Background Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings In 2020, low back pain affected 619 million (95% uncertainty interval 554-694) people globally, with a projection of 843 million (759-933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578-1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10 center dot 4% (10 center dot 9-10 center dot 0) and 10 center dot 5% (11 center dot 1-10 center dot 0), respectively. A total of 38 center dot 8% (28 center dot 7-47 center dot 0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change. Funding Bill and Melinda Gates Foundation. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Abstract Background Bystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders’ willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders’ preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference. Methods The population was a convenience sample of individuals who attended the Kentucky State Fair, August 18–28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice. Results After training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7–10]), naloxone dose (8 [5–10]), and product familiarity (5 [5–9]). Conclusions Bystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.

Transcatheter aortic valve replacement (TAVR) is an established therapy for the treatment of severe aortic stenosis. The evolution of technology and procedural approaches has facilitated the development of streamlined clinical pathways to optimize patient care and improve outcomes. The revision of historical practices and the adoption of contemporary best practices throughout patients' journey from referral to discharge create opportunities to drive quality improvement. Nursing expertise and leadership are essential to recalibrate preprocedure, periprocedure, and postprocedure practice to transform the way we care for TAVR, achieve excellent outcomes, and promote high-performing health services for the treatment of valvular heart disease.

AIMS:The optimal strategy of monitoring for conduction disturbances in patients undergoing transcatheter aortic valve implantation (TAVI) is uncertain. We evaluated a pre- and post-TAVI remote ambulatory cardiac monitoring (rACM) strategy for identification of conduction disturbances and to reduce unplanned pre-discharge post-TAVI permanent pacemaker implantation (PPMI).METHODS AND RESULTS:REdireCT TAVI (NCT0381820) was a prospective cohort study of patients referred for outpatient TAVI. Patients with prior PPMI were excluded. Remote ambulatory cardiac monitoring consisted of 2 weeks of continuous electrocardiogram (ECG) monitoring (Pocket-ECGTM) both before and after TAVI. Compliance to monitoring, frequency of notifications, unplanned PPMI post-TAVI, and length of hospitalization were measured. Between June 2018 and March 2020, in 192 undergoing TAVI (mean age: 81.8 years; female sex 46%; balloon-expandable valve 95.3%), compliance to rACM was 91.7% pre-TAVI (mean duration: 12.8 days), and 87.5% post-TAVI (mean duration: 12.9 days). There were 24 (12.5%) rACM notifications (13 pre-TAVI; 11 post-TAVI) resulting in 14 (7.3%) planned PPMI: seven pre-TAVI [due to sinus pauses n = 2 or atrio-ventricular block (AVB) n = 5] and seven post-TAVI [due to sinus pauses n = 1 or AVB n = 5 or ventricular tachycardia (VT) n = 1]. In addition, nine (4.7%) patients received pre-TAVI PPMI due to high-risk baseline ECG (right bundle branch block with hemi-block or prolonged PR interval). Unplanned PPMI post-TAVI during index hospitalization occurred in six (3.1%) patients due to AVB and in one patient readmitted with AVB. The median length of stay post-TAVI was 1 day.CONCLUSION:A strategy of routine rACM was feasible and frequently led to PPMI. Our approach of 2-week rACM both pre- and post-TAVI achieves both high patient compliance and sufficient surveillance.CLINICAL TRIAL REGISTRATION:Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03810820.

Transcatheter aortic valve replacement (TAVR) is an established therapy for the treatment of severe aortic stenosis. The evolution of technology and procedural approaches has facilitated the development of streamlined clinical pathways to optimize patient care and improve outcomes. The revision of historical practices and the adoption of contemporary best practices throughout patients' journey from referral to discharge create opportunities to drive quality improvement. Nursing expertise and leadership are essential to recalibrate preprocedure, periprocedure, and postprocedure practice to transform the way we care for TAVR, achieve excellent outcomes, and promote high-performing health services for the treatment of valvular heart disease.

As scientists and stakeholders in the field of population, we are concerned that the highly publicised population forecasts by Stein Vollset and colleagues,1 and their models, data, and underlying assumptions, have not received enough critical scrutiny.

Background: Transcatheter aortic valve replacement (TAVR) computed tomographic angiography (CTA) images can be used to evaluate coronary artery disease (CAD). Methods: We conducted a prospective cohort study of consecutive TAVR patients from November 2019 to February 2021 to evaluate TAVR CTA assessment of CAD on the rate of pre-TAVR invasive angiography. Patients had CTA first or invasive angiography first at the discretion of their treating physicians. TAVR CTA scans were categorised as normal/mild CAD, single-vessel disease, high risk (multivessel or left main disease), or nondiagnostic in patients without previous coronary artery bypass grafting (CABG) and as low risk or high risk in patients with previous CABG. Invasive angiography was recommended before TAVR for high-risk or nondiagnostic CTA findings. Results: TAVR was performed on 354 patients; CTA first was performed in 273 and invasive angiography first in 81. Among 231 patients without previous CABG who had CTA first, 22.1% (51/231) had pre-TAVR invasive angiography and 1.3% (3/231) had pre-TAVR revascularisation. Normal/mild CAD or single-vessel disease was found on CTA in 174 patients, of whom 0.5% (1/174) had high-risk disease on invasive angiography. Among 42 patients with previous CABG who had CTA first, 14.3% (6/42) had pre-TAVR invasive angiography and 2.4% (1/42) had pre-TAVR revascularisation. Conclusion: TAVR CTA CAD evaluation can avoid pre-TAVR invasive angiography in more than 70% of patients while rarely missing high risk findings. A CIA-first strategy to assess CAD should be considered, especially among patients where conservative management of CAD is preferred.

Purpose The purpose of this study was to develop a publicly available, psychometrically sound item bank and short forms for measuring resilience in any population, but especially resilience in individuals with chronic medical conditions or long-term disability. Research methods A panel of 9 experts including disability researchers, clinical psychologists, and health outcomes researchers developed a definition of resilience that guided item development. The rigorous methodology used focus groups, cognitive interviews, and modern psychometric theory quantitative methods, including item response theory (IRT). Items were administered to a sample of people with chronic medical conditions commonly associated with disability (N = 1,457) and to a general population sample (N = 300) representative of the Unites States general population with respect to age, gender, race, and ethnicity. Results The final item bank includes 28 items calibrated to IRT with the scores on a T-metric. A mean of 50 represents the mean resilience in the general population sample. Four and eight item short forms are available, and their scores are highly correlated with the item bank score (r ≥ .94). Reliability is excellent across most of the resilience continuum. Initial analyses provide strong support for validity of the score. Conclusions The findings support reliability and validity of the University of Washington Resilience Scale (UWRS) for assessing resilience in any population, including individuals with chronic health conditions or disabilities. It can be administered using computerized adaptive testing or by short forms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND:Evidence is lacking to standardize post-procedure care after transcatheter aortic valve replacement (TAVR).OBJECTIVE:We report on the findings of the post-procedure sub-study of the multimodality, multidisciplinary but minimalist TAVR (3M TAVR) study.METHODS:A standardized protocol to guide monitoring, early mobilization, reconditioning, communication, and criteria-driven discharge was implemented in a multicenter, prospective, sequential case series study in 13 North American low, medium, and high-volume centers in 2015-2017. Outcome measures pertaining to post-procedure care included avoidance of invasive lines and delirium, in-hospital bed utilization, patient disposition at the time of discharge, and 30-day use of nonelective medical services.RESULTS:Four hundred eleven participants were enrolled. In the post-procedure phase, 365 (88.8%) participants were admitted without a temporary pacemaker; urinary catheterization was avoided in 402 (97.8%) participants. Of note, 91.7% received care in a single unit (critical care: 72.5%; cardiac telemetry: 19.2%); 99.0% were discharged home. At the time of 30-day follow-up, 6 (1.6%) participants required admission to a rehabilitation or a skilled nursing facility; 30-day emergency department visits were 13.5%.CONCLUSIONS:The implementation of the 3M TAVR standardized accelerated reconditioning protocol is a safe and effective strategy to facilitate next-day discharge home after TAVR in centers of varying size.

Background Understanding potential patterns in future population levels is crucial for anticipating and planning for changing age structures, resource and health-care needs, and environmental and economic landscapes. Future fertility patterns are a key input to estimation of future population size, but they are surrounded by substantial uncertainty and diverging methodologies of estimation and forecasting, leading to important differences in global population projections. Changing population size and age structure might have profound economic, social, and geopolitical impacts in many countries. In this study, we developed novel methods for forecasting mortality, fertility, migration, and population. We also assessed potential economic and geopolitical effects of future demographic shifts. Methods We modelled future population in reference and alternative scenarios as a function of fertility, migration, and mortality rates. We developed statistical models for completed cohort fertility at age 50 years (CCF50). Completed cohort fertility is much more stable over time than the period measure of the total fertility rate (TFR). We modelled CCF50 as a time-series random walk function of educational attainment and contraceptive met need. Age-specific fertility rates were modelled as a function of CCF50 and covariates. We modelled age-specific mortality to 2100 using underlying mortality, a risk factor scalar, and an autoregressive integrated moving average (ARIMA) model. Net migration was modelled as a function of the Socio-demographic Index, crude population growth rate, and deaths from war and natural disasters; and use of an ARIMA model. The model framework was used to develop a reference scenario and alternative scenarios based on the pace of change in educational attainment and contraceptive met need. We estimated the size of gross domestic product for each country and territory in the reference scenario. Forecast uncertainty intervals (UIs) incorporated uncertainty propagated from past data inputs, model estimation, and forecast data distributions. Findings The global TFR in the reference scenario was forecasted to be 1.66 (95% UI 1.33-2.08) in 2100. In the reference scenario, the global population was projected to peak in 2064 at 9.73 billion (8.84-10.9) people and decline to 8.79 billion (6.83-11.8) in 2100. The reference projections for the five largest countries in 2100 were India (1.09 billion [0.72-1.71], Nigeria (791 million [594-1056]), China (732 million [456-1499]), the USA (336 million [248-456]), and Pakistan (248 million [151-427]). Findings also suggest a shifting age structure in many parts of the world, with 2.37 billion (1.91-2.87) individuals older than 65 years and 1.70 billion (1.11-2.81) individuals younger than 20 years, forecasted globally in 2100. By 2050, 151 countries were forecasted to have a TFR lower than the replacement level (TFR <2.1), and 183 were forecasted to have a TFR lower than replacement by 2100. 23 countries in the reference scenario, including Japan, Thailand, and Spain, were forecasted to have population declines greater than 50% from 2017 to 2100; China's population was forecasted to decline by 48.0% (-6.1 to 68.4). China was forecasted to become the largest economy by 2035 but in the reference scenario, the USA was forecasted to once again become the largest economy in 2098. Our alternative scenarios suggest that meeting the Sustainable Development Goals targets for education and contraceptive met need would result in a global population of 6.29 billion (4.82-8.73) in 2100 and a population of 6.88 billion (5.27-9.51) when assuming 99th percentile rates of change in these drivers. Interpretation Our findings suggest that continued trends in female educational attainment and access to contraception will hasten declines in fertility and slow population growth. A sustained TFR lower than the replacement level in many countries, including China and India, would have economic, social, environmental, and geopolitical consequences. Policy options to adapt to continued low fertility, while sustaining and enhancing female reproductive health, will be crucial in the years to come. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Remote ambulatory cardiac monitoring (rACM) could identify high-grade atrioventricular block (AVB) before and after transcatheter aortic valve replacement (TAVR). Retrospective analysis of patients undergoing TAVR, with 14-day rACM before and after TAVR, was performed. Of 62 patients undergoing TAVR, 41 patients had rACM before TAVR. Three patients had asymptomatic AVB leading to planned pacemaker (PM) implant. After TAVR, 23 patients had rACM, with 1 patient requiring a PM implant for asymptomatic AVB. Five patients underwent unplanned PM after TAVR. Using rACM, almost half of PM implants in TAVR recipients were identified electively. High-grade AVB requiring PM was identified in nearly 10% of patients before TAVR.

Poor diet is a major contributor to the burden of disease globally. However, whether or not sufficient supply of food is available to achieve a minimum-risk diet (MRD) in each country has not been systematically evaluated. Additionally, the future health effects of adopting a MRD have not yet been quantified. To address these gaps in knowledge, we estimated the gaps between current and optimal consumption and availability of major food groups in 196 countries. We also estimated the number of deaths that would be saved in 2050 if the world population adopted MRD by 2030. Using the data and methods of the Global Burden of Disease (GBD), we estimated the energy intake required to maintain a healthy active life in each country by age and sex. Then, we defined the country-specific MRD as the diet that provides the required energy through sufficient intake of healthy foods, minimal intake of unhealthy foods, and balanced intake of diverse neutral foods that are available in the country. Using the GBD Diet Database, we then assessed the gap between consumption and availability of each food group by comparing its current intake and availability with the intake and availability required to achieve MRD. Finally, we used Institute for Health Metrics and Evaluation forecasting methodology to evaluate the disease burden under a reference and two alternate scenarios (i.e., adopting MRD, adopting MRD and stabilizing BMI). We found a significant gap in the availability of healthy foods globally, with the largest gaps in nuts (60% of optimal availability), fruits (70%), and vegetables (80%). Our forecasting analyses show that 2.3 million deaths (38 deaths per 100,000 population) can be prevented in 2050 if the world adopts the MRD by 2030. Across geographic regions, the largest number of deaths prevented will be in Oceania (121 deaths per 100,000 population) and Central Asia (85 deaths per 100,000 population). In addition to achieving MRD, stabilizing the future trend in BMI would result in 4.6 million deaths globally (60 deaths per 100,000 population) averted in 2050. Our results inform national policies aiming at improving diet and highlight the need for a radical transformation in the food system to increase the production, distribution, and availability of healthy components of diet. The Rockefeller Foundation, Bill and Melinda Gates Foundation.

The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients' pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients' accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.

Background: The Global Burden of Disease Study 2019 (GBD 2019) estimated that approximately 2 million (95% uncertainty interval [UI] 1·7–2·3) deaths and 37·8 million (32·2–47·6) DALYs were attributable to non-optimal temperature in 2019. Globally, most of this burden was attributed to low temperatures, but high heat-attributable mortality rates were observed in warmer regions such as south Asia, north Africa and the Middle East, and sub-Saharan Africa. The impact of increases in global temperatures and demographic trends on future temperature-related mortality is unclear.Methods: We linked cause-specific temperature-mortality risk curves to daily temperature forecasts from the NEX-GDDP dataset. The NEX-GDDP data set comprises 21 individual General Circulation Models (GCM) that were spatially downscaled for two Representative Concentration Pathways (RCPs): RCP4.5 and RCP8.5. For each pixel, day, and cause, we estimated the population attributable fraction (PAF) based on the risk of cause-specific mortality at a given temperature relative to the theoretical minimum risk exposure level (TMREL); we then estimated temperature-attributable deaths by multiplying these PAFs with location-specific mortality estimates for the reference period from 1990 to 2020 and for the forecasted period from 2020 to 2100. Other upstream drivers in the model, including the Socio-demographic Index and air pollution levels, were held constant.Findings: Globally, we estimate increases in the number and rate of deaths attributable to non-optimal temperature, with 3.27 (2.11 – 4.70) million and 4.08 (2.67 – 5.86) million annual deaths by the end of the century, for RCP4.5 and RCP8.5, respectively. These increases are driven largely by heat-attributable burden, with smaller and more variable changes in cold-attributable deaths. Warm, low-latitude regions will be disproportionally affected, with the largest increases in temperature-attributable mortality expected in sub-Saharan Africa, south Asia, and Latin America and the Caribbean. As our study accounts for adaptation and does not extrapolate relative risks beyond the exposure currently experienced, these estimates are likely conservative.Interpretation: Globally increasing temperatures are projected to substantially increase the mortality burden attributable to non-optimal temperature. Higher global temperatures only lead to minor decreases in cold-related mortality which do not offset increases in heat-related mortality.Funding Statement: Bill & Melinda Gates FoundationDeclaration of Interests: None to declare.

For people living with long-term physical disability (LTPD) social participation may involve managing physical impairments and secondary health conditions (SHCs) that are not due to the pathophysiology of the LTPD diagnosis itself. Prior research found a negative relationship between SHCs and participation in social roles in people with spinal cord injury (SCI). We expand on this research by investigating the influence of SHCs on participation in social roles for people with one of four LTPDs, controlling for co-variates. We (1) evaluated the associations between SHCs and participation in social roles; and (2) determined whether SHCs on individuals' ability to participate in social roles varies by type of diagnosis in those aging with either SCI, muscular sclerosis, muscular dystrophy, or post-polio syndrome. Cross-sectional, secondary data analysis from a return-by-mail survey. N = 1,573. Data were analyzed with multiple linear regressions (hypothesis 1), and then three moderated regressions (hypothesis 2). After controlling for demographics, SHCs were associated with lower ability to participate in social roles and accounted for 48% of the variance (all p's <.001). The relationship between depression and social role participation was moderated by diagnosis, such that depression was more negatively associated with social participation among individuals with SCI (p = .020). Thus, SHC negatively impact participation in social roles.