Heavy Disease Burden of High Systolic Blood Pressure During 1990-2019: Highlighting Regional, Sex, and Age Specific Strategies in Blood Pressure Control

Objective: High systolic blood pressure (HSBP) remains the leading risk factor for mortality worldwide; however, limited data have revealed all-cause and cause-specific burdens attributed to HSBP at global and regional levels. This study aimed to estimate the global burden and priority diseases attributable to HSBP by region, sex, and age.Methods: Based on data and evaluation methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated trends of age-standardized mortality rate (ASMR), the age-standardized rate of disability-adjusted life years (ASDRs), and the age-standardized rate of years lived with disability (ASYRs) attributable to HSBP during 1990-2019. Further, we analyzed cause-specific burdens attributable to HSBP by sex, age, year, and region.Results: Globally, a significant downtrend was found in the ASMR attributed to HSBP while ASYRs did not change substantially during 1990-2019. The majority of HSBP burden has shifted from high-middle sociodemographic index (SDI) regions to lower SDI regions. All-cause and most cause-specific burdens related to HSBP were improved in high SDI regions but the downtrends have stagnated in recent years. Although many cause-specific deaths associated with HSBP declined, chronic kidney disease (CKD) and endocarditis associated deaths were aggravated globally and ischemic heart disease (IHD), atrial fibrillation and flutter, aortic aneurysm (AA), and peripheral artery disease (PAD) associated deaths were on the rise in low/low-middle/middle SDI regions. Additionally, males had higher disease burdens than females. Middle-aged people with CVDs composed the major subgroup affected by HSBP while older people had the highest ASMRs associated with HSBP.Conclusions: This study revealed the global burden and priority diseases attributable to HSBP with wide variation by region, sex, and age, calling for effective and targeted strategies to reduce the prevalence and mortality of HSBP, especially in low/low-middle/middle SDI regions.

Impact of Structural Ageism on Greater Violence Against Older Persons: A Cross-National Study of 56 Countries

Violence directed against older persons is recognized as a global health problem. However, structural drivers for violence remain under-studied. This country-level ecological study aimed to examine a previously unexplored link between structural ageism and violence against older persons. Following extensive structural stigma literature, structural ageism consisted of two components: (1) discriminatory national policies related to older persons’ economic, social, civil, and political rights, gathered from global databases including UN, WHO, and others; and (2) societal-level prejudicial social norms against older persons, measured by negative attitudes toward older persons by the World Values Survey. Two components were z scored and combined such that higher score indicated greater structural ageism. Prevalence rates of violence per 100,000 persons aged 70 and over in each country were drawn from the Global Burden of Diseases Study. Final analysis included 56 countries, representing 63% of the world’s aging population aged 60 and over across all six WHO regions. As predicted, structural ageism was significantly associated with the prevalence rates of violence in multivariate models (β =205.7, SE=96.3, P=.03), after adjusting for country-level sociodemographic and health covariates. Three sets of sensitivity analyses supported the robustness of our findings. That is, structural ageism did not predict other types of violence and other types of prejudice did not predict violence against older persons. Public health and population-based violence prevention policies may benefit from a targeted approach that tackles the harmful effects of structural ageism.

Measuring the health of populations

Over the last two decades, the global health landscape has undergone rapid transformation. People around the world are living longer than ever before, and populations are getting older. Many countries have made remarkable progress in preventing child deaths. As a result, disease burden is increasingly defined by disability as opposed to being dominated by premature mortality. The leading causes of death and disability are shifting from communicable diseases in children to non-communicable diseases in adults. These global trends differ across regions and by level of development. Notably, in sub-Saharan Africa, communicable, maternal, and newborn diseases and nutritional deficiencies continue to dominate. While low- and middle-income countries are tackling this ‘unfinished agenda’ of largely poverty-related diseases, increasingly they also need to prepare their health services for a growing burden of non-communicable diseases and injuries. In high-income countries, health budgets are steadily increasing relative to gross domestic product due to ageing of the population, an ever-expanding array of medical technologies, and greater demands of consumers for healthcare services. For governments and other healthcare providers to be able to respond to these challenges, high-quality comparable data on the size and trends in mortality and morbidity are essential. In 2007, the Bill & Melinda Gates Foundation funded the Global Burden of Diseases, Injuries, and Risk Factors Study 2010, which endeavoured to rethink methods and assumptions underlying population health measurement while making use of the vastly improved health data and computational resources. This chapter describes the methods underlying the Global Burden of Disease (GBD) study.

Prevalence of Antenatal Depression in a Teaching Hospital South/South Nigeria.

Background: Over 30 million people living in Africa suffer from depression which also contributes to global burden of diseases with a steady rise in prevalence, affecting all groups, including pregnant women. Factors which account for the psychological effects of pregnancy on mothers include; maternal age, planned pregnancy, previous experiences, spouse support, and partner violence. These risk factors may lead to antenatal depression which endangers the mother and the pregnancy. To safeguard mothers from depression during pregnancy, these factors need to be determined. Objective: To determine the prevalence, risk factors and predictors of antenatal depression. Methods: Pregnant women attending antenatal care, who met the study inclusion criteria were interviewed and screened for depression using the risk factor and socio-demographic questionnaire and Edinburgh Postnatal Depression Scale (EPDS). Data obtained was fed into the statistical package for social sciences (SPSS) version 23.0 and cross-tabulation of the relevant variables obtained using chi-squared and t-test. P values <0.05 were statistically significant. Results: Of 500 respondents, 158 (31.6%) had depression. Risk factors of cohabiting with spouse, lack of financial support from spouse, fight with spouse, threat to life, history of still birth and child health challenges were determined, four of which turned out to be predictors of antenatal depression (AD). Conclusion: The high prevalence of 31.6% of antenatal depression calls for a review of obstetrics practice to include screening and diagnosis for antenatal depression. Keywords: Antenatal depression, socio-demographic factors, EPDS, Obstetrics risk factors, social support, predictors.

Emphasizing the Role of Neurosurgery Within Global Health and National Health Systems: A Call to Action

Background: Worldwide, neurological disorders are the leading cause of disability-adjusted life years lost and the second leading cause of death. Despite global health capacity-building efforts, each year, 22.6 million individuals worldwide require neurosurgeon's care due to diseases such as traumatic brain injury and hydrocephalus, and 13.8 million of these individuals require surgery. It is clear that neurosurgical care is indispensable in both national and international public health discussions. This study highlights the role neurosurgeons can play in supporting the global health agenda, national surgical plans, and health strengthening systems (HSS) interventions.Methods: Guided by a literature review, the authors discuss key topics such as the global burden of neurosurgical diseases, the current state of neurosurgical care around the world and the inherent benefits of strong neurosurgical capability for health systems.Results: Neurosurgical diseases make up an important part of the global burden of diseases. Many neurosurgeons possess the sustained passion, resilience, and leadership needed to advocate for improved neurosurgical care worldwide. Neurosurgical care has been linked to 14 of the 17 Sustainable Development Goals (SDGs), thus highlighting the tremendous impact neurosurgeons can have upon HSS initiatives.Conclusion: We recommend policymakers and global health actors to: (i) increase the involvement of neurosurgeons within the global health dialogue; (ii) involve neurosurgeons in the national surgical system strengthening process; (iii) integrate neurosurgical care within the global surgery movement; and (iv) promote the training and education of neurosurgeons, especially those residing in Low-and middle-income countries, in the field of global public health.

Surveillance Studies Reveal Diverse and Potentially Pathogenic-Incriminated Vector Mosquito Species across Major Botswana Touristic Hotspots

Vector mosquitoes contribute significantly to the global burden of diseases in humans, livestock and wildlife. As such, the spatial distribution and abundance of mosquito species and their surveillance cannot be ignored. Here, we surveyed mosquito species across major tourism hotspots in semi-arid Botswana, including, for the first time, the Central Kalahari Game Reserve. Our results reported several mosquito species across seven genera, belonging to Aedes, Anopheles, Culex, Mansonia, Mimomyia, Coquillettidia and Uranotaenia. These results document a significant species inventory that may inform early warning vector-borne disease control systems and likely help manage the risk of emerging and re-emerging mosquito-borne infections.

Conquering stroke epidemiological statistics in Brazil an innovative initiative from the Brazilian Society of Cardiology

Background Stroke has been the second major cause of death in Brazil in the last decades. A better understanding on epidemiological statistics as well as on the diseases burden is crucial for enabling stakeholders to better tackle the disease. Purpose This project aims to continuously monitor and evaluate the data sources on heart disease and stroke in Brazil to provide the most up-to-date information on the epidemiology of these diseases to Brazilian society annually. Methods This initiative is based on the Heart Disease & Stroke Statistics Update methodology of the American Heart Association, with the support of the Brazilian Society of Cardiology, the Global Burden of Diseases Brazil network and an international committee. The project incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, as well as data generated by other sources and scientific studies on heart disease, stroke, and other CVD, including GBD/IHME data. Results The age-standardized prevalence rates per 100.000 for ischemic stroke in 1990 was 1327,6 (1151.2 to 1516) and 870.1 (761.1 to 992.8) in 2019 representing a percent change of −34.5 (−36.7 to −0.3). The age-standardized prevalence rates for intracerebral hemorrhage in 1990 was 507.5 (438.9 to584.1) and 315.9 (275 to 361.4) in 2019 representing a percent change of −37.7 (−40.5 to −0.3). The age-standardized incidence rates for stroke in 1990 was 224.6 (201.6 to 251.8) and 127 (113.8 to 142.1) in 2019 representing a percent change of −43.5 (−44.7 to −0.4). the age-standardized mortality rates for stroke in 1990 was 137.8 (127.8 to 144) and 58.1 (52.6 to 61.8) in 2019 representing a percent change of −57.8 (−60.4 to −0.6). The age-standardized DALY rates for stroke in 1990 was 2959 (2829.6 to 3063) and 1219.6 (1142 to 1285.5) in 2019 representing a percent change of −58.8 (−61 to −0.6). Conclusion This project represents a fundamental step on a better understanding on the stroke epidemiology in Brazil. While we observed a significant decrease in mortality rates from 1990 to 2019, we also raise a concern on a possible shift for a plateau curve or even increased rates in the next years. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology

Global burden for dengue and the evolving pattern in the past 30 years

Background: Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. We present the global, regional, and national burden of dengue from 1990 to 2019 based on the findings from the Global Burden of Diseases, Injures, and Risk Factors Study 2019 (GBD 2019). Methods: Based upon GBD 2019 dengue data on age-standardized incidence rate (ASIR), age-standardized death rate (ASDR) and age-standardized disability-adjusted life years (DALYs) rate, this study estimates and presents annual percentage change (EAPC) to quantify trends over time to assess potential correlates of increased dengue activity such as global travel, and warming. Results: Globally from 1990 to 2019, dengue incident cases, deaths and DALYs gradually increased. Those under 5, once accounting for the largest portion of deaths and DALYs in 1990, were eclipsed by those 15–49 years old in 2019. Age standardized incidence (ASIR: EAPC 3.16, 95%CI: 2.90–3.43), death (ASDR: EAPC 5.42, 95%CI: 2.64–8.28), and DALY rates (EAPC 2.31, 95%CI: 2.00–2.62) accelerated most among high-middle and high socio-demographic index (SDI) regions. Southeast Asia and South Asia had most of the dengue incident cases, deaths and DALYs, but East Asia had the fastest rise in ASIR (EAPC 4.57, 95%CI: 4.31, 4.82), while Tropical Latin America led in ASDR (EAPC 11.32, 95%CI: 9.11, 13.58) and age-standardized DALYs rate (EAPC 4.13, 95%CI: 2.98, 5.29). SDI showed consistent bell shape relationship with ASIR, ASDR and age-standardized DALYs rate. Global Land-Ocean Temperature Index and air passenger travel metrics were found to be remarkably positively correlated with dengue burden. Conclusions: The burden of dengue has become heavier from 1990 to 2019, amidst the three decades of urbanization, warming climates and increased human mobility in much of the world. Southeast Asia and South Asia remain regions of concern, especially in conjunction with the Americas swift rise in dengue burden.

SPINE20 A global advocacy group promoting evidence-based spine care of value

Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. Methods The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. Results The areas of immediate concern were “Aging spine,” “Future of spine care,” “Spinal cord injuries,” “Children and adolescent spine,” “Spine-related disability,” “Spine Educational Standards,” “Patient safety,” and “Burden on economy.” Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10–11, 2020 held from the G20 platform. Conclusions This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.