Medicine (Western Health) - Research Publications

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    World Brain Day 2019; migraine - the painful truth
    Wijeratne, T ; Dodick, D ; Grisold, W ; Carroll, W (WILEY, 2019-11)
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    Effects of early motivational interviewing on post-stroke depressive symptoms: A pilot randomized study of the Good Mood Intervention program
    Kerr, D ; McCann, T ; Mackey, E ; Wijeratne, T (WILEY, 2018-08)
    AIMS: The aim of this pilot randomized study was to investigate the feasibility of early motivational interviewing, for reducing mood after acute stroke. BACKGROUND: Depression is a frequent consequence of stroke that can adversely affect recovery. METHODS: DESIGN: Pilot randomized study. Intervention group patients received 3, individual motivational interviewing sessions by nurses or social workers prior to hospital discharge. PARTICIPANTS: Adult patients with acute stroke during 2013 to 2014. BLINDING: Research assistant who collected data was blind to group assignment. OUTCOMES: Data were collected at 3 time points: baseline, 1-month, and 3-month follow-up. Outcome measures (anxiety, depression, quality of life) were analysed by descriptive statistics. RESULTS: Forty-eight patients were enrolled, and 79% retention was achieved at 3 months. Eight participants withdrew (16.7%), and 2 were unable to participate (death: 2.1% and new onset aphasia: 2.1%), leaving 38 participants in the final cohort (Intervention: N = 18, Control: N = 20). Anxiety, depression, and quality of life measures did not alter significantly in the study period. CONCLUSIONS: Carefully designed studies are required to investigate the effectiveness of early motivational interviewing for improving mood after stroke. The therapy can be administered by nurses, but significant resources are required in terms of training and fidelity.
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    Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice - protocol for a cluster randomised controlled trial in acute stroke care
    Paul, CL ; Levi, CR ; D'Este, CA ; Parsons, MW ; Bladin, CF ; Lindley, RI ; Attia, JR ; Henskens, F ; Lalor, E ; Longworth, M ; Middleton, S ; Ryan, A ; Kerr, E ; Sanson-Fisher, RW (BMC, 2014-03-25)
    BACKGROUND: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. OBJECTIVES: To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months. METHODS AND DESIGN: A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS ≥2), compared to international benchmarks. DISCUSSION: TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12613000939796.
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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
    Kassebaum, NJ ; Arora, M ; Barber, RM ; Bhutta, ZA ; Carter, A ; Casey, DC ; Charlson, FJ ; Coates, MM ; Coggeshall, M ; Cornaby, L ; Dandona, L ; Dicker, DJ ; Erskine, HE ; Ferrari, AJ ; Fitzmaurice, C ; Foreman, K ; Forouzanfar, MH ; Fullman, N ; Gething, PW ; Goldberg, EM ; Graetz, N ; Haagsma, JA ; Johnson, C ; Kemmer, L ; Khalil, IA ; Kinfu, Y ; Kutz, MJ ; Kyu, HH ; Leung, J ; Liang, X ; Lim, SS ; Lozano, R ; Mensah, GA ; Mikesell, J ; Mokdad, AH ; Mooney, MD ; Naghavi, M ; Nguyen, G ; Nsoesie, E ; Pigott, DM ; Pinho, C ; Rankin, Z ; Reinig, N ; Salomon, JA ; Sandar, L ; Smith, A ; Sorensen, RJD ; Stanaway, J ; Steiner, C ; Teeple, S ; Thomas, BA ; Troeger, C ; VanderZanden, A ; Wagner, JA ; Wanga, V ; Whiteford, HA ; Zhou, M ; Zoeckler, L ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abraham, B ; Abubakar, I ; Abu-Raddad, LJ ; Abu-Rmeileh, NME ; Achoki, T ; Ackerman, IN ; Adebiyi, AO ; Adedeji, IA ; Adsuar, JC ; Afanvi, KA ; Afshin, A ; Agardh, EE ; Agarwal, A ; Kumar, S ; Ahmed, MB ; Kiadaliri, AA ; Ahmadieh, H ; Akseer, N ; Al-Aly, Z ; Alam, K ; Alam, NKM ; Aldhahri, SF ; Alegretti, MA ; Aleman, AV ; Alemu, ZA ; Alexander, LT ; Raghib, A ; Alkerwi, A ; Alla, F ; Allebeck, P ; Alsharif, U ; Altirkawi, KA ; Martin, EA ; Alvis-Guzman, N ; Amare, AT ; Amberbir, A ; Amegah, AK ; Amini, H ; Ammar, W ; Amrock, SM ; Anderson, GM ; Anderson, BO ; Antonio, CAT ; Anwari, P ; Arnlov, J ; Arsenijevic, VSA ; Artaman, A ; Asayesh, H ; Asghar, RJ ; Avokpaho, EFGA ; Awasthi, A ; Quintanilla, BPA ; Azzopardi, P ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Banerjee, A ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barregard, L ; Barrero, LH ; Basu, S ; Bayou, TA ; Beardsley, J ; Bedi, N ; Beghi, E ; Bell, B ; Bell, ML ; Benjet, C ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Bernabe, E ; Betsu, BD ; Beyene, AS ; Bhala, N ; Bhansali, A ; Bhatt, S ; Biadgilign, S ; Bienhofff, K ; Bikbov, B ; Bin Abdulhak, AA ; Bisanzio, D ; Bjertness, E ; Blore, JD ; Borschmann, R ; Boufous, S ; Bourne, RRA ; Brainin, M ; Brazinova, A ; Breitborde, NJK ; Brugha, TS ; Buchbinder, R ; Buckle, GC ; Butt, ZA ; Calabria, B ; Campos-Nonato, IR ; Campuzano, JC ; Carabin, H ; Carapetis, JR ; Cardenas, R ; Carrero, JJ ; Castaneda-Orjuela, CA ; Rivas, JC ; Catala-Lopez, F ; Cavalleri, F ; Chang, J-C ; Chiang, PP-C ; Chibalabala, M ; Chibueze, CE ; Chisumpa, VH ; Choi, J-YJ ; Choudhury, L ; Christensen, H ; Ciobanu, LG ; Colistro, V ; Colomar, M ; Colquhoun, SM ; Cortinovis, M ; Crump, JA ; Damasceno, A ; Dandona, R ; Dargan, PI ; Das Neves, J ; Davey, G ; Davis, AC ; De Leo, D ; Degenhardt, L ; Del Gobbo, LC ; Derrett, S ; Des Jarlais, DC ; Deveber, GA ; Dharmaratne, SD ; Dhillon, PK ; Ding, EL ; Doyle, KE ; Driscoll, TR ; Duan, L ; Dubey, M ; Duncan, BB ; Ebrahimi, H ; Ellenbogen, RG ; Elyazar, I ; Endries, AY ; Ermakov, SP ; Eshrati, B ; Esteghamati, A ; Estep, K ; Fahimi, S ; Farid, TA ; Sa Farinha, CSE ; Faro, A ; Farvid, MS ; Farzadfar, F ; Feigin, VL ; Fereshtehnejad, S-M ; Fernandes, JG ; Fernandes, JC ; Fischer, F ; Fitchett, JRA ; Foigt, N ; Fowkes, FGR ; Franklin, RC ; Friedman, J ; Frostad, J ; Furst, T ; Futran, ND ; Gabbe, B ; Gankpe, FG ; Garcia-Basteiro, AL ; Gebrehiwot, TT ; Gebremedhin, AT ; Geleijnse, JM ; Gibney, KB ; Gillum, RF ; Ginawi, IAM ; Giref, AZ ; Giroud, M ; Gishu, MD ; Godwin, WW ; Gomez-Dantes, H ; Gona, P ; Goodridge, A ; Gopalani, SV ; Gotay, CC ; Goto, A ; Gouda, HN ; Guo, Y ; Gupta, R ; Gupta, R ; Gupta, V ; Gutierrez, RA ; Hafezi-Nejad, N ; Haile, D ; Hailu, AD ; Hailu, GB ; Halasa, YA ; Hamadeh, RR ; Hamidi, S ; Hammami, M ; Handal, AJ ; Hankey, GJ ; Harb, HL ; Harikrishnan, S ; Haro, JM ; Hassanvand, MS ; Hassen, TA ; Havmoeller, R ; Hay, RJ ; Hedayati, MT ; Heredia-Pi, IB ; Heydarpour, P ; Hoek, HW ; Hoffman, DJ ; Horino, M ; Horita, N ; Hosgood, HD ; Hoy, DG ; Hsairi, M ; Huang, H ; Huang, JJ ; Iburg, KM ; Idrisov, BT ; Innos, K ; Inoue, M ; Jacobsen, KH ; Jauregui, A ; Jayatilleke, AU ; Jeemon, P ; Jha, V ; Jiang, G ; Jiang, Y ; Jibat, T ; Jimenez-Corona, A ; Jin, Y ; Jonas, JB ; Kabir, Z ; Kajungu, DK ; Kalkonde, Y ; Kamal, R ; Kan, H ; Kandel, A ; Karch, A ; Karema, CK ; Karimkhani, C ; Kasaeian, A ; Katibeh, M ; Kaul, A ; Kawakami, N ; Kazi, DS ; Keiyoro, PN ; Kemp, AH ; Kengne, AP ; Keren, A ; Kesavachandran, CN ; Khader, YS ; Khan, AR ; Khan, EA ; Khang, Y-H ; Khoja, TAM ; Khubchandani, J ; Kieling, C ; Kim, C-I ; Kim, D ; Kim, YJ ; Kissoon, N ; Kivipelto, M ; Knibbs, LD ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Koul, PA ; Koyanagi, A ; Defo, BK ; Kuchenbecker, RS ; Bicer, BK ; Kuipers, EJ ; Kumar, GA ; Kwan, GF ; Lalloo, R ; Lallukka, T ; Larsson, A ; Latif, AA ; Lavados, PM ; Lawrynowicz, AEB ; Leasher, JL ; Leigh, J ; Leung, R ; Li, Y ; Li, Y ; Lipshultz, SE ; Liu, PY ; Liu, Y ; Lloyd, BK ; Logroscino, G ; Looker, KJ ; Lotufo, PA ; Lucas, RM ; Lunevicius, R ; Lyons, RA ; El Razek, HMA ; Mahdavi, M ; Majdan, M ; Majeed, A ; Malekzadeh, R ; Malta, DC ; Marcenes, W ; Martinez-Raga, J ; Masiye, F ; Mason-Jones, AJ ; Matzopoulos, R ; Mayosi, BM ; McGrath, JJ ; Mckee, M ; Meaney, PA ; Mehari, A ; Melaku, YA ; Memiah, P ; Memish, ZA ; Mendoza, W ; Meretoja, A ; Meretoja, TJ ; Mesfin, YM ; Mhimbira, FA ; Miller, TR ; Mills, EJ ; Mirarefin, M ; Mirrakhimov, EM ; Mitchell, PB ; Mock, CN ; Mohammad, KA ; Mohammadi, A ; Mohammed, S ; Monasta, L ; Montanez Hernandez, JC ; Montico, M ; Moradi-Lakeh, M ; Mori, R ; Mueller, UO ; Mumford, JE ; Murdoch, ME ; Murthy, GVS ; Nachega, JB ; Naheed, A ; Naldi, L ; Nangia, V ; Newton, JN ; Ng, M ; Ngalesoni, FN ; Le Nguyen, Q ; Nisar, MI ; Pete, PMN ; Nolla, JM ; Norheim, OF ; Norman, RE ; Norrving, B ; Obermeyer, CM ; Ogbo, FA ; Oh, I-H ; Oladimeji, O ; Olivares, PR ; Olusanya, BO ; Olusanya, JO ; Oren, E ; Ortiz, A ; Ota, E ; Oyekale, AS ; Pa, M ; Park, E-K ; Parsaeian, M ; Patten, SB ; Patton, GC ; Pedro, JM ; Pereira, DM ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Piel, FB ; Pillay, JD ; Pishgar, F ; Plass, D ; Polinder, S ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prasad, NM ; Qorbani, M ; Rabiee, RHS ; Radfar, A ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, SU ; Rai, D ; Rai, RK ; Rajsic, S ; Raju, M ; Ram, U ; Ranganathan, K ; Refaat, AH ; Reitsma, MB ; Remuzzi, G ; Resnikoff, S ; Reynolds, A ; Ribeiro, AL ; Ricci, S ; Roba, HS ; Rojas-Rueda, D ; Ronfani, L ; Roshandel, G ; Roth, GA ; Roy, A ; Sackey, BB ; Sagar, R ; Sanabria, JR ; Dolores Sanchez-Nino, M ; Santos, IS ; Santos, JV ; Sarmiento-Suarez, R ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Schmidt, MI ; Schneider, IJC ; Schutte, AE ; Schwebel, DC ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shahraz, S ; Shaikh, MA ; Sharma, R ; She, J ; Sheikhbahaei, S ; Shen, J ; Sheth, KN ; Shibuya, K ; Shigematsu, M ; Shin, M-J ; Shin, R ; Sigfusdottir, ID ; Santos Silva, DA ; Silverberg, JI ; Simard, EP ; Singh, A ; Singh, JA ; Singh, PK ; Skirbekk, V ; Skogen, JC ; Soljak, M ; Soreide, K ; Sreeramareddy, CT ; Stathopoulou, V ; Steel, N ; Stein, DJ ; Stein, MB ; Steiner, TJ ; Stovner, LJ ; Stranges, S ; Stroumpoulis, K ; Sunguya, BF ; Sur, PJ ; Swaminathan, S ; Sykes, BL ; Szoeke, CEI ; Tabares-Seisdedos, R ; Landon, N ; Tanne, D ; Tavakkoli, M ; Taye, B ; Taylor, HR ; Ao, BJT ; Tegegne, TK ; Tekle, DY ; Terkawi, AS ; Tessema, GA ; Thakur, JS ; Thomson, AJ ; Thorne-Lyman, AL ; Thrift, AG ; Thurston, GD ; Tobe-Gai, R ; Tonelli, M ; Topor-Madry, R ; Topouzis, F ; Tran, BX ; Dimbuene, ZT ; Tsilimbaris, M ; Tura, AK ; Tuzcu, EM ; Tyrovolas, S ; Ukwaja, KN ; Undurraga, EA ; Uneke, CJ ; Uthman, OA ; van Gool, CH ; van Os, J ; Vasankari, T ; Vasconcelos, AMN ; Venketasubramanian, N ; Violante, FS ; Vlassov, VV ; Vollset, SE ; Wagner, GR ; Wallin, MT ; Wang, L ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Werdecker, A ; WestermaM, R ; Wijeratne, T ; Wilkinson, JD ; Williams, HC ; Wiysonge, CS ; Woldeyohannes, SM ; Wolfe, CDA ; Won, S ; Xu, G ; Yadav, AK ; Yakob, B ; Yan, LL ; Yan, Y ; Yaseri, M ; Ye, P ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Zeeb, H ; Zodpey, S ; Zonies, D ; Zuhlke, LJ ; Vos, T ; Lopez, AD ; Murray, CJL (ELSEVIER SCIENCE INC, 2016-10-08)
    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 offset 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. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
    Wang, H ; Naghavi, M ; Allen, C ; Barber, RM ; Bhutta, ZA ; Carter, A ; Casey, DC ; Charlson, FJ ; Chen, AZ ; Coates, MM ; Coggeshall, M ; Dandona, L ; Dicker, DJ ; Erskine, HE ; Ferrari, AJ ; Fitzmaurice, C ; Foreman, K ; Forouzanfar, MH ; Fraser, MS ; Pullman, N ; Gething, PW ; Goldberg, EM ; Graetz, N ; Haagsma, JA ; Hay, SI ; Huynh, C ; Johnson, C ; Kassebaum, NJ ; Kinfu, Y ; Kulikoff, XR ; Kutz, M ; Kyu, HH ; Larson, HJ ; Leung, J ; Liang, X ; Lim, SS ; Lind, M ; Lozano, R ; Marquez, N ; Mensah, GA ; Mikesell, J ; Mokdad, AH ; Mooney, MD ; Nguyen, G ; Nsoesie, E ; Pigott, DM ; Pinho, C ; Roth, GA ; Salomon, JA ; Sandar, L ; Silpakit, N ; Sligar, A ; Sorensen, RJD ; Stanaway, J ; Steiner, C ; Teeple, S ; Thomas, BA ; Troeger, C ; VanderZanden, A ; Vollset, SE ; Wanga, V ; Whiteford, HA ; Wolock, T ; Zoeckler, L ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abera, SF ; Abreu, DMX ; Abu-Raddad, LJ ; Abyu, GY ; Achoki, T ; Adelekan, AL ; Ademi, Z ; Adou, AK ; Adsuar, JC ; Afanvi, KA ; Afshin, A ; Agardh, EE ; Agarwal, A ; Agrawal, A ; Kiadaliri, AA ; Ajala, ON ; Akanda, AS ; Akinyemi, RO ; Akinyemiju, TF ; Akseer, N ; Al Lami, FH ; Alabed, S ; Al-Aly, Z ; Alam, K ; Alam, NKM ; Alasfoor, D ; Aldhahri, SF ; Aldridge, RW ; Alegretti, MA ; Aleman, AV ; Alemu, ZA ; Alexander, LT ; Alhabib, S ; Ali, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Martin, EA ; Alvis-Guzman, N ; Amare, AT ; Amegah, AK ; Ameh, EA ; Amini, H ; Ammar, W ; Amrock, SM ; Andersen, HH ; Anderson, B ; Anderson, GM ; Antonio, CAT ; Aregay, AF ; Arnlov, J ; Arsenijevic, VSA ; Al, A ; Asayesh, H ; Asghar, RJ ; Atique, S ; Arthur Avokpaho, EFG ; Awasthi, A ; Azzopardi, P ; Bacha, U ; Badawi, A ; Bahit, MC ; Balakrishnan, K ; Banerjee, A ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barregard, L ; Barrero, LH ; Basu, A ; Basu, S ; Bayou, YT ; Bazargan-Hejazi, S ; Beardsley, J ; Bedi, N ; Beghi, E ; Belay, HA ; Bell, B ; Bell, ML ; Bello, AK ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Bernabe, E ; Betsu, BD ; Beyene, AS ; Bhala, N ; Bhalla, A ; Biadgilign, S ; Bikbov, B ; Bin Abdulhak, AA ; Biroscak, BJ ; Biryukov, S ; Bjertness, E ; Blore, JD ; Blosser, CD ; Bohensky, MA ; Borschmann, R ; Bose, D ; Bourne, RRA ; Brainin, M ; Brayne, CEG ; Brazinova, A ; Breitborde, NJK ; Brenner, H ; Brewer, JD ; Brown, A ; Brown, J ; Brugha, TS ; Buckle, GC ; Butt, ZA ; Calabria, B ; Campos-Novato, IR ; Campuzano, JC ; Carapetis, JR ; Cardenas, R ; Carpenter, D ; Carrero, JJ ; Castaneda-Oquela, CA ; Rivas, JC ; Catala-Lopez, F ; Cavalleri, F ; Cercy, K ; Cerda, J ; Chen, W ; Chew, A ; Chiang, PP-C ; Chibalabala, M ; Chibueze, CE ; Chimed-Ochir, O ; Chisumpa, VH ; Choi, J-YJ ; Chowdhury, R ; Christensen, H ; Christopher, DJ ; Ciobanu, LG ; Cirillo, M ; Cohen, AJ ; Colistro, V ; Colomar, M ; Colquhoun, SM ; Cooper, C ; Cooper, LT ; Cortinovis, M ; Cowie, BC ; Crump, JA ; Damsere-Derry, J ; Danawi, H ; Dandona, R ; Daoud, F ; Darby, SC ; Dargan, PI ; das Neves, J ; Davey, G ; Davis, AC ; Davitoiu, DV ; de Castro, EF ; de Jager, P ; De Leo, D ; Degenhardt, L ; Dellavalle, RP ; Deribe, K ; Deribew, A ; Dharmaratne, SD ; Dhillon, PK ; Diaz-Torne, C ; Ding, EL ; dos Santos, KPB ; Dossou, E ; Driscoll, TR ; Duan, L ; Dubey, M ; Bartholow, B ; Ellenbogen, RG ; Lycke, C ; Elyazar, I ; Endries, AY ; Ermakov, SP ; Eshrati, B ; Esteghamati, A ; Estep, K ; Faghmous, IDA ; Fahimi, S ; Jose, E ; Farid, TA ; Sa Farinha, CSE ; Faro, A ; Farvid, MS ; Farzadfar, F ; Feigin, VL ; Fereshtehnejad, S-M ; Fernandes, JG ; Fernandes, JC ; Fischer, F ; Fitchett, JRA ; Flaxman, A ; Foigt, N ; Fowkes, FGR ; Franca, EB ; Franklin, RC ; Friedman, J ; Frostad, J ; Hirst, T ; Futran, ND ; Gall, SL ; Gambashidze, K ; Gamkrelidze, A ; Ganguly, P ; Gankpe, FG ; Gebre, T ; Gebrehiwot, TT ; Gebremedhin, AT ; Gebru, AA ; Geleijnse, JM ; Gessner, BD ; Ghoshal, AG ; Gibney, KB ; Gillum, RF ; Gilmour, S ; Giref, AZ ; Giroud, M ; Gishu, MD ; Giussani, G ; Glaser, E ; Godwin, WW ; Gomez-Dantes, H ; Gona, P ; Goodridge, A ; Gopalani, SV ; Gosselin, RA ; Gotay, CC ; Goto, A ; Gouda, HN ; Greaves, F ; Gugnani, HC ; Gupta, R ; Gupta, R ; Gupta, V ; Gutierrez, RA ; Hafezi-Nejad, N ; Haile, D ; Hailu, AD ; Hailu, GB ; Halasa, YA ; Hamadeh, RR ; Hamidi, S ; Hancock, J ; Handal, AJ ; Hankey, GJ ; Hao, Y ; Harb, HL ; Harikrishnan, S ; Haro, JM ; Havmoeller, R ; Heckbert, SR ; Heredia-Pi, IB ; Heydarpour, P ; Hilderink, HBM ; Hoek, HW ; Hogg, RS ; Horino, M ; Horita, N ; Hosgood, HD ; Hotez, PJ ; Hoy, DG ; Hsairi, M ; Htet, AS ; Than Htike, MM ; Hu, G ; Huang, C ; Huang, H ; Huiart, L ; Husseini, A ; Huybrechts, I ; Huynh, G ; Iburg, KM ; Innos, K ; Inoue, M ; Iyer, VJ ; Jacobs, TA ; Jacobsen, KH ; Jahanmehr, N ; Jakovljevic, MB ; James, P ; Javanbakht, M ; Jayaraman, SP ; Jayatilleke, AU ; Jeemon, P ; Jensen, PN ; Jha, V ; Jiang, G ; Jiang, Y ; Jibat, T ; Jimenez-Corona, A ; Jonas, JB ; Joshi, TK ; Kabir, Z ; Karnak, R ; Kan, H ; Kant, S ; Karch, A ; Karema, CK ; Karimkhani, C ; Karletsos, D ; Karthikeyan, G ; Kasaeian, A ; Katibeh, M ; Kaul, A ; Kawakami, N ; Kayibanda, JF ; Keiyoro, PN ; Kemmer, L ; Kemp, AH ; Kengne, AP ; Keren, A ; Kereselidze, M ; Kesavachandran, CN ; Khader, YS ; Khalil, IA ; Khan, AR ; Khan, EA ; Khang, Y-H ; Khera, S ; Muthafer Khoja, TA ; Kieling, C ; Kim, D ; Kim, YJ ; Kissela, BM ; Kissoon, N ; Knibbs, LD ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Krog, NH ; Defo, BK ; Bicer, BK ; Kudom, AA ; Kuipers, EJ ; Kulkarni, VS ; Kumar, GA ; Kwan, GF ; Lal, A ; Lal, DK ; Lalloo, R ; Lam, H ; Lam, JO ; Langan, SM ; Lansingh, VC ; Larsson, A ; Laryea, DO ; Latif, AA ; Lawrynowicz, AEB ; Leigh, J ; Levi, M ; Li, Y ; Lindsay, MP ; Lipshultz, SE ; Liu, PY ; Liu, S ; Liu, Y ; Lo, L-T ; Logroscino, G ; Lotufo, PA ; Lucas, RM ; Lunevicius, R ; Lyons, RA ; Ma, S ; Pedro Machado, VM ; Mackay, MT ; MacLachlan, JH ; Abd El Razek, HM ; Abd El Razek, MM ; Majdan, M ; Majeed, A ; Malekzadeh, R ; Ayele Manamo, WA ; Mandisarisa, J ; Mangalam, S ; Mapoma, CC ; Marcenes, W ; Margolis, DJ ; Martin, GR ; Martinez-Raga, J ; Marzan, MB ; Masiye, F ; Mason-Jones, AJ ; Massano, J ; Matzopoulos, R ; Mayosi, BM ; McGarvey, ST ; McGrath, JJ ; Mckee, M ; McMahon, BJ ; Meaney, PA ; Mehari, A ; Mehndiratta, MM ; Mena-Rodriguez, F ; Mekonnen, AB ; Melaku, YA ; Memiah, P ; Memish, ZA ; Mendoza, W ; Meretoja, A ; Meretoja, TJ ; Mhimbira, FA ; Micha, R ; Miller, TR ; Mirarefin, M ; Misganaw, A ; Mock, CN ; Abdulmuhsin Mohammad, K ; Mohammadi, A ; Mohammed, S ; Mohan, V ; Mola, GLD ; Monasta, L ; Montanez Hernandez, JC ; Montero, P ; Montico, M ; Montine, TJ ; Moradi-Lakeh, M ; Morawska, L ; Morgan, K ; Mori, R ; Mozaffarian, D ; Mueller, U ; Satyanarayana Murthy, GV ; Murthy, S ; Musa, KI ; Nachega, JB ; Nagel, G ; Naidoo, KS ; Naik, N ; Naldi, L ; Nangia, V ; Nash, D ; Nejjari, C ; Neupane, S ; Newton, CR ; Newton, JN ; Ng, M ; Ngalesoni, FN ; Ngirabega, JDD ; Quyen, LN ; Nisar, MI ; Nkamedjie Pete, PM ; Nomura, M ; Norheim, OF ; Norman, PE ; Norrving, B ; Nyakarahuka, L ; Ogbo, FA ; Ohkubo, T ; Ojelabi, FA ; Olivares, PR ; Olusanya, BO ; Olusanya, JO ; Opio, JN ; Oren, E ; Ortiz, A ; Osman, M ; Ota, E ; Ozdemir, R ; Pa, M ; Pandian, JD ; Pant, PR ; Papachristou, C ; Park, E-K ; Park, J-H ; Parry, CD ; Parsaeian, M ; Caicedo, AJP ; Patten, SB ; Patton, GC ; Paul, VK ; Pearce, N ; Pedro, JM ; Stokic, LP ; Pereira, DM ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Piel, FB ; Pillay, JD ; Plass, D ; Platts-Mills, JA ; Polinder, S ; Pope, CA ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prabhakaran, D ; Qorbani, M ; Quame-Amaglo, J ; Quistberg, DA ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, SU ; Rai, RK ; Rajavi, Z ; Rajsic, S ; Raju, M ; Rakovac, I ; Rana, SM ; Ranabhat, CL ; Rangaswamy, T ; Rao, P ; Rao, SR ; Refaat, AH ; Rehm, J ; Reitsma, MB ; Remuzzi, G ; Resnikofff, S ; Ribeiro, AL ; Ricci, S ; Blancas, MJR ; Roberts, B ; Roca, A ; Rojas-Rueda, D ; Ronfani, L ; Roshandel, G ; Rothenbacher, D ; Roy, A ; Roy, NK ; Ruhago, GM ; Sagar, R ; Saha, S ; Sahathevan, R ; Saleh, MM ; Sanabria, JR ; Sanchez-Nino, MD ; Sanchez-Riera, L ; Santos, IS ; Sarmiento-Suarez, R ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Schaub, MP ; Schmidt, MI ; Schneider, IJC ; Schottker, B ; Schutte, AE ; Schwebel, DC ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shackelford, KA ; Shaddick, G ; Shaheen, A ; Shahraz, S ; Shaikh, MA ; Shakh-Nazarova, M ; Sharma, R ; She, J ; Sheikhbahaei, S ; Shen, J ; Shen, Z ; Shepard, DS ; Sheth, KN ; Shetty, BP ; Shi, P ; Shibuya, K ; Shin, M-J ; Shiri, R ; Shiue, I ; Shrime, MG ; Sigfusdottir, ID ; Silberberg, DH ; Silva, DAS ; Silveira, DGA ; Silverberg, JI ; Simard, EP ; Singh, A ; Singh, GM ; Singh, JA ; Singh, OP ; Singh, PK ; Singh, V ; Soneji, S ; Soreide, K ; Soriano, JB ; Sposato, LA ; Sreeramareddy, CT ; Stathopoulou, V ; Stein, DJ ; Stein, MB ; Stranges, S ; Stroumpoulis, K ; Sunguya, BF ; Sur, P ; Swaminathan, S ; Sykes, BL ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tabb, KM ; Takahashi, K ; Takala, JS ; Talongwa, RT ; Tandon, N ; Tavakkoli, M ; Taye, B ; Taylor, HR ; Ao, BJT ; Tedla, BA ; Tefera, WM ; Ten Have, M ; Terkawi, AS ; Tesfay, FH ; Tessema, GA ; Thomson, AJ ; Thorne-Lyman, AL ; Thrift, AG ; Thurston, GD ; Tillmann, T ; Tirschwell, DL ; Tonelli, M ; Topor-Madry, R ; Topouzis, F ; Nx, JAT ; Traebert, J ; Tran, BX ; Truelsen, T ; Trujillo, U ; Tura, AK ; Tuzcu, EM ; Uchendu, US ; Ukwaja, KN ; Undurraga, EA ; Uthman, OA ; Van Dingenen, R ; Van Donkelaar, A ; Vasankari, T ; Vasconcelos, AMN ; Venketasubramanian, N ; Vidavalur, R ; Vijayakumar, L ; Villalpando, S ; Violante, FS ; Vlassov, VV ; Wagner, JA ; Wagner, GR ; Wallin, MT ; Wang, L ; Watkins, DA ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Werdecker, A ; Westerman, R ; White, RA ; Wijeratne, T ; Wilkinson, JD ; Williams, HC ; Wiysonge, CS ; Woldeyohannes, SM ; Wolfe, CDA ; Won, S ; Wong, JQ ; Woolf, AD ; Xavier, D ; Xiao, Q ; Xu, G ; Yakob, B ; Yalew, AZ ; Yan, LL ; Yano, Y ; Yaseri, M ; Ye, P ; Yebyo, HG ; Yip, P ; Yirsaw, BD ; Yonemoto, N ; Yonga, G ; Younis, MZ ; Yu, S ; Zaidi, Z ; Zaki, MES ; Zannad, F ; Zavala, DE ; Zeeb, H ; Zeleke, BM ; Zhang, H ; Zodpey, S ; Zonies, D ; Zuhlke, LJ ; Vos, T ; Lopez, AD ; Murray, CJL (ELSEVIER SCIENCE INC, 2016-10-08)
    BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. FUNDING: Bill & Melinda Gates Foundation.
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    Symptoms of anxiety and depression in adolescent students; a perspective from Sri Lanka.
    Rodrigo, C ; Welgama, S ; Gurusinghe, J ; Wijeratne, T ; Jayananda, G ; Rajapakse, S (Springer Science and Business Media LLC, 2010-03-24)
    BACKGROUND: Sri Lanka recorded an extraordinary high suicide rate for adolescents aged 15 - 19 in the early 1990s (46.5/100,000). With this in perspective, the Ministry of Health in Sri Lanka recommends school programmes for adolescents by mental health units of local hospitals. METHODS: We conducted cross sectional surveys to screen for symptoms of anxiety and depression among students aged 14 - 18 during school mental health programmes. Two schools were randomly selected within the Ratnapura municipality (urban population of approx. 50,000), Sri Lanka and all students aged 14-18 were assessed with self administered (pre tested, Sinhalese translations) questionnaires [Center for epidemiologic studies depression scale, Anxiety screening test of suicide and mental health association international]. RESULTS: A total of 445 students were assessed (male-54.4%, female 45.6%). Thirty six percent screened positive for depression (mild depression-17%, severe depression-19%) and 28% screened positive for severe anxiety. Females screened positive for depression and anxiety significantly more than the males (p = 0.0001, 0.005 respectively). Students in classes facing barrier examinations at the end of the year had the highest positivity rates. Examination related issues (36%) were the most commonly cited problem. RECOMMENDATIONS: It is recommended that: 1. School mental health development programmes in Sri Lanka concentrate more on reducing examination related stress, and in particular focus on the female students. 2. Policy decisions are made to reduce competition for higher education. 3. A nationally coordinated survey on mental health of adolescent students is carried out utilizing the island-wide network of medical officers of mental health.
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    Intracerebral hemorrhage location and outcome among INTERACT2 participants
    Delcourt, C ; Sato, S ; Zhang, S ; Sandset, EC ; Zheng, D ; Chen, X ; Hackett, ML ; Arima, H ; Hata, J ; Heeley, E ; Salman, RA-S ; Robinson, T ; Davies, L ; Lavados, PM ; Lindley, RI ; Stapf, C ; Chalmers, J ; Anderson, CS (LIPPINCOTT WILLIAMS & WILKINS, 2017-04-11)
    OBJECTIVE: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: Associations between ICH sites and poor outcomes (death [6] or major disability [3-5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models. RESULTS: Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively). CONCLUSION: Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule. CLINICALTRIALSGOV REGISTRATION: NCT00716079.
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    Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
    Dieleman, J ; Campbell, M ; Chapin, A ; Eldrenkamp, E ; Fan, VY ; Haakenstad, A ; Kates, J ; Liu, Y ; Matyasz, T ; Micah, A ; Reynolds, A ; Sadat, N ; Schneider, MT ; Sorensen, R ; Evans, T ; Evans, D ; Kurowski, C ; Tandon, A ; Abbas, KM ; Abera, SF ; Kiadaliri, AA ; Ahmed, KY ; Ahmed, MB ; Alam, K ; Alizadeh-Navaei, R ; Alkerwi, A ; Amini, E ; Ammar, W ; Amrock, SM ; Antonio, CAT ; Atey, TM ; Avila-Burgos, L ; Awasthi, A ; Barac, A ; Alberto Bernal, O ; Beyene, AS ; Beyene, TJ ; Birungi, C ; Bizuayehu, HM ; Breitborde, NJK ; Cahuana-Hurtado, L ; Estanislao Castro, R ; Catala-Lopez, F ; Dalal, K ; Dandona, L ; Dandona, R ; de Jager, P ; Dharmaratne, SD ; Dubey, M ; Farinha, CSES ; Faro, A ; Feigl, AB ; Fischer, F ; Fitchett, JRA ; Foigt, N ; Giref, AZ ; Gupta, R ; Hamidi, S ; Harb, HL ; Hay, SI ; Hendrie, D ; Horino, M ; Jurisson, M ; Jakovljevic, MB ; Javanbakht, M ; John, D ; Jonas, JB ; Karimi, SM ; Khang, Y-H ; Khubchandani, J ; Kim, YJ ; Kinge, JM ; Krohn, KJ ; Kumar, GA ; Abd El Razek, HM ; Abd El Razek, MM ; Majeed, A ; Malekzadeh, R ; Masiye, F ; Meier, T ; Meretoja, A ; Miller, TR ; Mirrakhimov, EM ; Mohammed, S ; Nangia, V ; Olgiati, S ; Osman, AS ; Owolabi, MO ; Patel, T ; Paternina Caicedo, AJ ; Pereira, DM ; Perelman, J ; Polinder, S ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Ram, U ; Ranabhat, CL ; Roba, HS ; Salama, J ; Savic, M ; Sepanlou, SG ; Shrime, MG ; Talongwa, RT ; Te Ao, BJ ; Tediosi, F ; Tesema, AG ; Thomson, AJ ; Tobe-Gai, R ; Topor-Madry, R ; Undurraga, EA ; Vasankari, T ; Violante, FS ; Werdecker, A ; Wijeratne, T ; Xu, G ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-05-20)
    BACKGROUND: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. METHODS: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. FINDINGS: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. INTERPRETATION: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. FUNDING: The Bill & Melinda Gates Foundation.
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    Beyond Neglect: Preliminary Evidence of Retrospective Time Estimation Abnormalities in Non-Neglect Stroke and Transient Ischemic Attack Patients
    Low, E ; Crewther, SG ; Perre, DL ; Ong, B ; Laycock, R ; Tu, H ; Wijeratne, T (NATURE PUBLISHING GROUP, 2016-03-04)
    Perception of the passage of time is essential for safe planning and navigation of everyday activities. Findings from the literature have demonstrated a gross underestimation of time interval in right-hemisphere damaged neglect patients, but not in non-neglect unilaterally-damaged patients, compared to controls. This study aimed to investigate retrospective estimation of the duration of a target detection task over two occasions, in 30 stroke patients (12 left-side stroke 15 right-side stroke, and 3 right-side stroke with neglect) and 10 transient ischemic attack patients, relative to 31 age-matched controls. Performances on visual short-term and working memory tasks were also examined to investigate the associations between timing abilities with residual cognitive functioning. Initial results revealed evidence of perceptual time underestimation, not just in neglect patients, but also in non-neglect unilaterally-damaged stroke patients and transient ischemic attack patients. Three months later, underestimation of time persisted only in left-side stroke and right-side stroke with neglect patients, who also demonstrated reduced short-term and working memory abilities. Findings from this study suggest a predictive role of residual cognitive impairments in determining the prognosis of perceptual timing abnormalities.
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    Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation: Data From ROCKET AF
    Pokorney, SD ; Piccini, JP ; Stevens, SR ; Patel, MR ; Pieper, KS ; Halperin, JL ; Breithardt, G ; Singer, DE ; Hankey, GJ ; Hacke, W ; Becker, RC ; Berkowitz, SD ; Nessel, CC ; Mahaffey, KW ; Fox, KAA ; Califf, RM (WILEY, 2016-03-01)
    BACKGROUND: Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. METHODS AND RESULTS: In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). CONCLUSIONS: In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.