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The increasing stroke burden in the world strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new effective primary prevention strategies with larger effect size are needed. In this article, we reviewed the latest stroke epidemiology literature with the emphasis on the recent Global Burden of Disease 2013 Study stroke burden estimates from 1990 to 2013, highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies, and outline new developments in primary stroke and CVD prevention. We also suggested key priorities for the future, including comprehensive prevention strategies that target people with all levels of CVD risk, implementation of an integrated approach to promote health behaviors and reduce health disparities, capitalizing on information technology to advance prevention approaches and techniques, and incorporation of culturally appropriate education about healthy lifestyle into standard education curricula early in life. Given the already immense and fast increasing burden of stroke and other major noncommunicable diseases (NCDs) which threatens worldwide sustainability, governments could develop and implement an emergency action plan addressing the primary prevention of NCDs.

BACKGROUND AND PURPOSE: Prediction of stroke impact provides essential information for healthcare planning and priority setting. We aim to estimate 30-year projections of stroke epidemiology in the European Union using multiple modeling approaches. METHODS: Data on stroke incidence, prevalence, deaths, and disability-adjusted life years in the European Union between 1990 and 2017 were obtained from the global burden of disease study. Their trends over time were modeled using 3 modeling strategies: linear, Poisson, and exponential regressions-adjusted for the gross domestic product per capita, which reflects the impact of economic development on health status. We used the Akaike information criterion for model selection. The 30-year projections up to 2047 were estimated using the best fitting models, with inputs on population projections from the United Nations and gross domestic product per capita prospects from the World Bank. The technique was applied separately by age-sex-country groups for each stroke measure. RESULTS: In 2017, there were 1.12 million incident strokes in the European Union, 9.53 million stroke survivors, 0.46 million deaths, and 7.06 million disability-adjusted life years lost because of stroke. By 2047, we estimated an additional 40 000 incident strokes (+3%) and 2.58 million prevalent cases (+27%). Conversely, 80 000 fewer deaths (-17%) and 2.31 million fewer disability-adjusted life years lost (-33%) are projected. The largest increase in the age-adjusted incidence and prevalence rates are expected in Lithuania (average annual percentage change, 0.48% and 0.7% respectively), and the greatest reductions in Portugal (-1.57% and -1.3%). Average annual percentage change in mortality rates will range from -2.86% (Estonia) to -0.08% (Lithuania), and disability-adjusted life years' from -2.77% (Estonia) to -0.23% (Romania). CONCLUSIONS: The number of people living with stroke is estimated to increase by 27% between 2017 and 2047 in the European Union, mainly because of population ageing and improved survival rates. Variations are expected to persist between countries showing opportunities for improvements in prevention and case management particularly in Eastern Europe.

BACKGROUND AND PURPOSE: Prediction of stroke impact provides essential information for healthcare planning and priority setting. We aim to estimate 30-year projections of stroke epidemiology in the European Union using multiple modeling approaches. METHODS: Data on stroke incidence, prevalence, deaths, and disability-adjusted life years in the European Union between 1990 and 2017 were obtained from the global burden of disease study. Their trends over time were modeled using 3 modeling strategies: linear, Poisson, and exponential regressions―adjusted for the gross domestic product per capita, which reflects the impact of economic development on health status. We used the Akaike information criterion for model selection. The 30-year projections up to 2047 were estimated using the best fitting models, with inputs on population projections from the United Nations and gross domestic product per capita prospects from the World Bank. The technique was applied separately by age-sex-country groups for each stroke measure. RESULTS: In 2017, there were 1.12 million incident strokes in the European Union, 9.53 million stroke survivors, 0.46 million deaths, and 7.06 million disability-adjusted life years lost because of stroke. By 2047, we estimated an additional 40 000 incident strokes (+3%) and 2.58 million prevalent cases (+27%). Conversely, 80 000 fewer deaths (–17%) and 2.31 million fewer disability-adjusted life years lost (–33%) are projected. The largest increase in the age-adjusted incidence and prevalence rates are expected in Lithuania (average annual percentage change, 0.48% and 0.7% respectively), and the greatest reductions in Portugal (–1.57% and –1.3%). Average annual percentage change in mortality rates will range from −2.86% (Estonia) to −0.08% (Lithuania), and disability-adjusted life years' from −2.77% (Estonia) to −0.23% (Romania). CONCLUSIONS: The number of people living with stroke is estimated to increase by 27% between 2017 and 2047 in the European Union, mainly because of population ageing and ...

Noncommunicable diseases (NCD) now account for more than one-half of the global burden of disease. Cardiovascular diseases account for about one-half of NCD deaths, and the majority of cardiovascular disease deaths occur in low- and middle-income countries. The GBD (Global Burden of Disease) study measures and benchmarks health loss from death or disability from more than 300 diseases in over 100 countries. According to GBD analyses, the rise of NCD is in part due to increased life expectancy due to reduced premature mortality from communicable, child, and maternal illnesses, but preventable risk factors also contribute and present targets for NCD control efforts. In addition to traditional NCD risk factors, like tobacco smoking, high blood pressure, and unhealthful diet, nontraditional risk factors like air pollution and unhealthful alcohol consumption also play a role. The GBD study continues to grow by gathering more data from country partners than ever before, and by measuring health at the national and subnational levels and in smaller time increments. The GBD study will continue to provide the data to set priorities for and measure progress in the global effort to control the rising burden of NCD.HighlightsNoncommunicable diseases (NCD), including cardiovascular diseases, account for the majority of the potentially preventable disease burden worldwide.National governments and international organizations have committed themselves to NCD risk factor control and mortality reduction goals for the year 2025.The GBD (Global Burden of Disease) is an ongoing study that systematically and comprehensively estimates health loss from more than 300 diseases in >100 countries worldwide.As global health promotion shifts focus to NCD, the GBD study will highlight high-priority prevention opportunities and monitor progress in NCD control.

Prior to the end of the Cold War, the word 'democracy' was rarely used by international lawyers. Few international organisations supported democratic governance, and the criteria for recognition of governments took little account of whether regimes enjoyed a popular mandate. But the events of 1989-1991 profoundly shook old assumptions. Democratic Governance and International Law attempts to assess international law's new-found interest in fostering transitions to democracy. Is an entitlement to democratic government now emerging in international law? If so, what are its normative foundations? How have global and regional organisations encouraged transitions to democracy, and are their efforts consistent with their constitutional frameworks? How should international law react to elections in which profoundly anti-democratic parties win the vote? In this volume, leading legal scholars grapple with these and other questions to assess the future of international law on this most domestic of questions

"How do treaties function in the American legal system? This book provides a comprehensive analysis of the current status of treaties in American law. Its ten chapters examine major areas of change in treaty law in recent decades, including treaty interpretation, federalism, self-execution, treaty implementing legislation, treaty form, and judicial barriers to treaty enforcement. The book also includes two in-depth case studies: one on the effectiveness of treaties in the regulation of armed conflict and one on the role of a resurgent federalism in complicating US efforts to ratify and implement treaties in private international law. Each chapter asks whether the treaty rules of the 1987 Third Restatement of Foreign Relations Law accurately reflect today's judicial, executive, and legislative practices. This volume is original and provocative, a useful desk companion for judges and practicing lawyers, and an engaging read for the general reader and graduate students"--

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.