| 1. |
- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2019
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 18:5, s. 459-480
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.Funding: Bill & Melinda Gates Foundation.
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| 2. |
- Demanelis, Kathryn, et al.
(författare)
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Association of Arsenic Exposure with Whole Blood DNA Methylation : An Epigenome-Wide Study of Bangladeshi Adults
- 2019
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Ingår i: Environmental Health Perspectives. - 1552-9924. ; 127:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Arsenic exposure affects [Formula: see text] people worldwide, including [Formula: see text] in Bangladesh. Arsenic exposure increases the risk of cancer and other chronic diseases, and one potential mechanism of arsenic toxicity is epigenetic dysregulation. OBJECTIVE: We assessed associations between arsenic exposure and genome-wide DNA methylation measured at baseline among 396 Bangladeshi adults participating in the Health Effects of Arsenic Longitudinal Study (HEALS) who were exposed by drinking naturally contaminated well water. METHODS: Methylation in whole blood DNA was measured at [Formula: see text] using the Illumina InfiniumMethylationEPIC (EPIC) array. To assess associations between arsenic exposure and CpG methylation, we used linear regression models adjusted for covariates and surrogate variables (SVs) (capturing unknown technical and biologic factors). We attempted replication and conducted a meta-analysis using an independent dataset of [Formula: see text] from 400 Bangladeshi individuals with arsenical skin lesions. RESULTS: We identified 34 CpGs associated with [Formula: see text] creatinine-adjusted urinary arsenic [[Formula: see text]]. Sixteen of these CpGs annotated to the [Formula: see text] array, and 10 associations were replicated ([Formula: see text]). The top two CpGs annotated upstream of the ABR gene (cg01912040, cg10003262 ). All urinary arsenic-associated CpGs were also associated with arsenic concentration measured in drinking water ([Formula: see text]). Meta-analysis ([Formula: see text] samples) identified 221 urinary arsenic-associated CpGs ([Formula: see text]). The arsenic-associated CpGs from the meta-analysis were enriched in non-CpG islands and shores ([Formula: see text]) and depleted in promoter regions ([Formula: see text]). Among the arsenic-associated CpGs ([Formula: see text]), we observed significant enrichment of genes annotating to the reactive oxygen species pathway, inflammatory response, and tumor necrosis factor [Formula: see text] ([Formula: see text]) signaling via nuclear factor kappa-B ([Formula: see text]) hallmarks ([Formula: see text]). CONCLUSIONS: The novel and replicable associations between arsenic exposure and DNA methylation at specific CpGs observed in this work suggest that epigenetic alterations should be further investigated as potential mediators in arsenic toxicity and as biomarkers of exposure and effect in exposed populations. https://doi.org/10.1289/EHP3849.
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| 3. |
- Saha, Ratnajit, et al.
(författare)
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Geogenic Arsenic and Microbial Contamination in Drinking Water Sources : Exposure Risks to the Coastal Population in Bangladesh
- 2019
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Ingår i: Frontiers in Environmental Science. - : FRONTIERS MEDIA SA. - 2296-665X. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to investigate the most usable drinking water sources quality and the dependent population's exposure to potentially contaminated water. The specific area chosen for the study was the coastal area in Satkhira district's Tala Upazila. Six hundred and fourty nine most usable drinking water sources were selected, that included Deep Tubewell (DTW), Shallow Tubewell (STW) and Pond Sand Filter (PSF) for drinking water sampling. Following standard sampling procedures, in-situ measurements were taken for seven important water quality parameters: Arsenic-As, Iron-Fe, Electrical Conductivity-EC, Temperature-Temp, Total Coliform- TC, E-coli, and Fecal Coliform-FC. In addition, semi-structured questionnaire surveys were conducted at corresponding dependent households (HH). Weighted arithmetic water quality index (WQI) was used to calculate the suitability of the derived water for drinking purposes. In the tested water sources, As, Fe and EC range were found 0-500 mu g/L, 0-18 mg/L, and 165-8,715 mu S/cm, respectively. Of all the tested water sources, 74% exceeded the permissible limit for As, 83% for Fe and 99% for EC, according to WHO standards. Comparatively higher percentages of Point of Uses (PoU) were found to be more contaminated than Point of Sources (PoS), such as TC found in 38% PoS and 54% of corresponding PoU, E. coli found in 24% PoS and 35% of PoU and FC found in 45% PoS and 55% of PoU. WQI suggested that the majority (72%) of most usable drinking water sources were found to be unsuitable for drinking. Thus, 40% of the population (0.12 million) in the study area were directly consuming contaminated water. Dependent household members most frequently suffered from fever, diarrhea and high blood pressure, resulting in the average household spending USD 3-13 per month/HH for health-related expenditures, which is higher than national average. To acquire safe drinking water, the majority (58%) of the dependent HH expressed willingness to pay USD 1 per month/ HH which is costly for them. The situation can be improved by installing a deep tube well for safe drinking water, periodically testing the water quality, educating the public for better hygiene practices, and providing entrepreneurial incentives to help deliver safe water to the public at lower cost.
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