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  1. Thomas B, Gupta K
    J Esthet Restor Dent, 2017 Nov 12;29(6):435-441.
    PMID: 28703476 DOI: 10.1111/jerd.12317
    OBJECTIVE: Nano-hydroxyapatite-added GIC has been developed to improve the physical properties of conventional GIC. However, biological response of periodontal cells to this potentially useful cervical restorative material has been unexplored. The aim of this study was to investigate the in vitro response of human periodontal ligament fibroblasts to hydroxyapatite-added GIC.

    MATERIALS AND METHODS: Three categories of materials, namely, test group 1 (cGIC or type IX GIC), test group 2 (HA-GIC or hydroxyapatite-added GIC), and positive control (glass cover slips) were incubated with human periodontal ligament fibroblasts. The samples were viewed under scanning electron microscope to study the morphological characteristics of fibroblasts. Additionally, elemental analysis was performed to differentiate between the two test groups based on surface chemical composition.

    RESULTS: Test group 1 (cGIC) exhibited cells with curled up morphology, indicative of poor attachment to the substrate. Test group 2 (Ha-GIC) exhibited cells with flattened morphology and numerous cellular extensions such as lamellipodia and blebs, indicative of good attachment to the substrate. The test group 2 (Ha-GIC) demonstrated higher surface elemental percentages of calcium and phosphorus.

    CONCLUSION: Within the limitations of this study, it may be concluded that hydroxyapatite-added GIC is more biocompatible than conventional GIC (type IX), probably attributed to high elemental percentages of calcium and phosphorus.

    CLINICAL SIGNIFICANCE: The search for an ideal cervical restorative dental material has been ever elusive. Hydroxyapatite-added GIC is a simple and economical dental material to fabricate from basic conventional GIC. The results from this study strengthen its candidature for cervical and root surface restorations which may later require soft tissue augmentation. The possibility of connective tissue adhesion to this material is an exciting prospect in the field of periorestorative dentistry.

  2. Kumar S, Thomas BS, Gupta K, Guddattu V, Alexander M
    Niger J Clin Pract, 2018 Aug;21(8):1029-1033.
    PMID: 30074006 DOI: 10.4103/njcp.njcp_341_17
    Aim and objectives: The aim and the objectives were. (1) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™), (2) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used in combination with iontophoresis, and (3) to compare the effectiveness of the above methods.

    Subjects and Methods: Two groups of 40 patients each having dentinal hypersensitivity were treated using 8% proarginine and iontophoresis. The patients were recalled after 1, 2, and 4 weeks. The scores were tabulated and the results were analyzed using SPSS statistical software.

    Results: Visual analog scale between the two groups showed a significant difference from the 1st week till the 4th week. ANOVA values showed the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. The Cochran-Mantel-Haenszel correlation test of the Schiff's dentinal hypersensitivity cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis.

    Conclusion: Iontophoresis, when used along with Colgate® Sensitive Pro-Relief™ toothpaste, can provide additional benefit as this provides a better sealing effect.

  3. Pandey M, Thomas BC, Ramdas K, Eremenco S, Nair MK
    Qual Life Res, 2002 Mar;11(2):87-90.
    PMID: 12018741
    BACKGROUND: Recent advances in diagnosis and treatment of cancer have led to an increase in cancer survival, and hence, there is a greater emphasis on quality beside quantity of survival. Developing countries too have begun to recognize the need for monitoring quality of life (QOL). However, in most of the developing countries, a validated and reliable tool for the purpose is yet to be realized.

    MATERIAL AND METHOD: The functional assessment of chronic illness therapy (FACIT) system is a collection of QOL questionnaires targeted to measure QOL in chronic illness. The functional assessment of cancer therapy for breast cancer (FACT-B) was translated into the local language (Malayalam) and tested for validity and reliability.

    RESULTS: The tool thus developed showed substantial sensitivity, as does the source tool. The Cronbach's alpha for the total FACT-B was 0.87, which is similar to the alpha of 0.9 observed in the FACT-B English version. The mean FACT-B score was 94.3 compared to 112.8 for the source tool.

    CONCLUSION: The Malayalam translation of the FACT-B questionnaire was developed, tested and validated, and was found satisfactory in comparison to the source tool.

  4. Zywitza V, Frahm S, Krüger N, Weise A, Göritz F, Hermes R, et al.
    iScience, 2022 Nov 18;25(11):105414.
    PMID: 36388963 DOI: 10.1016/j.isci.2022.105414
    Less than 80 Sumatran rhinos (SR, Dicerorhinus sumatrensis) are left on earth. Habitat loss and limited breeding possibilities are the greatest threats to the species and lead to a continuous population decline. To stop the erosion of genetic diversity, reintroduction of genetic material is indispensable. However, as the propagation rate of captive breeding is far too low, innovative technologies have to be developed. Induced pluripotent stem cells (iPSCs) are a powerful tool to fight extinction. They give rise to each cell within the body including gametes and provide a unique modality to preserve genetic material across time. Additionally, they enable studying species-specific developmental processes. Here, we generate iPSCs from the last male Malaysian SR Kertam, who died in 2019, and characterize them comprehensively. Differentiation in cells of the three germ layers and cerebral organoids demonstrate their high quality and great potential for supporting the rescue of this critically endangered species.
  5. Nash DA, Friedman JW, Kardos TB, Kardos RL, Schwarz E, Satur J, et al.
    Int Dent J, 2008 Apr;58(2):61-70.
    PMID: 18478885
    In 1921, New Zealand began training school dental nurses, subsequently deploying them throughout the country in school-based clinics providing basic dental care for children. The concept of training dental nurses, later to be designated dental therapists, was adopted by other countries as a means of improving access to care, particularly for children. This paper profiles six countries that utilise dental therapists, with a description of the training that therapists receive in these countries, and the context in which they practice. Based on available demographic information, it also updates the number of dental therapists practising globally, as well as the countries in which they practice. In several countries, dental therapy is now being integrated with dental hygiene in training and practice to create a new type of professional complementary to a dentist. Increasingly, dental therapists are permitted to treat adults as well as children. The paper also describes the status of a current initiative to introduce dental therapy to the United States. It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.
  6. Tao X, Jin X, Gao S, Yi X, Liu Y, Rockett TBO, et al.
    ACS Photonics, 2024 Nov 20;11(11):4846-4853.
    PMID: 39584037 DOI: 10.1021/acsphotonics.4c01343
    The presence of large bismuth (Bi) atoms has been shown to increase the spin-orbit splitting energy in bulk GaAsBi, reducing the hole ionization coefficient (β) and thereby reducing the excess noise seen in avalanche photodiodes. In this study, we show that even very thin layers of GaAsBi introduced as quantum wells (QWs) in a GaAs matrix exhibit a significant reduction of β while leaving the electron ionization coefficient, α, largely unchanged. The optical and avalanche multiplication properties of a series of GaAsBi/GaAs multiple quantum well (MQW) p-i-n structures with nominally 5 nm thick, 4.4% Bi GaAsBi QWs, varying from 5 to 63 periods and corresponding barrier widths of 101 to 4 nm were investigated. From photoluminescence, ω-2θ X-ray diffraction, and cross section transmission electron microscopy measurements, the material was found to be of high quality despite the strain introduced by the Bi in all except the samples with 54 and 63 QW periods. Photomultiplication measurements undertaken with different wavelengths showed that α in these MQW structures did not change appreciably with the number of QWs; however, β decreased significantly, especially at lower values, the noise factor, F, is reduced by 58% to 3.5 at a multiplication of 10, compared to a similar thickness bulk GaAs structure without any Bi. This result suggests that Bi-containing QWs could be introduced into the avalanching regions of APDs as a way of reducing their excess noise.
  7. Hari P, Dutta S, Hanapi NSBM, Ali TBT, Thomas B, Tang TH, et al.
    Can J Dent Hyg, 2021 06 01;55(2):101-109.
    PMID: 34221034
    Objective: To evaluate the clinical efficacy and safety profile of a novel-designed isosceles-configured (SUN Teeth™) toothbrush in comparison to a standard reference toothbrush with end-rounded bristles (approved by the American Dental Association [ADA]).

    Methods: The sample size was determined using the G-Power-software, version 3.1.2 and, accordingly, 104 subjects (ages 19 years to 25 years) were recruited and randomized into either the test group (n = 54) or the control group (n = 50). Prior to study commencement, scaling was performed followed by abstinence from oral hygiene for 24 hours. Baseline pre-brushing gingivitis scores (Lobene) and plaque scores (Turesky modification of Quigley Hein) were recorded. Brushing was performed for 3 minutes and post-brushing scores were recorded on days 1, 14, and 28 without refraining from regular brushing. Data were analysed with Statistical Package for Social Sciences (IBM-SPSS, v.25.0).

    Results: Post-brushing plaque scores showed significant reduction in both groups at all time intervals. However, no significant differences between the test and control brush groups were achieved at any time points.

    Conclusion: The isosceles-configured SUN TeethTMtoothbrush is equivalent in plaque removal to the conventional flat-bristled ADA reference brush.

  8. Hildebrandt TB, Hermes R, Goeritz F, Appeltant R, Colleoni S, de Mori B, et al.
    Theriogenology, 2021 Jul 15;169:76-88.
    PMID: 33940218 DOI: 10.1016/j.theriogenology.2021.04.006
    The ongoing mass extinction of animal species at an unprecedented rate is largely caused by human activities. Progressive habitat destruction and fragmentation is resulting in accelerated loss of biodiversity on a global scale. Over decades, captive breeding programs of non-domestic species were characterized by efforts to optimize species-specific husbandry, to increase studbook-based animal exchange, and to improve enclosure designs. To counter the ongoing dramatic loss of biodiversity, new approaches are warranted. Recently, new ideas, particularly the application of assisted reproduction technologies (ART), have been incorporated into classical zoo breeding programs. These technologies include semen and oocyte collection, artificial insemination, and in-vitro embryo generation. More futuristic ideas of advanced ART (aART) implement recent advances in biotechnology and stem-cell related approaches such as cloning, inner cell mass transfer (ICM), and the stem-cell-associated techniques (SCAT) for the generation of gametes and ultimately embryos of highly endangered species, such as the northern white rhinoceros (Ceratotherium simum cottoni) of which only two female individuals are left. Both, ART and aART greatly depend on and benefit from the rapidly evolving cryopreservation techniques and biobanking not only of genetic, but also of viable cellular materials suitable for the generation of induced pluripotent stem cells (iPSC). The availability of cryopreserved materials bridges gaps in time and space, thereby optimizing the available genetic variability and enhancing the chance to restore viable populations.
  9. Ismail BA, Kafy HT, Sulieman JE, Subramaniam K, Thomas B, Mnzava A, et al.
    Parasit Vectors, 2018 03 02;11(1):122.
    PMID: 29499751 DOI: 10.1186/s13071-018-2732-9
    BACKGROUND: Long-lasting insecticidal nets (LLINs) (with pyrethroids) and indoor residual spraying (IRS) are the cornerstones of the Sudanese malaria control program. Insecticide resistance to the principal insecticides in LLINs and IRS is a major concern. This study was designed to monitor insecticide resistance in Anopheles arabiensis from 140 clusters in four malaria-endemic areas of Sudan from 2011 to 2014. All clusters received LLINs, while half (n = 70), distributed across the four regions, had additional IRS campaigns.

    METHODS: Anopheles gambiae (s.l.) mosquitoes were identified to species level using PCR techniques. Standard WHO insecticide susceptibility bioassays were carried out to detect resistance to deltamethrin (0.05%), DDT (4%) and bendiocarb (0.1%). TaqMan assays were performed on random samples of deltamethrin-resistant phenotyped and pyrethrum spray collected individuals to determine Vgsc-1014 knockdown resistance mutations.

    RESULTS: Anopheles arabiensis accounted for 99.9% of any anopheline species collected across all sites. Bioassay screening indicated that mosquitoes remained susceptible to bendiocarb but were resistance to deltamethrin and DDT in all areas. There were significant increases in deltamethrin resistance over the four years, with overall mean percent mortality to deltamethrin declining from 81.0% (95% CI: 77.6-84.3%) in 2011 to 47.7% (95% CI: 43.5-51.8%) in 2014. The rate of increase in phenotypic deltamethrin-resistance was significantly slower in the LLIN + IRS arm than in the LLIN-only arm (Odds ratio 1.34; 95% CI: 1.02-1.77). The frequency of Vgsc-1014F mutation varied spatiotemporally with highest frequencies in Galabat (range 0.375-0.616) and New Halfa (range 0.241-0.447). Deltamethrin phenotypic-resistance correlated with Vgsc-1014F frequency.

    CONCLUSION: Combining LLIN and IRS, with different classes of insecticide, may delay pyrethroid resistance development, but the speed at which resistance develops may be area-specific. Continued monitoring is vital to ensure optimal management and control.

  10. Alishaq M, Al Ajmi JA, Shaheen M, Elgendy M, Vinoy S, Thomas AG, et al.
    PLoS One, 2023;18(10):e0291989.
    PMID: 37792687 DOI: 10.1371/journal.pone.0291989
    BACKGROUND: There is debate over whether physical attendance at school affects the spread of the SARS-CoV-2 pandemic.

    METHODS: A cohort of personnel from several schools in Qatar provided nasopharyngeal swabs (NPS) for SARS-CoV-2 RT-PCR and rapid antigen testing. Each of them was monitored for infection until February 2022.

    RESULTS: In total, 3,241 employees gave samples for analysis. Prior to the start of the 2020-2021 academic year (Group I), 3.49% of samples tested positive for SARS-CoV-2. Most of the positive PCR results were from male, senior, non-teaching staff members. Only 110 (3.39%) employees who had enrolled in face-to-face instruction before the B.1.1.7 variant's emergence (Group II), 238 (7.34%) after the B.1.1.7 variant's emergence (Group III), and 410 (12.65%) after the introduction of the Omicron variant (Group IV) had reported infection by PCR test. Most people who tested positive by PCR after enrolling in school were young, female teachers. In the Cox Proportional-Hazards Model, exposure to a confirmed case, the presence of symptoms in the two weeks prior to exposure in all groups-young age in Groups II and III, male gender in Groups I and IV, shared housing in Group III, and the presence of comorbidities in Groups II and III independently predicted SARS-CoV-2 infection in school staff.

    CONCLUSION: Critical information about the risk of SARS-CoV-2 infection in school workers during the whole pandemic is provided by our study. School operations in Qatar were made safer through initial and ongoing screenings, as well as widespread vaccination of school personnel.

  11. Makki M, Shafie AA, Awaisu A, Hussain R, Al Hail M, ElMotasim WM, et al.
    Explor Res Clin Soc Pharm, 2024 Dec;16:100517.
    PMID: 39435401 DOI: 10.1016/j.rcsop.2024.100517
    BACKGROUND: The COVID-19 outbreak had significant global healthcare implications, including the use of medications. This is specifically evident in the surge in use of some medication and a decline in the use of others. As a result, some medications end up unused, which may have subsequent health, economic, and environmental impacts.

    AIM: To explore patients' insights into unused medications during the COVID-19 outbreak.

    MATERIALS AND METHODS: Semi-structured interviews were conducted with 30 patients attending various public and private healthcare facilities in Qatar between January and July 2021. A thematic analysis approach was utilized, with 2 researchers independently analyzing, comparing, and discussing the coding. The resulting themes were further discussed in research group meetings until a consensus was reached.

    RESULTS: Seven themes emerged: awareness of unused medications and their impacts on health, economy, and the environment; barriers contributing to nonadherence/unused medications; sources of medications; factors facilitating medication use; patients' behaviors toward donated medications/reuse; patients' awareness of medication storage requirements; and patients' desire to appropriately dispose of unused medications.

    CONCLUSION: The COVID-19 outbreak disrupted medication supply and adherence, resulting in an increase in unused medications and inappropriate disposal. Adherence is crucial for improving patients' health and preserving medications. Implementing mail-return systems for unused medications could be a viable solution during disease outbreaks.

  12. Cale EM, Gorman J, Radakovich NA, Crooks ET, Osawa K, Tong T, et al.
    Immunity, 2017 05 16;46(5):777-791.e10.
    PMID: 28514685 DOI: 10.1016/j.immuni.2017.04.011
    Most HIV-1-specific neutralizing antibodies isolated to date exhibit unusual characteristics that complicate their elicitation. Neutralizing antibodies that target the V1V2 apex of the HIV-1 envelope (Env) trimer feature unusually long protruding loops, which enable them to penetrate the HIV-1 glycan shield. As antibodies with loops of requisite length are created through uncommon recombination events, an alternative mode of apex binding has been sought. Here, we isolated a lineage of Env apex-directed neutralizing antibodies, N90-VRC38.01-11, by using virus-like particles and conformationally stabilized Env trimers as B cell probes. A crystal structure of N90-VRC38.01 with a scaffolded V1V2 revealed a binding mode involving side-chain-to-side-chain interactions that reduced the distance the antibody loop must traverse the glycan shield, thereby facilitating V1V2 binding via a non-protruding loop. The N90-VRC38 lineage thus identifies a solution for V1V2-apex binding that provides a more conventional B cell pathway for vaccine design.
  13. Kafy HT, Ismail BA, Mnzava AP, Lines J, Abdin MSE, Eltaher JS, et al.
    Proc Natl Acad Sci U S A, 2017 12 26;114(52):E11267-E11275.
    PMID: 29229808 DOI: 10.1073/pnas.1713814114
    Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.
  14. Makki M, Akmal Shafie A, Awaisu A, Hussain R, Al Hail M, ElMotasim WM, et al.
    Heliyon, 2024 Jun 30;10(12):e31931.
    PMID: 39015807 DOI: 10.1016/j.heliyon.2024.e31931
    BACKGROUND: Global evidence has linked unused medications and their inappropriate disposal to adverse health, economic, environmental, and ethical impacts. However, such evidence is scarce in Qatar. This study explored patients' knowledge and attitude toward unused medications and their practices toward medication supply and disposal (KAP) in Qatar.Materials and methods.

    STUDY DESIGN: A cross-sectional survey using a pretested questionnaire was performed between February 2020 and October 2020. Descriptive statistics, Man Whitney U, and Kruskal-Wallis Rank-Sum tests were applied. The Chi square test assessed the association between socio-demographic characteristics and KAP scores. Characteristics that were found significantly associated with KAP (i.e., p-values <0.05) were further included as predictor variables in the multiple linear regression model.

    RESULTS: All items pertaining to patients' knowledge were found to be good (mean score > 3), except for "awareness of unwanted medication return policy" (mean score < 3), i.e., the lowest level of patient agreement (31 %) (median (M) = 3, Interquartile Range (IQR) = 3). Their attitude was generally good (mean score > 3). Conversely, their practice toward medication supply was poor (mean score < 3). Possible future use was the most reported reason (79 %) for keeping medications at home, and home trash was the most widely disposing place of unused ones (76 %). Knowledge was significantly higher among non-laborers and other occupations than among patients with no work (p 

  15. Vilizzi L, Copp GH, Hill JE, Adamovich B, Aislabie L, Akin D, et al.
    Sci Total Environ, 2021 Sep 20;788:147868.
    PMID: 34134389 DOI: 10.1016/j.scitotenv.2021.147868
    The threat posed by invasive non-native species worldwide requires a global approach to identify which introduced species are likely to pose an elevated risk of impact to native species and ecosystems. To inform policy, stakeholders and management decisions on global threats to aquatic ecosystems, 195 assessors representing 120 risk assessment areas across all six inhabited continents screened 819 non-native species from 15 groups of aquatic organisms (freshwater, brackish, marine plants and animals) using the Aquatic Species Invasiveness Screening Kit. This multi-lingual decision-support tool for the risk screening of aquatic organisms provides assessors with risk scores for a species under current and future climate change conditions that, following a statistically based calibration, permits the accurate classification of species into high-, medium- and low-risk categories under current and predicted climate conditions. The 1730 screenings undertaken encompassed wide geographical areas (regions, political entities, parts thereof, water bodies, river basins, lake drainage basins, and marine regions), which permitted thresholds to be identified for almost all aquatic organismal groups screened as well as for tropical, temperate and continental climate classes, and for tropical and temperate marine ecoregions. In total, 33 species were identified as posing a 'very high risk' of being or becoming invasive, and the scores of several of these species under current climate increased under future climate conditions, primarily due to their wide thermal tolerances. The risk thresholds determined for taxonomic groups and climate zones provide a basis against which area-specific or climate-based calibrated thresholds may be interpreted. In turn, the risk rankings help decision-makers identify which species require an immediate 'rapid' management action (e.g. eradication, control) to avoid or mitigate adverse impacts, which require a full risk assessment, and which are to be restricted or banned with regard to importation and/or sale as ornamental or aquarium/fishery enhancement.
  16. Thomas B, Matsushita K, Abate KH, Al-Aly Z, Ärnlöv J, Asayama K, et al.
    J Am Soc Nephrol, 2017 Jul;28(7):2167-2179.
    PMID: 28408440 DOI: 10.1681/ASN.2016050562
    The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.
  17. Global Burden of Disease Child and Adolescent Health Collaboration, Kassebaum N, Kyu HH, Zoeckler L, Olsen HE, Thomas K, et al.
    JAMA Pediatr, 2017 Jun 01;171(6):573-592.
    PMID: 28384795 DOI: 10.1001/jamapediatrics.2017.0250
    IMPORTANCE: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

    OBJECTIVE: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

    EVIDENCE REVIEW: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

    FINDINGS: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

    CONCLUSIONS AND RELEVANCE: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

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