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Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission
2023
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs)The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Journal Article
The World report on ageing and health: a policy framework for healthy ageing
by
Peeters, G M E E (Geeske)
,
Mahanani, Wahyu Retno
,
Sadana, Ritu
in
Aging
,
Aging - physiology
,
Caregivers
2016
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
Journal Article
'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities
by
Iezzoni, Lisa I
,
Haywood, Carol
,
Reimold, Kimberly
in
Americans with Disabilities Act 1990-US
,
Attitudes
,
Barriers
2022
People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.
Journal Article
The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016
2018
Previous efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available.
We used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India.
8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016.
The substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focus on the ten cancers contributing the highest DALYs in India, including cancers of the stomach, lung, pharynx other than nasopharynx, colon and rectum, leukaemia, oesophageal, and brain and nervous system, in addition to breast, lip and oral cavity, and cervical cancer, which are currently the focus of screening and early detection programmes.
Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Journal Article
Università ed enti territoriali in processi decisionali per comunità accessibili. Il caso di Udine
by
Conti, Christina
,
Cervesato, Alberto
in
Accessibility
,
Handicapped accessibility
,
People with disabilities
2025
The set of activities undertaken in the field of environmental accessibility and inclusion, based on the skills of the Dalt Laboratory research group, provide an example of the potential of structured sharing of knowledge between public bodies and institutes for the social enhancement of the architectural heritage. Environmental accessibility beyond the removal of architectural barriers The current scope of environmental accessibility is the result of significant changes in cultural, social, economic and political models, and of the functional progress inherent in the tools, techniques, strategies and regulations available to science and the market. The UN Convention, with the support of the ICF, has introduced a psycho-biomedical and social approach to the definition of disabilities by introducing a global point of view aimed at ensuring the full inclusion of people with disabilities within society. According to the first article of the UN Convention, the person with disabilities is an individual who «has permanent or temporary long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers, may hinder the full and effective participation in society on an equal basis with others» (UN, 2006).
Journal Article
The Impact of Technology on People with Autism Spectrum Disorder: A Systematic Literature Review
by
Valencia, Katherine
,
Quiñones, Daniela
,
Rusu, Cristian
in
accessibility
,
Autism
,
autism spectrum disorder
2019
People with autism spectrum disorder (ASD) tend to enjoy themselves and be engaged when interacting with computers, as these interactions occur in a safe and trustworthy environment. In this paper, we present a systematic literature review on the state of the research on the use of technology to teach people with ASD. We reviewed 94 studies that show how the use of technology in educational contexts helps people with ASD develop several skills, how these approaches consider aspects of user experience, usability and accessibility, and how game elements are used to enrich learning environments. This systematic literature review shows that the development and evaluation of systems and applications for users with ASD is very promising. The use of technological advancements such as virtual agents, artificial intelligence, virtual reality, and augmented reality undoubtedly provides a comfortable environment that promotes constant learning for people with ASD.
Journal Article
Inclusive AR/VR: accessibility barriers for immersive technologies
2024
Augmented and virtual reality (AR/VR) hold significant potential to transform how we communicate, collaborate, and interact with others. However, there has been a lack of work to date investigating accessibility barriers in relation to immersive technologies for people with disabilities. To address current gaps in knowledge, we led two multidisciplinary sandpits with key stakeholders (including academic researchers, AR/VR industry specialists, people with lived experience of disability, assistive technologists, and representatives from national charities and special needs colleges) to collaboratively explore and identify existing challenges with AR and VR experiences. We present key themes that emerged from sandpit activities and map out the interaction barriers identified across a spectrum of impairments (including physical, cognitive, visual, and auditory disabilities). We conclude with recommendations for future work addressing the challenges highlighted to support the development of more inclusive AR and VR experiences.
Journal Article
Watersports Inclusion Games: The Benefits for Participants and the Impact of COVID-19 on Access
2024
IntroductionThe Watersports Inclusion Games is a free annual weekend event, where young people with a range of physical and intellectual disabilities and their families/siblings participate in various inclusive watersports activities.ObjectivesThis study aims to assess the psychological benefits of watersports for young people with various physical and intellectual disabilities and investigate the extent of the impact of the COVID-19 pandemic on their access to watersports.MethodsFollowing a literature review, a survey containing both quantitative and qualitative aspects was constructed using SurveyMonkey and circulated to the parents/guardians of participants three times following the event. The survey was completed anonymously on an opt-in basis and 28 responses that met our criteria for analysis were collected. Qualitative data from free-text responses were grouped under themes and quantitative data was analysed using SPSS.ResultsDespite 64% (n=18) of respondents indicating that their disability increased their vulnerability to COVID-19 in some capacity, the effect of the pandemic on accessibility was not statistically significant. This could be due to the small response number, or the everyday limitations participants faced prior to the pandemic. 92% (n=25) of participants indicated that there was great inclusion in the watersports activities and that they were “very beneficial” regarding the possibility of the whole family’s participation [p=0.005]. The survey also found a statistically significant association between the event’s activities being considered both “accessible” and “very beneficial” in terms of boosting self-confidence, with 57.1% of responses indicating agreement to this. (p=0.016)ConclusionsFull-family participation and accessibility of activities were key facilitators to the enjoyment and benefit of participants. Programmes should be established that allow able-bodied siblings and young people with disabilities to participate in the same activities.Disclosure of InterestNone Declared
Journal Article
Migraine: integrated approaches to clinical management and emerging treatments
by
Ashina, Håkan
,
Buse, Dawn C
,
Pozo-Rosich, Patricia
in
Analgesics
,
Cardiovascular disease
,
Cerebrovascular disease
2021
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
Journal Article