Theo Vos

Publications (104)569.8 Total impact

• Article: Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010.

  Joshua A Salomon, Haidong Wang, Michael K Freeman, Theo Vos, Abraham D Flaxman, Alan D Lopez, Christopher Jl Murray
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  ABSTRACT: Healthy life expectancy (HALE) summarises mortality and non-fatal outcomes in a single measure of average population health. It has been used to compare health between countries, or to measure changes over time. These comparisons can inform policy questions that depend on how morbidity changes as mortality decreases. We characterise current HALE and changes over the past two decades in 187 countries. Using inputs from the Global Burden of Disease Study (GBD) 2010, we assessed HALE for 1990 and 2010. We calculated HALE with life table methods, incorporating estimates of average health over each age interval. Inputs from GBD 2010 included age-specific information for mortality rates and prevalence of 1160 sequelae, and disability weights associated with 220 distinct health states relating to these sequelae. We computed estimates of average overall health for each age group, adjusting for comorbidity with a Monte Carlo simulation method to capture how multiple morbidities can combine in an individual. We incorporated these estimates in the life table by the Sullivan method to produce HALE estimates for each population defined by sex, country, and year. We estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010. In 2010, global male HALE at birth was 58·3 years (uncertainty interval 56·7-59·8) and global female HALE at birth was 61·8 years (60·1-63·4). HALE increased more slowly than did life expectancy over the past 20 years, with each 1-year increase in life expectancy at birth associated with a 0·8-year increase in HALE. Across countries in 2010, male HALE at birth ranged from 27·9 years (17·3-36·5) in Haiti, to 68·8 years (67·0-70·4) in Japan. Female HALE at birth ranged from 37·1 years (26·9-43·7) in Haiti, to 71·7 years (69·7-73·4) in Japan. Between 1990 and 2010, male HALE increased by 5 years or more in 42 countries compared with 37 countries for female HALE, while male HALE decreased in 21 countries and 11 for female HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. This relation was consistent between sexes, in cross-sectional and longitudinal analysis, and when assessed at birth, or at age 50 years. Changes in disability had small effects on changes in HALE compared with changes in mortality. HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. HALE is an attractive indicator for monitoring health post-2015. The Bill & Melinda Gates Foundation.
  The Lancet 12/2013; 380(9859):2144-62. · 38.28 Impact Factor
• Article: GBD 2010: design, definitions, and metrics.

  Christopher Jl Murray, Majid Ezzati, Abraham D Flaxman, Stephen Lim, Rafael Lozano, Catherine Michaud, Mohsen Naghavi, Joshua A Salomon, Kenji Shibuya, Theo Vos, Daniel Wikler, Alan D Lopez
  The Lancet 12/2013; 380(9859):2063-6. · 38.28 Impact Factor
• Article: GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology.

  Christopher Jl Murray, Majid Ezzati, Abraham D Flaxman, Stephen Lim, Rafael Lozano, Catherine Michaud, Mohsen Naghavi, Joshua A Salomon, Kenji Shibuya, Theo Vos, Alan D Lopez
  The Lancet 12/2013; 380(9859):2055-8. · 38.28 Impact Factor
• Article: The Role of Cost-Effectiveness Analysis in Developing Nutrition Policy.

  Linda J Cobiac, Lennert Veerman, Theo Vos
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  ABSTRACT: Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities. Expected final online publication date for the Annual Review of Nutrition Volume 33 is July 17, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
  Annual Review of Nutrition 04/2013; · 9.45 Impact Factor
• Article: Cost-effectiveness of preventive interventions for depressive disorders: an overview.

  Cathrine Mihalopoulos, Theo Vos
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  ABSTRACT: The last 7 years have seen a growing number of cost-effectiveness studies demonstrating that screening people for signs of depression and the subsequent provision of psychological therapy to prevent the onset of depressive disorder is a cost-effective intervention. Many of the studies have expressed outcomes generically, either as quality-adjusted life-years or disability-adjusted life-years, and reported results well below conventional thresholds of 'value for money.' However, such interventions are still not routinely delivered in many healthcare systems, suggesting a 'translational' gap between evidence and practice. Future research needs to better integrate comprehensive economic evaluation indices into study designs, such as broad assessment of costs and impacts, including non-health impacts, to gain an accurate insight into the broader economic benefits of such interventions. Furthermore, a focus on interventions aimed at children and adolescents, which can demonstrate impact into adulthood, are likely to be highly favourable, both clinically and economically.
  Expert Review of Pharmacoeconomics & Outcomes Research 04/2013; 13(2):237-42.
• Source

  Available from: Rob Carter

  Article: Priority-setting for mental health services.

  Cathrine Mihalopoulos, Rob Carter, Jane Pirkis, Theo Vos
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  ABSTRACT: Background: Economic evaluation of individual interventions can have limited usefulness due to the potential for methodological confounding, particularly for those decision contexts where strategies involving multiple interventions are required. Aims: To introduce readers to different approaches of priority-setting, with a focus on economics-based examples of priority-setting in mental health. Method: A selective review of the priority-setting literature, with particular attention given to the mental health context and economics-based approaches. Results: Six priority-setting approaches in mental health are described and assessed. Conclusions: Priority-setting approaches that incorporate methodological rigour, due process for involving stakeholders and broad-based notions of "benefit", are likely to be of most use to mental healthcare decision-makers. Challenges, both in relation to data bases and method remain, but are within the capacity of the mental health research community to resolve.
  Journal of Mental Health 01/2013; · 1.01 Impact Factor
• Article: The disability adjusted life years due to stroke in South Africa in 2008.

  Melanie Y Bertram, Judith Katzenellenbogen, Theo Vos, Debbie Bradshaw, Karen J Hofman
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  ABSTRACT: BACKGROUND: South Africa is experiencing epidemiological transition, with the burden of chronic diseases increasing. Stroke is currently the second leading cause of death in South Africa; however, limited data are available on incidence, prevalence and resulting disability. Quantifying the epidemiological parameters and disease burden is important in the planning of health services. AIMS: To synthesize the data surrounding stroke in South Africa and calculate disability adjusted life years attributable to stroke in South Africa in 2008. METHODS: We undertook a systematic review to identify studies on the prevalence and mortality of stroke in South Africa. We used the DisMod program to calculate missing epidemiological parameters, in particular incidence and duration. Using these values, we calculated the burden of disease in years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY). RESULTS: Data on prevalence and mortality of stroke in South Africa are scarce. We estimate there are 75 000 strokes in South Africa each year, with 25 000 of these fatal within the first month. The burden of disease due to stroke in South Africa was 564 000 DALYs. Of this, 17% is contributed by YLD (14-20% in sensitivity analysis). CONCLUSIONS: This study provides information on prevalence, incidence and disease burden of stroke at the national level in South Africa. The results of this analysis will enable further work on priority setting and health service planning for primary and secondary prevention of stroke in South Africa.
  International Journal of Stroke 01/2013; · 2.38 Impact Factor
• Article: Cost-Effectiveness of Interventions for Reducing Road Traffic Injuries Related to Driving under the Influence of Alcohol.

  Vallop Ditsuwan, Jacob Lennert Veerman, Melanie Bertram, Theo Vos
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  ABSTRACT: To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand. We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective. Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect. A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.
  Value in Health 01/2013; 16(1):23-30. · 2.19 Impact Factor
• Article: Disability weights for vision disorders in Global Burden of Disease study - Authors' reply.

  Joshua A Salomon, Theo Vos, Christopher Jl Murray
  The Lancet 12/2012; · 38.28 Impact Factor
• Article: Cost-Effectiveness of Nutrition Interventions for Prevention of Noncommunicable Diseases

  Linda Cobiac, Lennert Veerman, Theo Vos
  09/2012;
• Article: Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study.

  Alize J Ferrari, Sukanta Saha, John J McGrath, Rosana Norman, Amanda J Baxter, Theo Vos, Harvey A Whiteford
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  ABSTRACT: A comprehensive revision of the Global Burden of Disease (GBD) study is expected to be completed in 2012. This study utilizes a broad range of improved methods for assessing burden, including closer attention to empirically derived estimates of disability. The aim of this paper is to describe how GBD health states were derived for schizophrenia and bipolar disorder. These will be used in deriving health state-specific disability estimates. A literature review was first conducted to settle on a parsimonious set of health states for schizophrenia and bipolar disorder. A second review was conducted to investigate the proportion of schizophrenia and bipolar disorder cases experiencing these health states. These were pooled using a quality-effects model to estimate the overall proportion of cases in each state. The two schizophrenia health states were acute (predominantly positive symptoms) and residual (predominantly negative symptoms). The three bipolar disorder health states were depressive, manic, and residual. Based on estimates from six studies, 63% (38%-82%) of schizophrenia cases were in an acute state and 37% (18%-62%) were in a residual state. Another six studies were identified from which 23% (10%-39%) of bipolar disorder cases were in a manic state, 27% (11%-47%) were in a depressive state, and 50% (30%-70%) were in a residual state. This literature review revealed salient gaps in the literature that need to be addressed in future research. The pooled estimates are indicative only and more data are required to generate more definitive estimates. That said, rather than deriving burden estimates that fail to capture the changes in disability within schizophrenia and bipolar disorder, the derived proportions and their wide uncertainty intervals will be used in deriving disability estimates.
  Population Health Metrics 08/2012; 10(1):16. · 2.11 Impact Factor
• Article: Improving the cost-effectiveness of cardiovascular disease prevention in Australia: a modelling study.

  Linda J Cobiac, Anne Magnus, Jan J Barendregt, Rob Carter, Theo Vos
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  ABSTRACT: BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Like many countries, Australia is currently changing its guidelines for cardiovascular disease prevention from drug treatment for everyone with 'high blood pressure' or 'high cholesterol', to prevention based on a patient's absolute risk. In this research, we model cost-effectiveness of cardiovascular disease prevention with blood pressure and lipid drugs in Australia under three different scenarios: (1) the true current practice in Australia; (2) prevention as intended under the current guidelines; and (3) prevention according to proposed absolute risk levels. We consider the implications of changing to absolute risk-based cardiovascular disease prevention, for the health of the Australian people and for Government health sector expenditure over the long term. METHODS: We evaluate cost-effectiveness of statins, diuretics, ACE inhibitors, calcium channel blockers and beta-blockers, for Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Epidemiological changes and health care costs are simulated by age and sex in a discrete time Markov model, to determine total impacts on population health and health sector costs over the lifetime, from which we derive cost-effectiveness ratios in 2008 Australian dollars per quality-adjusted life year. RESULTS: Cardiovascular disease prevention based on absolute risk is more cost-effective than prevention under the current guidelines based on single risk factor thresholds, and is more cost-effective than the current practice, which does not follow current clinical guidelines. Recommending blood pressure-lowering drugs to everyone with at least 5% absolute risk and statin drugs to everyone with at least 10% absolute risk, can achieve current levels of population health, while saving $5.4 billion for the Australian Government over the lifetime of the population. But savings could be as high as $7.1 billion if Australia could match the cheaper price of statin drugs in New Zealand. CONCLUSIONS: Changing to absolute risk-based cardiovascular disease prevention is highly recommended for reducing health sector spending, but the Australian Government must also consider measures to reduce the cost of statin drugs, over and above the legislated price cuts of November 2010.
  BMC Public Health 06/2012; 12(1):398. · 2.00 Impact Factor
• Article: Cost-effectiveness of extending the coverage of water supply fluoridation for the prevention of dental caries in Australia.

  Linda J Cobiac, Theo Vos
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  ABSTRACT: Fluoride was first added to the Australian water supply in 1953, and by 2003, 69% of Australia's population was receiving the minimum recommended dose. Extending coverage of fluoridation to all remaining communities of at least 1000 people is a key strategy of Australia's National Oral Health Plan 2004-2013. We evaluate the cost-effectiveness of this strategy from an Australian health sector perspective. Health gains from the prevention of caries in the Australian population are modelled over the average 15-year lifespan of a treatment plant. Taking capital and on-going operational costs of fluoridation into account, as well as costs of caries treatment, we determine the dollars per disability-adjusted life years (DALY) averted from extending coverage of fluoridation to all large (≥ 1000 people) and small (<1000 people) communities in Australia. Extending coverage of fluoridation to all communities of at least 1000 people will lead to improved population health (3700 DALYs, 95% uncertainty interval: 2200-5700 DALYs), with a dominant cost-effectiveness ratio and 100% probability of cost-savings. Extending coverage to smaller communities leads to 60% more health gains, but is not cost-effective, with a median cost-effectiveness ratio of A$92 000/DALY and only 10% probability of being under a cost-effectiveness threshold of A$50 000/DALY. Extension of fluoridation coverage under the National Oral Health Plan is highly recommended, but given the substantial dental health disparities and inequalities in access to dental care that currently exist for more regional and remote communities, there may be good justification for extending coverage to include all Australians, regardless of where they live, despite less favourable cost-effectiveness.
  Community Dentistry And Oral Epidemiology 03/2012; 40(4):369-76. · 1.89 Impact Factor
• Article: The population cost-effectiveness of interventions designed to prevent childhood depression.

  Cathrine Mihalopoulos, Theo Vos, Jane Pirkis, Rob Carter
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  ABSTRACT: Depression in childhood and adolescence is common and often persists into adulthood. This study assessed the population-level cost-effectiveness of a preventive intervention that screens children and adolescents for symptoms of depression in schools and the subsequent provision of a psychological intervention to those showing elevated signs of depression. The target population for screening comprised 11- to 17-year-old children and adolescents in the 2003 Australian population. Economic modeling techniques were used to assess the incremental cost-effectiveness of the intervention compared with no intervention. The perspective was that of the health sector, and outcomes were measured by using disability-adjusted life-years (DALYs). Multivariate probabilistic and univariate sensitivity testing was applied to quantify variations in the model parameters. The modeled psychological intervention had an incremental cost-effectiveness ratio of $5400 per DALY averted, with just 2% of iterations falling above a $50 000 per DALY value-for-money threshold. Results were robust to model assumptions. After school screening, screening and the psychological intervention represent good value-for-money. Such an intervention needs to be seriously considered in any national package of preventive health services. Acceptability issues, particularly to intervention providers, including schools and mental health professionals, need to be considered before wide-scale adoption.
  PEDIATRICS 03/2012; 129(3):e723-30. · 4.47 Impact Factor
• Article: Economic burden of schizophrenia: empirical analyses from a survey in Thailand.

  Pudtan Phanthunane, Harvey Whiteford, Theo Vos, Melanie Bertram
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  ABSTRACT: Evidence consistently indicates that schizophrenia is a costly disease although it is not a high prevalence disorder. There are a few studies in developing countries but no study in Thailand reporting the cost of schizophrenia from a societal perspective. Health policy makers need to be aware of the cost of health care for people with schizophrenia as well as the economic burden on patients and families. This study aims to provide a detailed breakdown of the costs attributed to schizophrenia including the consumption of public health care resources by people with schizophrenia and the negative consequences on patients and families due to productivity losses. Data from a survey conducted in 2008 among people in treatment for schizophrenia were used to estimate annual medical costs for treatment including outpatient services, hospitalization and patient travel. Indirect costs were estimated for reported productivity losses of patients and families. Uncertainty analysis was performed using Monte Carlo simulation methods. We tested the sensitivity of varying assumptions about market wages to estimate productivity losses. All cost estimates are adjusted to 2008 using the Consumer Price Index and reported in Thai baht (THB). The average annual exchange rate of Thai baths to one US dollar was 33.5 in 2008. The annual overall cost of schizophrenia was estimated to be THB 87 000 (USD 2600) (95% CI: 83 000, 92 000) per person or THB 31 000 million (USD 925 million) (95% CI: 26 000, 37 000) for the entire population with schizophrenia in Thailand. Indirect costs due to high unemployment, absenteeism and presenteeism of patients and families accounted for 61% of the total economic burden of schizophrenia. The largest component of direct medical cost was for hospitalizations (50%), followed by outpatient services and drug costs. Sensitivity analyses suggest that using labor force survey and socioeconomic status survey provided similar results, while lost productivity when the minimum wage was used was significantly less. Productivity loss due to unemployment is the major contributor to the cost of schizophrenia. Due to data unavailability we did not include intangible costs (e.g. costs associated with pain and suffering or impact on quality of life) and direct non-health care costs (e.g. costs related to law enforcement and the criminal justice system). The survey sample is representative of only people who were in contact with mental health services and is not necessarily representative of all people with schizophrenia. In priority setting it is important that policy makers are aware of the high direct and indirect costs of schizophrenia. Providing optimal treatment (e.g. medication in combination with psychosocial interventions) could reduce some costs such has hospitalization but this may require increased investment in mental health care and time spent by patients and caregivers.
  The Journal of Mental Health Policy and Economics 03/2012; 15(1):25-32. · 0.97 Impact Factor
• Article: Joint prevalence and control of hypercholesterolemia and hypertension in Thailand: third national health examination survey.

  Panrasri Khonputsa, J Lennert Veerman, Theo Vos, Wichai Aekplakorn, Melanie Bertram, Jesse Abbott-Klafter, Margaret C Hogan, Stephen S Lim
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  ABSTRACT: The prevalence, diagnosis, treatment, and control of hypercholesterolemia and/or hypertension were estimated for Thailand using data from a recent, nationally representative health examination survey. Multivariate logistic regression was used to assess factors associated with diagnosis, treatment, and control. In all, 14% of men and 17% of women had hypercholesterolemia, 23% and 21% had hypertension, and 5% and 6%, respectively, had both. A large proportion of individuals with these risk factors is neither diagnosed nor treated, let alone adequately controlled; 30% of people with hypertension had been diagnosed and 24% treated, and 9% had their blood pressure controlled. The figures for hypercholesterolemia were 13%, 9%, and 6%, respectively. Those for both risk factors combined were below 15% and did not differ by sex, urbanicity, age, or marital status. Among men, education correlated with diagnosis and treatment odds. There is great scope for improved prevention of cardiovascular disease in Thailand.
  Asia-Pacific Journal of Public Health 01/2012; 24(1):185-94. · 1.06 Impact Factor
• Source

  Available from: Rob Carter

  Article: Which interventions offer best value for money in primary prevention of cardiovascular disease?

  Linda J Cobiac, Anne Magnus, Stephen Lim, Jan J Barendregt, Rob Carter, Theo Vos
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  ABSTRACT: Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease. In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit. There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.
  PLoS ONE 01/2012; 7(7):e41842. · 4.09 Impact Factor
• Article: Characteristics, availability and uses of vital registration and other mortality data sources in post-democracy South Africa.

  Jané Joubert, Chalapati Rao, Debbie Bradshaw, Rob E Dorrington, Theo Vos, Alan D Lopez
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  ABSTRACT: The value of good-quality mortality data for public health is widely acknowledged. While effective civil registration systems remains the 'gold standard' source for continuous mortality measurement, less than 25% of deaths are registered in most African countries. Alternative data collection systems can provide mortality data to complement those from civil registration, given an understanding of data source characteristics and data quality. We aim to document mortality data sources in post-democracy South Africa; to report on availability, limitations, strengths, and possible complementary uses of the data; and to make recommendations for improved data for mortality measurement. Civil registration and alternative mortality data collection systems, data availability, and complementary uses were assessed by reviewing blank questionnaires, death notification forms, death data capture sheets, and patient cards; legislation; electronic data archives and databases; and related information in scientific journals, research reports, statistical releases, government reports and books. Recent transformation has enhanced civil registration and official mortality data availability. Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and a number of national surveys, mortality audits, and disease notification programmes. Child and adult mortality items were found in all national data sources, and maternal mortality items in most. Detailed cause-of-death data are available from civil registration and demographic surveillance. In a continent often reported as lacking the basic data to infer levels, patterns and trends of mortality, there is evidence of substantial improvement in South Africa in the availability of data for mortality assessment. Mortality data sources are many and varied, providing opportunity for comparing results and improved public health planning. However, more can and must be done to improve mortality measurement by improving data quality, triangulating data, and expanding analytic capacity. Cause data, in particular, must be improved.
  Global Health Action 01/2012; 5:1-19. · 1.27 Impact Factor
• Source

  Available from: Jacob Lennert Veerman

  Article: Sobriety Checkpoints in Thailand: A Review of Effectiveness and Developments Over Time.

  Vallop Ditsuwan, J Lennert Veerman, Melanie Bertram, Theo Vos
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  ABSTRACT: This review describes the legal basis for and implementation of sobriety checkpoints in Thailand and identifies factors that influenced their historical development and effectiveness. The first alcohol and traffic injury control law in Thailand was implemented in 1934. The 0.05 g/100 mL blood alcohol concentration limit was set in 1994. Currently, 3 types of sobriety checkpoints are used: general police checkpoints, selective breath testing, and special event sobriety checkpoints. The authors found few reports on the strategies, frequencies, and outcomes for any of these types of checkpoints, despite Thailand having devoted many resources to their implementation. In Thailand and other low-middle income countries, it is necessary to address the country-specific barriers to successful enforcement (including political and logistical issues, lack of equipment, and absence of other supportive alcohol harm reduction measures) before sobriety checkpoints can be expected to be as effective as reported in high-income countries.
  Asia-Pacific Journal of Public Health 12/2011; · 1.06 Impact Factor
• Article: Television viewing time and reduced life expectancy: a life table analysis.

  J Lennert Veerman, Genevieve N Healy, Linda J Cobiac, Theo Vos, Elisabeth A H Winkler, Neville Owen, David W Dunstan
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  ABSTRACT: BACKGROUND: Prolonged television (TV) viewing time is unfavourably associated with mortality outcomes, particularly for cardiovascular disease, but the impact on life expectancy has not been quantified. The authors estimate the extent to which TV viewing time reduces life expectancy in Australia, 2008. METHODS: The authors constructed a life table model that incorporates a previously reported mortality risk associated with TV time. Data were from the Australian Bureau of Statistics and the Australian Diabetes, Obesity and Lifestyle Study, a national population-based observational survey that started in 1999-2000. The authors modelled impacts of changes in population average TV viewing time on life expectancy at birth. RESULTS: The amount of TV viewed in Australia in 2008 reduced life expectancy at birth by 1.8 years (95% uncertainty interval (UI): 8.4 days to 3.7 years) for men and 1.5 years (95% UI: 6.8 days to 3.1 years) for women. Compared with persons who watch no TV, those who spend a lifetime average of 6 h/day watching TV can expect to live 4.8 years (95% UI: 11 days to 10.4 years) less. On average, every single hour of TV viewed after the age of 25 reduces the viewer's life expectancy by 21.8 (95% UI: 0.3-44.7) min. This study is limited by the low precision with which the relationship between TV viewing time and mortality is currently known. CONCLUSIONS: TV viewing time may be associated with a loss of life that is comparable to other major chronic disease risk factors such as physical inactivity and obesity.
  British journal of sports medicine 08/2011; · 2.55 Impact Factor