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- 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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| 2. |
- Pilesjo, Petter, et al.
(författare)
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Features of the international MSC educational programme in environmental management and modelling
- 2018
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Ingår i: Geodesy and Cartography. - : Vilnius Gediminas Technical University. - 2029-6991 .- 2029-7009. ; 44:4, s. 134-139
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Tidskriftsartikel (refereegranskat)abstract
- “International Msc Educational Programme in Environmental Management and Modelling” (GeoNetC) is a European Commission funded project under ERASMUS+: Higher Education – International Capacity Building programme (Project No 561967-EPP-1-2015-1-SE-EPPKA2-CBHE-JP). It began in October 2015 and ended in October 2018. Initiated by the Lund University and partners from the Middle East countries, the GeoNetC project is an ambitious project aiming to match labour market needs with geospatial education offer both in Europe and Middle East countries. The aim of this three-year project is to enable European universities to exchange best practices and innovation with each other and with Middle Eastern universities regarding the mismatch between Europe’s geospatial education and training and the geospatial education in Middle East countries. There is a growing need for well-trained students at all levels – vocational, bachelors, masters – in the field of geospatial technologies. Obviously there is a growing number of jobs available in land surveying, mapping data collection, data processing, data delivery and turning data into information in both European and Middle East countries. Through cooperation, all partners will improve the quality of their respective academic programs. The European partners will make their courses more attractive and well adjusted for students from the Middle East. As well, they will increase the general quality and add state-of-the-art learning components to their offerings, and the partners from the region will significantly increase the academic level and quality in the education they provide. There will be spin-offs into other subjects than environment/Geomatics, since both the pedagogic models developed (e.g. e-Learning) and communication and administrative tools can be used throughout the partner universities. Therefore, this partnership cooperation will be of great value to Partner Countries as well as to Programme Countries. A number of distance learning courses/modules are developed jointly by partner institutions in Europe and the Middle East. The main aim of the network is to promote the use of spatial information and earth observation for environmental management and modelling through capacity building and institutional development, via a network in which all partners would contribute from their own positions of strength. All 13 modules are following EU higher education standards regarding e.g. ECTS, and learning outcomes. The outcome of the project, in terms of courses/modules, will be freely used among the partners, with the possibilities of offering individual courses or a whole MSc programme, whether individually or together. All produced material was evaluated/quality controlled by an external evaluation group of independent experts within environmental management and modelling, higher education, as well as pedagogy.
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