Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Study of Life Stressors and Suicidal Intent of Suicidal Attempters with or Without Axis 1 Psychiatric Comorbidities: A Case Control Study

Background: Suicide attempts and Psychiatric illness are interrelated in a complex and bi directional way such that either of them leaves an impact on the other. People with Psychiatric morbidity are at high risk of attempting suicide. Even though extensive research works have been done in suicide, there is a paucity of studies focusing the mentally ill attempters, especially with reference to Intent and Lethality. Hence the present study designed to study the various parameters , contributing factors and Risk factors associated with suicide attempts of patient with Axis I disorders. Aim: 1.To assess the life stressors and suicidal intent in suicide attempters with Axis I psychiatric disorders. 2. To assess the life stressors and suicidal intent in suicide attempters without Axis I psychiatric disorders. 3. Compare the life stressors and suicidal intent in suicide attempters with and without axis I disorders. Material and Methods: The study subjects of this case control study were recruited from the patients referred to the department of Psychiatry from Medicine, Surgical and Intensive care wards for Psychiatric evaluation.30 patients of attempted suicide who had Axis I diagnosis as per the ICD – 10 criteria were taken as cases and 30 age and sex matched patients were taken as controls. Results: 1.The suicidal intent is high in Suicide attempters with Axis I Disorders. 2. The lethality is high in Suicidal attempters with Axis I Disorders. 3. Stress factors play a major role in Suicide attempters with Axis I disorders.</jats:p

Incidence of oral white lesions in patients attending a private dental hospital

The oral cavity is vulnerable to a limitless number of environmental insults; white lesions are common findings in the oral cavity. White lesions in the oral cavity may be benign, premalignant or malignant. Early determination is the most significant single factor in battling oral malignancy and improving endurance rate. So white lesions occurring in the oral mucosa are promptly needed to be identified and treated. The aim of the study was to determine the incidence of oral white lesions occurring among patients visiting a private dental hospital. A total of 10,000 patient data were selected for the study; patients who reported to the dental college between June 2019 to March 2020 were included for the study. This was a retrospective study, and the data were obtained from patient case records, and the data were reviewed for the presence of white lesions. White lesions coexisting with other types of lesions such as red lesions, vesiculoerosive lesions, pigmented lesions etc. have been excluded from the study. The overall incidence of white lesions was found to be 7.3 per 1000 per year. The number of oral white lesions was 0.65% in males and 0.08% in females. The number of Leukoplakia was 26.03% in male, and 1.37% in female, OSMF 24.66% in male and 4.11% in female, Tobacco pouch keratosis 31.51% in males and chemical burn 4.11% in males and 2.74% in females, candidiasis was 2.74% in both male and female. From the present study, we can conclude that the typical white lesion in the oral cavity is tobacco pouch keratosis and most of the lesions belong to the category of potentially malignant disorders hence the timely diagnosis of these lesions is paramount and can minimize the progression of oral cancer.</jats:p

Intercondylar Ganglion Cyst with Mucoid Degeneration of Posterior Cruciate Ligament of Knee: Report of A Rare Case and Review of Literature

Introduction: Mucoid degeneration and Ganglion cysts arising from the posterior cruciate ligament (PCL) of the knee are rare. The aetiology, clinical features and Magnetic resonance imaging (MRI) appearance of PCL mucoid degeneration and intercondylar ganglion cyst are discussed. Case Report: We present a 36 year-old male patient who presented with chronic right knee pain for the duration of 5-6 months. No evidence of ligament instability on clinical examination was found. A diagnosis of PCL mucoid degeneration and intercondylar ganglion cyst was made on MRI. Conclusion: Mucoid degeneration and ganglion cyst involving PCL are uncommon lesions and represents the spectrum of same pathology. MR imaging is sensitive, specific, accurate and noninvasive, while providing multiplanar imaging and superior identification of the anatomical and morphological relationship of the synovial tissue to the surrounding structures, an additional intra-articular lesions can also be detected. Keywords: Ganglion cyst, mucoid degeneration, intercondylar, posterior cruciate ligament

Challenges of an Internet of Things-Based Health Monitoring System

The Internet of Things (IoT) is a cutting-edge and quickly advancing innovation wherein everything (brilliant items and keen gadgets) is connected to the web for effective correspondence between them. The web of things is an impetus for medical care and assumes a basic part in an assortment of medical services following applications. By gathering internal heat level, circulatory strain, and sugar levels, organized sensors gadgets, regardless of whether worn on the body or installed in living conditions; permit the assortment of rich information to decide a patient’s physical and psychological well-being condition. The troublesome errand in the Internet of things is conveying the gathered information to the specialist, settling on the right choices dependent on the information gathered, and advising the patient. The creator of this paper centers around an investigation of IoT-based medical care frameworks, just as promising circumstances and difficulties for IoT-based patient wellbeing checking frameworks.</jats:p

Real Time-Detection of Lung Cancer

Lung infections are the most intense ailments that influence the lungs. Lung assumes a fundamental job which takes care in the breathing procedure in people. Lung ailments is said to be the most widely recognized ailments around the world, particularly in India it is increasingly normal. The regular maladies, for example, pleural emanation and typical lung can be recognized and grouped right now. This paper introduces a PC helped order Method in Computer Tomography (CT) Images of lungs created utilizing NN. The significant reason for this framework is to recognize and characterize the most widely recognized lung ailments that causes the significant issues by viable component extraction through Dual-Tree Complex Wavelet Transform and GLCM Features.Right now whole lung is fragmented from the CT Images and the parameters are determined from the divided picture. The parameters are determined utilizing GLCM. We Propose and assess the Network intended for grouping of ILD designs. The parameters gives the greatest grouping Accuracy. After outcome we propose the bunching to portion the injury part from irregular lung.</jats:p