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- Kassebaum, Nicholas J., et al.
(författare)
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Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
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Tidskriftsartikel (refereegranskat)abstract
- Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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| 2. |
- Beal, Jacob, et al.
(författare)
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Robust estimation of bacterial cell count from optical density
- 2020
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Ingår i: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data.
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| 3. |
- Jalde, Francesca Campoccia, et al.
(författare)
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Standardized Unloading of Respiratory Muscles during Neurally Adjusted Ventilatory Assist : A Randomized Crossover Pilot Study
- 2018
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Ingår i: Anesthesiology. - 0003-3022 .- 1528-1175. ; 129:4, s. 769-777
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently, there is no standardized method to set the support level in neurally adjusted ventilatory assist (NAVA). The primary aim was to explore the feasibility of titrating NAVA to specific diaphragm unloading targets, based on the neuroventilatory efficiency (NVE) index. The secondary outcome was to investigate the effect of reduced diaphragm unloading on distribution of lung ventilation. Methods: This is a randomized crossover study between pressure support and NAVA at different diaphragm unloading at a single neurointensive care unit. Ten adult patients who had started weaning from mechanical ventilation completed the study. Two unloading targets were used: 40 and 60%. The NVE index was used to guide the titration of the assist in NAVA. Electrical impedance tomography data, blood-gas samples, and ventilatory parameters were collected. Results: The median unloading was 43% (interquartile range 32, 60) for 40% unloading target and 60% (interquartile range 47, 69) for 60% unloading target. NAVA with 40% unloading led to more dorsal ventilation (center of ventilation at 55% [51, 56]) compared with pressure support (52% [49, 56]; P = 0.019). No differences were found in oxygenation, CO2, and respiratory parameters. The electrical activity of the diaphragm was higher during NAVA with 40% unloading than in pressure support. Conclusions: In this pilot study, NAVA could be titrated to different diaphragm unloading levels based on the NVE index. Less unloading was associated with greater diaphragm activity and improved ventilation of the dependent lung regions.
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| 5. |
- Sackey, Peter V
(författare)
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Inhaled sedation with isoflurane in the intensive care unit
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients in the Intensive Care Unit (ICU) may experience distress and pain, for which they are often prescribed sedative and analgesic drugs, sometimes at the cost of clinically significant side effects, such as prolonged wake-up time, drug or solvent toxicity and withdrawal. The search for the ideal sedation regimen for these patients in ongoing. Isoflurane - an inhaled anaesthetic - has sedative properties in subanaesthetic concentrations and is theoretically appealing as an ICU sedative but modem ICU ventilators are not compatible with currently available vaporizers. The Anesthetic Conserving Device / AnaConDa® (ACD) - a modified heat-moisture exchanger, with features permitting infusion of isoflurane from a standard syringe pump and rebreathing of exhaled isoflurane, has been developed for high-flow ventilation anaesthesia. This novel method has been studied in the anaesthesia setting but not for isoflurane sedation in the ICU. The feasibility of isoflurane via the ACD for sedation in ICU patients was evaluated and sedation efficacy was compared with that of intravenous midazolam. Environmental aspects and agent-saving properties of the method were studied, as well as the potential benefit and limitations of ACD use in paediatric patients. The Bispectral indexTM (BIS), a non-invasive EEG-derived numerical measure of anaesthetic and sedative depth, was evaluated as a predictor of clinically assessed sedation depth for isoflurane sedation and for midazolam sedation. Short-term recovery, long-term memories and psychological recovery in patients receiving isoflurane or midazolam were studied. Wake-up times after isoflurane sedation via the ACD were significantly shorter than after midazolam. Few minor practical problems related to ACD use occurred and no adverse hepatic or renal effects related to either sedative were observed. Ambient isoflurane concentrations were low and well below recommended exposure limits. The novel method was useful in paediatric patients but required adapted placement in the breathing circuit to avoid increased dead-space in smaller children. BIS did not predict sedation depth well enough to replace clinical scoring during isoflurane or midazolam sedation. Patient follow-up did not reveal any differences in short-term recovery but significantly fewer patients reported delusions hallucinations after isoflurane sedation than after midazolam sedation. In conclusion, this thesis demonstrates that isoflurane via the ACD is efficacious for sedation of ICU patients, with shorter wake-up times than with midazolam. The use of the ACD for isoflurane delivery in the ICU is feasible, environmentally safe and reduces agent consumption compared with conventional vaporizer delivery. In paediatric ICU sedation, placement of the ACD in the inspiratory limb of the breathing circuit is necessary if the device is used in smaller children. BIS monitoring can not reliably replace clinical assessment of sedation depth in non-paralyzed ICU patients. Isoflurane sedation does not appear to have any serious negative psychological or cognitive effects compared to intravenous sedation and may possibly reduce the risk of delusions and hallucinations in the ICU.
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| 6. |
- Schandl, Anna, et al.
(författare)
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Developing an early screening instrument for predicting psychological morbidity after critical illness
- 2013
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 17:5, s. Art. no. R210-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression. Methods: Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression. Results: Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales >= 8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%. Conclusion: The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.
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