| 1. |
- 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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| 2. |
- 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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| 3. |
- Do, Hai Huu, et al.
(författare)
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Unravelling the economic impact of climate change in Vietnam's Mekong River Delta and Southeast region
- 2024
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Ingår i: Discover Sustainability. - 2662-9984. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Vietnam faces a heightened susceptibility to natural disasters stemming from climate change, yet the impact of these disasters varies markedly across its regions. Consequently, it is imperative to scrutinize the climatic factors affecting the regional economy, with a particular dearth of research addressing the nexus between natural threats and the economies of the Mekong River Delta and the Southeast region of Vietnam. The primary objective is to investigate how temperature fluctuations, rising sea levels, storms, and forest fires can detrimentally affect agriculture, forestry, and infrastructure in these regions. The present research uses the secondary data from Vietnam's General Statistics Office and the German Agency for International Cooperation. Employing quantitative analysis, the study endeavours to assess and compare the influence of climate change elements on the economic trajectories of the Mekong River Delta and the Southeast region. The findings reveal that the Mekong River Delta is disproportionately impacted by economic losses attributed to rising sea levels when juxtaposed with other regions in Vietnam. Firstly, the escalating sea levels significantly jeopardize residential and agricultural land in the Mekong River Delta (1). Secondly, while wildfires inflict damage on forestry in both the Mekong River Delta and the Southeast area, their overall impact is deemed negligible (2). Thirdly, the study ascertains that houses in the Mekong River Delta and the Southeast region remain relatively unscathed by storms (3). However, it is noted that specific storms have inflicted substantial damage on both regions (4). In light of these findings, future research should delve deeper into the analysis of storm risks in the Mekong River Delta and the Southeast region. Such insights are crucial for enhancing our understanding of the vulnerabilities and devising effective strategies to mitigate the economic repercussions of climate change in these pivotal areas.
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| 4. |
- Falk, Wiebke, 1978-, et al.
(författare)
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Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery : a randomised multicentre controlled trial
- 2021
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Ingår i: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771. ; 127:1, s. 65-74
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory.METHODS: In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT).RESULTS: We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P=0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups.CONCLUSIONS: There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.
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| 5. |
- Falk, Wiebke, 1978-, et al.
(författare)
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Epidural analgesia and mortality after colorectal cancer surgery : A retrospective cohort study
- 2021
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Ingår i: Annals of Medicine and Surgery. - : Elsevier. - 2049-0801. ; 66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidural analgesia (EA) has been the standard of care after major abdominal surgery for many years. This study aimed to correlate EA with postoperative complications, short- and long-term mortality in patients with and without EA after open surgery (OS) and minimally invasive surgery (MIS) for colorectal cancer.Methods: Patient, clinical and outcome data were obtained from the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry. All adult patients diagnosed with colorectal cancer without metastases who underwent elective curative MIS or OS for colorectal cancer between January 2016 and December 2018 and who had data recorded in both registries, were included in the study. Data were analyzed for OS and MIS procedures separately. A Poisson regression model was used to investigate the association between EA and the outcomes of interest.Results: Five thousand seven hundred sixty-two patients were included in the study, 2712 in the MIS and 3050 patients in the OS group. After adjusting for patient specific and clinically relevant variables in the regression model, no statistically significant difference in risk for complications; 30-day, 90-day, and up to 3-year mortality following either MIS or OS could be detected between the EA+ and EA-cohorts.Conclusions: In this large study cohort, EA as part of the comprehensive care provided was not associated with a reduction in postoperative complications risk or improved 30-day, 90-day, or 3-year survival after MIS or OS for colorectal cancer.
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| 6. |
- Falk, Wiebke, 1978-
(författare)
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Epidural Analgesia for Colorectal Cancer Surgery : Experimental and Clinical studies
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Epidural analgesia (EA) with local anaesthetics and opioids is used for pain management after colorectal cancer (CRC) surgery. In recent years, a possible beneficial effect of EA on cancer recurrence and survival after surgery has been proposed. The aim of this thesis was to study the effects of EA on short- and long-term postoperative outcomes after CRC surgery with curative intent.Study I, an in vitro study, investigated the effects of two different local anaesthetics, lidocaine and ropivacaine, on cell viability and cell proliferation in colon cancer cell lines SW480 and SW620. Neither lidocaine nor ropivacaine reduced cell viability or proliferation at systemically, by epidural administration achievable concentrations.In study II, the effect of EA on the systemic level of different cytokines as a marker of inflammation was studied. Except for a reduced level of the anti-inflammatory cytokine IL-10, no other significant effects of EA on the systemic cytokine levels at two time points postoperatively could be shown, when compared to patients receiving intravenous morphine.Study III was an epidemiological study, examining the question if EA affects postoperative complications and mortality after surgery using data from the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry. No association between EA and a reduction in postoperative complications or mortality could be established.Study IV, a randomised, controlled trial, the effects of EA on diseasefree survival (DFS), postoperative complications and pain after surgery were compared to patient-controlled intravenous analgesia with morphine. Apart from superior pain relief during the first postoperative day, no significant effects of EA on the occurrence of postoperative complications, length of hospital stay or DFS were found.
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| 7. |
- Gupta, Rahul, et al.
(författare)
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Engineering of spin mixing conductance at Ru/FeCo/Ru interfaces : Effect of Re doping
- 2020
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Ingår i: Physical Review B. Condensed Matter and Materials Physics. - : AMER PHYSICAL SOC. - 1098-0121 .- 1550-235X. ; 101:2
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Tidskriftsartikel (refereegranskat)abstract
- We have deposited polycrystalline Re-doped (Fe65Co35)(100-x)Rex (0 ≤ x ≤ 12.6 at. %) thin films grown under identical conditions and sandwiched between thin layers of Ru in order to study the phenomenon of spin pumping as a function of Re concentration. In-plane and out-of-plane ferromagnetic resonance spectroscopy results show an enhancement of the Gilbert damping with an increase in Re doping. We find 98% enhancement in the real part of effective spin mixing conductance [Re(g↑↓eff)] with Re doping. Conversely, the Re(g↑↓eff) does not change with Re doping in Fe65Co35 thin films which are seeded and capped with Cu layers. The enhancement in Re(g↑↓eff) of Re-doped Fe65Co35 thin films sandwiched between thin layers of Ru is linked to the Re doping-induced change of the interface electronic structure in the nonmagnetic Ru layer. The saturation magnetization decreases 35% with increasing Re doping up to 12.6 at. %. This study opens a direction of tuning the spin mixing conductance in magnetic heterostructures by doping of the ferromagnetic layer, which is essential for the realization of energyefficient operation of spintronic devices.
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| 8. |
- Gupta, R. K., et al.
(författare)
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Hot Deformation Studies on beta(0) Stabilized TiAl Alloy Made Through Ingot Metallurgy Route
- 2021
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Ingår i: Transactions of the Indian Institute of Metals. - : Springer Science and Business Media LLC. - 0972-2815 .- 0975-1645. ; 74:12, s. 2977-2989
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Tidskriftsartikel (refereegranskat)abstract
- Hot deformation studies of a newly designed gamma + alpha(2) based TiAl alloy of composition Ti-42Al-6Nb-3Cr-0.1B at.% (nominal) realized through ingot metallurgy route using double vacuum arc remelting were carried out. Hot isothermal compression testing was performed in Gleeble (TM) 3500 at different temperatures ranging from 1123 to 1373 K at 50 K intervals and strain rates of 0.001-1 s(-1). Processing maps were developed using an approach of dynamic material modeling of the flow curves to establish the safe hot working regime. Strain rate sensitivity and Zener-Holloman parameters were calculated and constitutive equation was derived. Microstructural investigation revealed dynamic recrystallization and activation of multiple twin systems as the main softening mechanisms operating at optimum hot working conditions. Safe hot working temperature and strain rate regime for the alloy was found to be in the temperature range of 1323-1373 K and strain rate range of 0.001-0.01 s(-1).
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| 9. |
- Hayden, Jane M., et al.
(författare)
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Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study.
- 2020
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Ingår i: British journal of anaesthesia. - : Elsevier BV. - 1471-6771 .- 0007-0912. ; 124:5, s. 562-70
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Tidskriftsartikel (refereegranskat)abstract
- Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.NCT02256228.
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| 10. |
- Kumari, Rani, et al.
(författare)
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Advancing Medical Recommendations With Federated Learning on Decentralized Data : A Roadmap for Implementation
- 2024
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Ingår i: IEEE transactions on consumer electronics. - : Institute of Electrical and Electronics Engineers (IEEE). - 0098-3063 .- 1558-4127. ; 70:1, s. 2666-2674
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Tidskriftsartikel (refereegranskat)abstract
- This proposal presents a road-map for implementing federated learning (FL) for personalized medical recommendations on decentralized data. FL is a privacy-preserving technique allowing multiple parties to train machine learning models collaboratively without sharing their data. Our proposed framework incorporates differential privacy techniques to protect patient privacy. We discuss several evaluation metrics, including KL divergence, fairness, confidence intervals, top-N hit rate, sensitivity analysis, and novelty to evaluate the performance of the federated learning system. These metrics collectively serve as a robust toolbox for assessing Space needed the performance of the federated learning system. The proposed framework and evaluation metrics can provide valuable insights into the system's effectiveness and guide the selection of optimal hyperparameters and model architectures.
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