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- Kaptoge, S., et al.
(författare)
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World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
- 2019
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Ingår i: Lancet Global Health. - : Elsevier BV. - 2214-109X. ; 7:10
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Tidskriftsartikel (refereegranskat)abstract
- Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0.685 (95% CI 0 . 629-0 741) to 0.833 (0 . 783-0- 882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
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| 3. |
- Tamagawa, T., et al.
(författare)
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Correlation between musculoskeletal structure of the hand and primate locomotion: Morphometric and mechanical analysis in prehension using the cross- and triple-ratios
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:5
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Tidskriftsartikel (refereegranskat)abstract
- Biometric ratios of the relative length of the rays in the hand have been analyzed between primate species in the light of their hand function or phylogeny. However, how relative lengths among phalanges are mechanically linked to the grasping function of primates with different locomotor behaviors remains unclear. To clarify this, we calculated cross and triple-ratios, which are related to the torque distribution, and the torque generation mode at different joint angles using the lengths of the phalanges and metacarpal bones in 52 primates belonging to 25 species. The torque exerted on the finger joint and traction force of the flexor tendons necessary for a cylindrical grip and a suspensory hand posture were calculated using the moment arm of flexor tendons measured on magnetic resonance images, and were compared among Hylobates spp., Ateles sp., and Papio hamadryas. Finally, the torques calculated from the model were validated by a mechanical study detecting the force exerted on the phalanx by pulling the digital flexor muscles during suspension in these three species. Canonical discriminant analysis of cross and triple-ratios classified primates almost in accordance with their current classification based on locomotor behavior. The traction force was markedly reduced with flexion of the MCP joint parallel to the torque in brachiating primates; this was notably lower in the terrestrial quadrupedal primates than in the arboreal primates at mild flexion. Our mechanical study supported these features in the torque and traction force generation efficiencies. Our results suggest that suspensory or terrestrial quadrupedal primates have hand structures that can exert more torque at a suspensory posture, or palmigrade and digitigrade locomotion, respectively. Furthermore, our study suggests availability of the cross and triple-ratios as one of the indicators to estimate the hand function from the skeletal structure.
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| 4. |
- Imai, Shinobu, et al.
(författare)
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Comparison of pharmaceutical policies to stimulate use of generics in Japan and Sweden
- 2016
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Ingår i: Health Policy and Technology. - : Elsevier BV. - 2211-8837. ; 5:2, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Among OECD countries, the proportion of total expenditure on health spent on pharmaceuticals is highest in Japan, 20%. In Sweden, the corresponding proportion is 13%. Swedish pharmaceutical expenditures increased dramatically in the 1990s and policy changes were introduced to curb this. Both countries have introduced policy changes to increase cost containment. This study aims to compare the pharmaceutical policies regarding generic medicines in Japan and Sweden. Methods: Information on pharmaceutical policies was collected. We compared pharmaceutical policies according to the 4E (Education, Engineering, Economics, and Enforcement) component framework developed to describe the differences in policies. Results and conclusions: In Sweden, there were several organizational and managerial interventions within the Engineering class. Japan had several positive incentives for health care actors in the Economics category. The Enforcement category had a stronger legal component in Sweden compared to Japan. The Swedish policies were mainly directed towards prescribing and dispensing whereas the Japanese addressed several stakeholders to promote use of generic drugs. The countries were similar with respect to the Education category. Within the Enforcement component the Swedish policies were legally enforced whereas the Japanese to large extent were recommendations. (C) 2016 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
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| 5. |
- Imai, Shinobu, et al.
(författare)
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Impact of new efficacy information on sales of antihypertensive medicines in Japan and Sweden
- 2018
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Ingår i: Health Policy and Technology. - : Elsevier BV. - 2211-8837. ; 7:2, s. 194-199
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The generic substitution of medicines has been introduced in Europe since the 1990s to increase price competition and the use of cheaper equivalents. Patent expiry is assumed to be associated with changes in sales patterns, particularly when combined with generic substitution. Other changes have been observed when prescribers obtain new information on drug safety and efficacy of medicines. This article examines to what extent patent expiry and new medical information on efficacy influence the pharmaceutical sales patterns of antihypertensive medicines in Japan and Sweden. Methods: Angiotensin-converting enzyme inhibitors and angiotensin II antagonists (ARBs) were selected, since they are widely used in both Japan and Sweden. The two analysed interventions were patent expiry and published information on lower efficacy for two ARBs. Seasonal autoregressive integrated moving average modelling with intervention was used to analyse changes in sales volumes. Results: Patent expiry was not associated with any significant changes in sales patterns. In Sweden, the sales rate of losartan increased following new information on lower efficacy for candesartan and telmisartan (0.77650 DDDs/1,000 inhabitants per day, p = 0.0068), whereas candesartan sales decreased (-0.50760 DDDs/1000 inhabitants per day, p = 0.0058). In Japan, the publication of new efficacy information was also associated with a significant decrease in candesartan (-1.21215 DDDs/1000 inhabitants per day, p = 0.001). Conclusions: We found sales patterns of antihypertensive medicines were to a large extent affected by information on efficacy rather than patent expiry. However, further assessment is needed for other medicine groups and settings. (248 words) (C) 2018 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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