (TB) is a global health problem caused by the Mycobacterium tuberculosis complex (MTBC). These bacteria secrete various proteins involved in the pathogenesis and persistence of MTBC. Among the secretory proteins, MPT64 (Rv1980C) is highly conserved and is also known as a major culture filtrate that is used in rapid diagnosis of MTBC. In the current study, we aimed to find the mutation in this highly conserved protein in isolates from the Pashtun-dominant province of Pakistan. We analyzed 470 M. tuberculosis whole-genome sequences of Khyber Pakhtunkhwa Province. Mutations in the MPT64 gene were screened through TB-Profiler and BioEdit software tools. The DynaMut web server was used to analyze the impact of the mutation on protein dynamics and stability. Among 470 MTB genomes, three non-synonymous mutations were detected in nine isolates, and one synonymous mutation (G208A) was found in four isolates. Mutation G211T (F159L), which was detected at the C-terminal domain of the protein in six isolates, was the most prominent. The second novel mutation, T480C (I70V), was detected in two isolates at the C-terminal side of the protein structure. The third novel mutation, A491C (L66R), was detected in a single isolate at the N-terminal side of the MPT64 protein. The effect of these three mutations was destabilizing on the protein structure. The molecular flexibility of the first two mutations increased, and the last one decreased. MPT64 is a highly conserved secretory protein, harboring only a few mutations. This study provides useful information for better managing the diagnosis of MTB isolates in high TB-burden countries.
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| 7. |
- Sepanlou, Sadaf G., et al.
(författare)
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The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017
- 2020
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Ingår i: The Lancet Gastroenterology & Hepatology. - 2468-1253. ; 5:3, s. 245-266
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Tidskriftsartikel (refereegranskat)abstract
- Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1.32 million (95% UI 1.27-1.45) deaths (440000 [416 000-518 000; 33.3%] in females and 883 000 [838 000-967 000; 66.7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2.4% (2.3-2.6) of total deaths globally in 2017 compared with 1.9% (1.8-2.0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21.0 (19.2-22.3) per 100 000 population in 1990 to 16.5 (15.8-18-1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32.2 [25.8-38.6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10.1 [9.8-10-5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3.7 [3.3-4.0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103.3 [64.4-133.4] per 100 000 in 2017). There were 10.6 million (10.3-10.9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33.2% for compensated cirrhosis and 54.8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases snore than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.
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| 8. |
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| 9. |
- Salman, Muhammad, et al.
(författare)
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Trajectory of COVID-19 vaccine hesitancy post-vaccination and public's intention to take booster vaccines : A cross-sectional analysis
- 2023
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Ingår i: Human Vaccines & Immunotherapeutics. - : Taylor & Francis. - 2164-5515 .- 2164-554X. ; 19:2
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Tidskriftsartikel (refereegranskat)abstract
- Vaccine hesitancy (VH) is not a new phenomenon in Pakistan and is regarded as one of the primary causes of unsatisfactory vaccination campaigns. This study determined post-vaccination COVID-19 VH, factors influencing COVID-19 vaccine uptake, and public's intent to receive booster vaccinations. A cross-sectional study was conducted among adult population of Lahore, Pakistan. Participants were recruited via convenience sampling between March and May 2022. SPSS version 22 was used for the data analysis. A total of 650 participants were included in the study (age = 28.1 & PLUSMN; 9.7 years; male-to-female ratio nearly 1: 1). The majority of participants received Sinopharm followed by Sinovac vaccine. The top three reasons of vaccine uptake were "only vaccinated individuals are allowed at the workplace, and educational institutes" (Relative importance index (RII) = 0.749), "only vaccinated people are allowed to go to markets, malls and other public places" (RII = 0.746), and "protect myself from the infection" (RII = 0.742). The mean COVID-19 VH score was 24.5 & PLUSMN; 6.2 (95% CI 23.9-24.9), with not being pro-vaccines and poor economic status were the significant predictors of COVID-19 vaccine hesitancy among immunized individuals (p < .05). Acceptance of booster vaccines was negatively associated with younger age and a lower level of education. Furthermore, being pro-vaccine was associated with a greater likelihood of accepting booster vaccines (p = .001). The Pakistani public continues to express VH toward COVID-19 vaccines. Therefore, aggressive measures must be taken to combat the community factors that contribute to it.
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| 10. |
- Khan, Adil, et al.
(författare)
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Predictive modeling for depth of wear of concrete modified with fly ash : A comparative analysis of genetic programming-based algorithms
- 2024
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Ingår i: Case Studies in Construction Materials. - : Elsevier. - 2214-5095. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- There has been increasing growth in incorporating fly ash as a supplementary cementitious material in concrete mixtures due to its potential to enhance the durability and strength properties of concrete. However, there is a lack of research on predicting the depth of wear of fly ash-based concrete. The laboratory methods available for estimating the depth of wear often involve destructive and expensive tests. Therefore, to avoid costly and laborious tests, this study utilized two machine learning methods, including multi-expression programming (MEP) and gene expression programming (GEP), to predict the depth of wear of fly ash-modified concrete. A comprehensive dataset of 216 experimental records was compiled from published studies for model training and validation. This extensive dataset encompasses the depth of wear as the target variable, along with nine explanatory parameters, namely fly ash, cement content, fine and coarse aggregate, water content, plasticizer, age of concrete, air-entraining agent, and testing time. The models were trained with 70% of the data, and the remaining 30% of data was used for validating the models. The models were developed by a continuous trial-and-error process and iterative refinement of hyperparameters until optimal results were achieved. The efficacy of the models was assessed via multiple statistical indicators. Furthermore, the SHapley Additive exPlanation (SHAP) was utilized for the interpretability of the model prediction from both global and local perspectives. The GEP model exhibited excellent accuracy with a correlation coefficient (R) of 0.989 (training) and 0.992 (validation). Similarly, the MEP model provided prediction accuracy with R values of 0.965 and 0.968 for training and validation sets, respectively. In addition, the MEP and GEP models outperformed the traditional multi-linear regression model. The SHAP interpretation revealed that testing time and age have a higher contribution in determining the depth of wear. The findings of this study can assist practitioners and designers in avoiding costly and laborious tests for durability assessment and promoting sustainable use of fly ash in the construction sector.
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