The Global Burden of Disease: Generating Evidence, Guiding Policy
Abstract
The Global Burden of Disease (GBD) approach is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geography for specific points in time. Box 1 describes the history of GBD. The latest iteration of that effort, the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), was published in The Lancet in December 2012. The intent is to create a global public good that will be useful for informing the design of health systems and the creation of public health policy. It estimates premature death and disability due to 291 diseases and injuries, 1,160 sequelae (direct consequences of disease and injury), and 67 risk factors for 20 age groups and both sexes in 1990, 2005, and 2010. GBD 2010 produced estimates for 187 countries and 21 regions. In total, the study generated over 1 billion estimates of health outcomes.
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For exploring the impact of environmental regulation policies on environmental pollution and public health, the measurement model for the effect of environmental regulation policies is constructed by utilizing the quantitative analysis of China's environmental regulation policies from the two dimensions of policy attribute intensity and policy content intensity, based on the 976 environmental regulation policies in China from 1978 to 2013. This paper introduces the method of intermediary effect test to analyze the environmental health economics, to examine the mediating effect of environmental pollution on environmental regulation policies and public health. The results show that environmental regulation policies can promote public health; China's general environmental regulation policies had a positive effect to a certain extent on the prevention and control of environmental pollution; Preventing pollution policies contribute to public health through significantly partial mediating effect of environmental pollution. This study examines the three-dimensional dynamic relationship of "policy-environment-health" based on the quantitative perspective of the general environmental regulation policies literature, trying to clarify the impact of environmental regulation policies, environmental pollution and public health factors transmission path, which show the theoretical value for the evaluation of environmental regulation policy effect, the protection of environmental quality and the sustainable improvement of public health. © 2018, Editorial Board of Journal of Systems Engineering Society of China. All right reserved.
... [3] DALYs are the summation of the years lived in an imperfect state of health with illness or injury and the years of life lost due to it. [4] The DALY Rate is defined as DALYs per 100,000 population. [4] This article aims to identify a set of evidencebased interventions that address the high risk factors of mental health in India and reduce the burden to zero (as measured by DALY). ...
... [4] The DALY Rate is defined as DALYs per 100,000 population. [4] This article aims to identify a set of evidencebased interventions that address the high risk factors of mental health in India and reduce the burden to zero (as measured by DALY). ...
In 2017, in India, 197.3 million people were estimated to have mental illnesses with a disability‐adjusted life years (DALYs) rate of 2,443. A treatment gap of over 80% exacerbates the high burden of disease. The review article identifies the varied risk factors that lead to poor mental health to determine the interventions needed. Through a careful survey of literature and consultation with experts, the authors then go on to ascertain the interventions required to address these risk factors across the dimensions of resilience, reduce, recognise and recovery, from the five domains of social determinants of health, public health, primary care, hospital care and long‐term care. The simulation exercise that follows, quantifies the impact of these interventions. There are two sets of interventions. One set is readily implementable and has the potential to reduce the disease burden from a projected 2040 DALY Rate of 3300 to 600, with improvements in social determinants contributing significantly. The second set has the potential to reduce the burden further, even to zero, and requires deeper policy change at the national level.
... The WHO South-East Asia Region is home to an estimated 39 million people with chronic HBV and an estimated 10 million people with HCV [1]. An estimated 410,000 people in the region die annually due to viral hepatitis, with chronic complications associated with HBV and HCV accounting for 78% of the total [5]. ...
... Yet, multiple outbreaks of these preventable diseases continue to be reported from across the region. Outbreaks of waterborne and foodborne hepatitis due to hepatitis viruses A and E continue to be reported from countries in the region, and there are an estimated 5416 and 31704 deaths per year attributed to hepatitis A and E, respectively [5]. ...
... Also, the IMR reduced to 41 per 1000 live births in 2015-16 (NFHS-4, 2015-16) against the target of 27 per 1000 live births. At the same time, burden of Non-communicable diseases is continuously increasing and India has highest number of people with the diabetes and hypertension problem (World Bank, 2013)[10]. The dual burden of diseases is putting enhanced pressure on India's stretched public health system. ...
... Also, the IMR reduced to 41 per 1000 live births in 2015-16 (NFHS-4, 2015-16) against the target of 27 per 1000 live births. At the same time, burden of Non-communicable diseases is continuously increasing and India has highest number of people with the diabetes and hypertension problem (World Bank, 2013)[10]. The dual burden of diseases is putting enhanced pressure on India's stretched public health system. ...
Provision of quality, affordable health services, closer to the beneficiaries is very important for ensuring good health of the people. India has made tremendous improvement, in last few decades, on most of the health-related indicators. Despite of this progress, several health challenges still remain in the country. India has missed the targets set, under the framework of MDGs, for reduction in maternal and infant mortality. Also, burden of Non-communicable diseases is continuously increasing and India has highest number of people with the diabetes and hypertension problem. The dual burden of diseases is putting enhanced pressure on India’s stretched public health system. One of the critical challenge faced in the delivery of public health services in the country, is severe shortage of skilled Human Resources. The delivery of public health services cannot be strengthened without ensuring availability of required skilled HR and this shortage has led to decrease in availability and quality of healthcare services and high inequities in utilization of health services.
... ommissioned by the World Bank in the 1990s. That study was done in collaboration with WHO and the Harvard School of Public Health. (Gibson et al., 2013.) It brought to light otherwise hidden or neglected health challenges like mental illness and road injuries, thus having a significant impact on health policy. This study was updated in 2002and 2004. (IHME, 2013 After that, the next comprehensive global burden of disease study was conducted by the Institute for Health Metrics and Evaluation (IHME) in 2012. The study was funded by the Bill & Melinda Gates Foundation and had some methodical changes compared to the original GBD study. Age weighting and discounting of the healthy life years had led ...
... As a result, these were dropped and thus all healthy life years were considered equally valuable. (IHME, 2013.) The latest update of the GBD study was calculated for 2015 (Forouzanfar et al., 2016). ...
Environmental disease burden has been widely studied for several factors. Disease burden studies are many times conducted to support decision makers. There are multiple sources of uncertainties in burden of disease estimates, and understanding the uncertainties, knowing their quantity and reporting them adequately is important to be able to take them into account in decision making and to be able to reduce them.
Air pollution is among the biggest environmental risks globally. In this thesis the aim was to quantify selected uncertainties in the most recent national disease burden estimates for ambient fine particles (PM2.5) in Finland. The uncertainties were selected based on literature. They were quantified separately and then compared, to find the most significant uncertainties.
The focus was set on parametric and model uncertainties. The selected uncertainties were related to the uncertainties in the relative risk and exposure estimates, selection of health endpoints, exposure characterisation and the shape of the concentration response function.
This thesis has been conducted under the Health impacts of air pollution (ISTE) -project at the National institute for health and welfare (THL). The uncertainties were analysed for the ISTE-project’s best estimate for the disease burden of fine particles (PM2.5) which was 20,800 DALY in 2013. The differences caused by the quantified uncertainties were calculated using this estimate as a reference point.
The quantified uncertainties resulted in 13,600 DALY/a and 42,700 DALY/a as a minimum and maximum estimate for the disease burden of fine particles, respectively. The biggest differences from the quantified uncertainties were caused by i) the selection of health endpoints; in this case the use of natural or cause-specific mortality, and ii) the shape of the concentration-response function.
... Geospatial data, including data collected by Earth observation satellites, are among the most important types of data for supporting the three SDG implementation phases [3][4][5]. Village-level data represents the highest resolution of all levels of administration and can provide more specific details about the different socioeconomic and environmental factors affecting SDGs, thus enabling more precise sustainable development decision making [6][7][8][9][10][11][12][13][14]. While village-level socioeconomic data such as census-based demographics are available for some nations, important environmental variables, including vegetation, climate, and terrain, are not yet readily available at such a fine-grained level, hindering sustainable development research and applications [6]. ...
The United Nations Sustainable Development Goals (SDGs) include 17 interlinked goals designed to be a blueprint for the world’s nations to achieve a better and more sustainable future, and the specific SDG 3 is a public health–related goal to ensure healthy living and promote well-being for all population groups. To facilitate SDG planning, implementation, and progress monitoring, many SDG indicators have been developed. Based on the United Nations General Assembly resolutions, SDG indicators need to be disaggregated by geographic locations and thematic environmental and socioeconomic characteristics for achieving the most accurate planning and progress assessment. High-resolution data such as those captured at the village level can provide comparatively more precise insights into the different socioeconomic and environmental factors relevant to SDGs, therefore enabling more effective sustainable development decision-making. Using India as our study area and the child malnutrition indicators stunting, underweight, and wasting as examples of public health–related SDG indicators, we have demonstrated a process to effectively derive environmental variables at the village level from satellite big datasets on a cloud platform for SDG research and applications. Spatial analysis of environmental variables regarding vegetation, climate, and terrain have shown spatial grouping patterns across the entire study area, with each village group having different statistics. Correlation analysis between these environmental variables and stunting, underweight, and wasting indicators show a meaningful relationship between these indicators and vegetation index, land surface temperature, rainfall, elevation, and slope. Identifying the spatial variation patterns of environmental variables at the village level and their correlations with child malnutrition indicators can be an invaluable tool to facilitate a clearer understanding of the causes of child malnutrition and to improve area-specific SDG 3 implementation planning. This analysis can also provide meaningful support in assessing and monitoring SDG implementation progress at the village level by spatially predicting SDG indicators using available socioeconomic and environmental independent variables. The methodology used in this study has the potential to be applied to other similar regions, especially low-to-middle income countries where a high number of children are severely affected by malnutrition, as well as to other environmentally related SDGs, such as Goal 1 (No Poverty) and Goal 2 (Zero Hunger).
... More than 88% of the world' adolescents live in developing countries, including Arab countries, where also 97% of adolescent death cases occur. Mental and behavioral disorders, with depression at the top of the list, contribute to nearly 25% of Arab adolescents' disability (IHME, 2013). Depression projection rates say it is on the rise because of the growing social and political unrest in the Arab region and the significant shortfalls in mental health systems, coupled with several structural determinants, including poverty, poor education quality and unemployment, and changing family environments. ...
Suicide is a global health problem that affects all age groups, yet it remains a particular concern in adolescence where it stands as the third leading cause of death (WHO, 2020). Depression is often implicated as the primary cause of adolescent suicidality (ideation, planning, and attempts) and completed suicide. More than 88% of the world’ adolescents live in developing countries, including Arab countries, where also 97% of adolescent death cases occur. Mental and behavioral disorders, with depression at the top of the list, contribute to nearly 25% of Arab adolescents’ disability (IHME, 2013).
... With a GDP per capita of $300, over half the households live below the poverty line (using the international poverty line of US$ 1.90 per person per day) [22], and about 50% of the national health expenditure is funded from external donors [23,24]. In common many sub-Saharan African (SSA) countries, Malawi is at the intersection of high rates of communicable respiratory diseases (Tuberculosis (TB), pneumonia), and increasing NCRD [25][26][27]. Although Malawi has a well-established TB control programme, only 10-20% of patients presenting at primary healthcare facilities with a persistent cough have TB [28]. ...
Purpose
The aim of this article is to provide a detailed description of the Chikwawa lung health cohort which was established in rural Malawi to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa.
Participants
A total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, mean age was 43.8 (SD:17.8) and mean body mass index (BMI) was 21.6 Kg/m² (SD: 3.46)
Findings to date
The cohort has reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9–15.4), spirometric obstruction (8.7%, 95% CI, 7.0–10.7), and spirometric restriction (34.8%, 95% CI, 31.7–38.0). Additionally, an annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1) has been reported.
Future plans
The ongoing phases of follow-up will determine the annual rate of decline in lung function as measured through spirometry and the development of airflow obstruction and restriction, and relate these to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.
... Health Metrics and Evaluation (IHME) initially applied age weighting factors and discounting of healthy life years depending on age but it was not included in final evaluation after heavy debate. 66 Environmental BoD methods ( Figure 4) can be divided into methods based on relative risk functions (1A and 1B) and unit risk functions (2A and 2B). Methods 1A and 2A can be used when background disease burden data are available for the health outcome. ...
The deliverable will include following topics:
- Air pollution regulations in the EU: An overview
- Air pollution measurement network and modeling: An overview
- Short summary of current Burden of Disease (BoD) studies: An update
- BoD calculation methods for particulate matter: IHME and GBD
- Sources of uncertainties, magnitude and significance on the BoD estimates.
- Future trends in air pollution regulations and expected impact on Non-Ferrous Metal industry
The project was funded by Eurométaux (Proposal No. 2019-1020).
... Depression is estimated to affect 260 million people worldwide and was the fifth leading cause of global disability in 2016 (Vos et al., 2017). In sub-Saharan Africa, it is even the leading cause of disability (Whiteford et al., 2013), and the burden is estimated to increase even further in the decades to come (Metrics & Evaluation, 2013) mainly due to the high risk for non-communicable diseases of this population (Correll et al., 2017). ...
Objectives:
A reason for the lack of interest in physical fitness testing in mental healthcare is limited time among existing staff. This cross-sectional study investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan patients with depression. We also explored practice effects and assessed the minimal detectable change (MDC) and clinical correlates with the 2MWT.
Methods:
This is a cross-sectional study executed in Butabika National Referral Hospital in Kampala, Uganda. Fifty Ugandan patients with depression (15 women; median age = 29.0 years) performed twice a 2MWT, once a 6MWT, and completed the Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18).
Results:
The median (interquartile) 2MWT score on the first and second test were 125.5 (59.2) meters and 131.0 (57.0) meters (p = .28). The intraclass correlation was.96 (95% confidence interval [0.94, 0.98]). The MDC was 23.5 m for men and 23.4 m for women. There was no evidence of a practice effect. Scores on BSI-18 depression, SIMPAQ walking, and SIMPAQ incidental physical activity explained 66.3% of 2MWT score variance.
Conclusion:
The 2MWT is a reliable test, which can be conducted without any special equipment or substantial time demands, to provide a valid assessment of the functional exercise capacity in outpatients with depression.
... Una vez obtenida la lista de causas, realizan la estimación de las tasas de mortalidad ajustadas por edad y sexo, por toda causa y por causa de muerte evitable. Adicionalmente, agruparon los eventos con base en la clasificación de grupo de causas del Estudio de Carga Global de Enfermedad, GBD-2010(IHME, 2010. Asimismo, estimaron los APVP para todas las causas de muerte evitable, a partir de la expectativa de vida de referencia del GBD, 2010. ...
Death is now an inevitable fact, however, life expectancy has changed significantly in time and still in our day it differs widely between human groups. The advancement of health technology has allowed certain causes of death to be controlled, postponed or avoided. Therefore, the objective of this research is to measure the impact of a preventable death cause on demographic variables in the Colombian Caribbean region 1999-2014. To achieve this, the hypothetical method of elimination death causes using life-tables. The results indicate that in this period of study, if deaths from diseases of the circulatory system and external causes of mortality had been avoided, the life expectancy of this population would have been significantly prolonged.
... However, the multivariate analysis suggested obstructed labour remained as single most important associated risk factor of obstetric fistula. We found a strong and highly significant association of obstetric fistula with obstructed labour, which is an important cause of maternal mortality (IHME, 2013;Waaldijk, 1994). The risk of fistula was two and a half times higher among women those experienced obstructed labour during the last pregnancy as compared to those who had normal labour. ...
Context: Obstetric fistula is a serious obstetric and social morbidity among women. Reliable data on incidence and prevalence of obstetric fistula are not available.
Aims: The present study attempted to measure the prevalence of obstetric fistula and evaluate factors associated with it.
Settings and design: Study was conducted in Rajasthan, India. The cross-sectional data were used for estimation of prevalence of obstetric fistula, while the case comparison design was used to identify the risk factors associated with obstetric fistula.
Methods and material: A cross-sectional population-based district level survey covered 41,448 ever married women of age group 15–49 years in 40,052 randomly selected households.
Statistical analysis used: To explore association between various identified demographic, social, economic, service delivery and utilization variables and obstetric fistula, simple and multivariate logistic regression was performed.
Results: The estimated prevalence of obstetric fistula was 4 per 1,000 women. About 85 per cent of the women with fistula were married below 18 years of age, and 48 per cent gave birth to the first child before 20 years of age. The risk of developing obstetric fistula was more than twice among women who experienced obstructed labour, the adjusted odds ratio being 2.21 (95% Confidence Interval (CI) 1.12 −4.80).
Conclusions: Obstructed labour was most prominent obstetric risk factor for obstetric fistula. The other risk factors were early marriage and early child birth. Ironically, obstetric fistula is preventable by improving quality of maternal care and effective emergency obstetric care. Education and communication can play an important role in postponement of early marriages and early child birth.
... Approximately 24% of the causes of ill health in Africa are attributable to the environment, compared to 21.8% for the rest of the world. The top risk factors are household air pollution, sanitation, ambient air pollution, water and occupational risks (World Bank, 2014a). In fact, on a per capita basis, the burden of deaths attributable to the environment is highest in Africa . ...
The costs and benefits of environment and health interventions in Africa
... Dari 291 kondisi dan kausus yang diteliti Global Burden of Diesease pada tahun 2010, low back pain menempati peringkat tertinggi dalam hal disabilitas dan peringkat keenam dalam hal beban secara keseluruhan 3 . Satu dari sepuluh orang di dunia menderita low back pain, yang menjadikannya penyebab disabilitas paling tinggi di dunia 4 .Pada tahun 2017 per bulan Mei, didapatkan angka kunjungan pasien low back pain di Instalasi Rehabilitasi Medik RSUP Dr. Mohammad Hoesin Palembang sebesar 1304 kunjungan. ...
Individu dengan keluhan low back pain sering menunjukkan keengganan untuk beraktivitas seperti biasa yang berujung dapat mengganggu kualitas hidup individu tersebut. Oleh sebab itu, penelitian ini dilakukan untuk mengetahui apakah ada pengaruh dari terapi short wave diathermy (SWD) dan transcutaneous electrical nerve stimulation (TENS) terhadap kejadian kinesiophobia dan pain catastrophizing pada pasien low back pain di Instalasi Rehabilitasi Medik RSUP Dr. Mohammad Hoesin Palembang. Jenis penelitian yang digunakan adalah kuasi eksperimental dengan desain penelitian pretes-postes without control group dengan sampel penelitian adalah semua pasien di Instalasi Rehabilitasi Medik RSUP Dr. Mohammad Hoesin Palembang. Data diambil dari wawancara secara langsung menggunakan kuesioner TSK-17 dan PCS. Uji normalitas data dilakukan dengan metode Saphiro-Wilk dan selanjutnya dianalisa dengan Paired T Test.Dari 25 responden, didapatkan 19 pasien wanita dan 6 pasien pria. Kejadian terbanyak yang didapatkan adalah low back pain kronik(72%). Hasil Paired T Test didapatkan bahwa ada hubungan antara fisioterapi yang dijalani dan TSK (P=0,012), dan ada hubungan antara fisioterapi dan PCS (P=0.046). Dapat disimpulkan bahwa terdapat pengaruh dari short wave diathermy (SWD) dan transcutaneous electrical nerve stimulation (TENS) yang dijalani oleh pasien low back pain di Instalasi Rehabilitasi Medik RSUP Dr. Mohammad Hoesin Palembang terhadap kejadian kinesiophobia dan pain catastrophizing.
... The aging population in many countries is expected to cause a significant growth in the prevalence of ageassociated chronic illnesses, such as lung diseases, heart and coronary conditions, and cancer [13,18]. Chronic illnesses in seniors are therefore considered to pose an increasing burden on health care resources in decades to come [23]. ...
We describe the results from a Norwegian case study of the attitudes of community-dwelling lung patients and health response center personnel toward a telecare service for such a patient group. The telecare service was intended to prevent exasperations in patients and employed a digital self-report application for remote monitoring of patients' health condition. Based on interviews conducted after a service trial of ten weeks, patient and provider-perceived benefits and concerns related to the service are described. Comparing the data from the two stakeholder groups, we highlight key tensions related to patient safety, what it constitutes as a value, and views on how it can be promoted or undermined through telecare. The way potential technology-embedded value biases can fuel patient-provider tensions are also discussed.
Our objective is to inform value-centered design of telecare technology and services by providing an in-depth empirical understanding of relevant value perspectives and tensions.
... Una vez obtenida la lista de causas, realizan la estimación de las tasas de mortalidad ajustadas por edad y sexo, por toda causa y por causa de muerte evitable. Adicionalmente, agruparon los eventos con base en la clasificación de grupo de causas del Estudio de Carga Global de Enfermedad, GBD-2010(IHME, 2010. Asimismo, estimaron los APVP para todas las causas de muerte evitable, a partir de la expectativa de vida de referencia del GBD, 2010. ...
... Recent estimates report about 305,800 babies with SCD are born every year in the word and over two-thirds are in sub-Saharan Africa rising to over 404,200 by 2050 [1,2]. The disease is associated with a high lifetime morbidity and premature mortality [3], as described in the 2013 Global Burden of Disease Study [4]. The age-standardized death rate in sickle cell anemia increased from 1990 to 2013 (median change 28) [5]. ...
Sickle cell nephopathy (SCN) begins early in childhood from failure of urinary concentration
(hyposthenuria), albuminuria to hyperfiltration, hematuria and progression to
falling glomerular filtration to end-stage renal disease and increased mortality. Renal
involvement is more severe in homozygous individuals (HbSS) than in compound heterozygous
patients (HbSC). The pathogenesis of SCN is multifactorial from hypoxia,
acidosis, hemolysis, ischemia-reperfusion injury and albuminuria. The clinical manifestations
depend on whether the main pathology is tubular, glomerular or a mixture of
both abnormalities. This chapter offers a critical review of the recent literature and will
highlight the pathophysiology, epidemiology, clinical manifestations and management
of sickle cell nephropathy with particular focus on the major advance in the early diagnosis.
Learning points: For SCN, the onset of hyperfiltration and albuminuria in infants and
childhood is an opportunity to intervene early. There is no diagnostic markertest capable
of detecting the onset of these changes. Moreover there is no reliable therapeutic agent to
prevent or halt early changes due to SCN. The development of a marker of renal impairment
in SCD such as such as Cystatin C assay if validated may be appropriate for wider
clinical application.
... Deaths from measles and tetanus have declined significantly throughout the region. However HIV/AIDS, malaria, infectious hepatitis and tuberculosis are major contributors to mortality and morbidity in the continent 20,21 . Interventions to counter burdens of disease are best prioritized according to the most cost effective means of limiting morbidity and mortality from the commonest diseases. ...
Gene therapy has made impressive recent progress and has potential for treating a wide range of diseases, many of which are important to Africa. However, as a result of lack of direct public funding and skilled personnel, direct research on gene therapy in Africa is currently limited and resources to support the endeavor are modest. A strength of the technology is that it is based on principles of rational design, and the tools of gene therapy are now highly versatile. For example gene silencing and gene editing may be used to disable viral genes for therapeutic purposes. Gene therapy may thus lead to cure from infections with HIV-1, hepatitis B virus and Ebola virus, which are of significant public health importance in Africa. Although enthusiasm for gene therapy is justified, significant challenges to implementing the technology remain. These include ensuring efficient delivery of therapeutic nucleic acids to target cells, limiting unintended effects, cost and complexity of treatment regimens. Additionally, implementation of effective legislation that will govern gene therapy research will be a challenge. Nevertheless, it is an exciting prospect that gene therapy should soon reach the mainstream of medical management. Participation of African researchers in the exciting developments is currently limited, but their involvement is important to address health problems, develop capacity and enhance economic progress of the continent.
... (5) Zoonotic antibiotic-resistant pathogens such as non-typhoidal Salmonella spp., Campylobacter spp., and enterotoxigenic Escherichia coli can transmit from livestock reservoirs to humans causing gastrointestinal illness, estimated to be responsible for 27 million disability adjusted life years (DALYs) and 30% of all diarrheal DALYs. (6) It is a well-known fact that, in India, livestock sector is playing a significant role in enhancing the socio-economic status and also ensuring food security to residents. According to the 2012 census, India's livestock population was approximately 108.7 million buffaloes, 190.9 million cattle, 65.1 million sheep, 135.2 million goat, 10.3 million pig, and 729.2 million poultry. ...
Intensification of the animal husbandry sector in India has coincided with increased administration of antibiotics in food producing animals for the treatment and prevention of diseases or to promote growth and enhanced productivity. Antibiotics are an important tool for the livestock sector to meet the increased domestic demand of food for the burgeoning human population. The irrational use of antibiotics in food-producing animals has resulted in the occurrence of the residues in milk, meat, eggs etc. and may lead to adverse health effects in consumers. Also there is growing concern that non-prudent use of antibiotics is linked with the escalating emergence of human infections with antibiotic resistant pathogens of zoonotic importance. Regulations controlling the use of antibiotics in human and animal medicine in India are very weak and in initial phases. The aim of this review is to investigate the Indian scenario with regards to the occurrence of antibiotics residues and emergence of antibiotic resistant pathogens from foods of animal origin. Studies conducted in various parts of the country revealed varying concentration of antibiotic residues and varying occurrence of antibiotic resistant pathogens in animals originated food highlighting the need of effective control strategies for combating this potentially serious problem.
... Mental and substance use disorders are the leading cause of years lived with disability in sub-Saharan Africa (SSA), accounting for almost 20% of all disability-associated burden [1]. The burden is estimated to increase even further [2]. The consequences of this rising burden will be devastating and will be worsened by secondary physical health co-morbidities people with mental and substance use disorders are confronted with [3][4][5]. ...
Background
There is a need for interventions to address the escalating mental health burden in sub-Saharan Africa (SSA). Addressing physical health needs should have a central role in reducing the burden and facilitating recovery in people with severe mental illness (SMI). We systematically investigated (1) physical health policies in the current mental health plans, and (2) the routine metabolic screening rates for people with SMI in SSA.
Methods
The Mental Health Atlas and MiNDbank of the World Health Organization were screened for physical health policies in mental health plans. Next, we systematically searched PubMed from inception until February 1st, 2017 for relevant studies on metabolic screening rates in people with SMI in SSA.
Results
The current systematic review shows that in 22 screened plans only 6 made reference to a physical health component or policy. Only the South-African mental health plan reported about routine screening and treatment of physical illness for people with SMI. In 2 South-African studies (n = 431) routine screening was unacceptably low with less than 1% adequately screened for all modifiable metabolic syndrome risk factors.
Conclusions
Our review data clearly show that a physical health policy is yet to be embraced in mental health care systems of most SSA countries. There is a clear need for integrated mental and medical services in SSA. All psychiatric services, including poorly developed community-based primary health care settings should standardly assess the body mass index and waist circumference at initiation of psycho-pharmacotherapy, and afterwards at regular intervals. Optimal monitoring should include assessments of fasting glucose, lipids, cholesterol, and blood pressure. Mental health care providers in SSA countries need to be informed that their roles extend beyond taking care of the mental health of their patients and assume responsibility for the physical health of their patients as well. Policy makers should be made aware that investment in continued medial education and in screening for physical health risks could optimize mental and physical health improvements. The increased physical health needs of people with mental illness should be integrated into the existing Information, Education and Communication public health awareness programs of the World Health Organization.
... It is estimated that by 2020 >80% of the CVD burden globally will be accounted for by low-and middle-income countries (LMIC) [1]. In South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), for example, healthy years lost due to ischemic heart disease and stroke increased by 73 and 54% between 1990 and 2010, respectively, compared with global increases of 30 and 21%, respectively [2]. While there are abundant data on CVD and their risk factors from longitudinal cohort studies in the West, good-quality data from South Asia have been lacking. ...
Purpose of review:
Cardiovascular disease (CVD) is now the leading cause of morbidity and mortality worldwide. Industrialization and economic growth have led to an unprecedented increment in the burden of CVD and their risk factors in less industrialized regions of the world. While there are abundant data on CVD and their risk factors from longitudinal cohort studies done in the West, good-quality data from South Asia are lacking.
Recent findings:
Several multi-institutional, observational, prospective registries, and epidemiologic cohorts in South Asia have been established to systematically evaluate the burden of CVD and their risk factors. The PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP), the Kerala Acute Coronary Syndrome (ACS), and Trivandrum Heart Failure registries have focused on secondary prevention of CVD and performance measurement in both outpatient and inpatient settings, respectively. The Prospective Urban and Rural Epidemiology (PURE), Centre for Cardiometabolic Risk Reduction in South Asia (CARRS), and other epidemiologic and genetic studies have focused on primary prevention of CVD and evaluated variables such as environment, smoking, physical activity, health systems, food and nutrition policy, dietary consumption patterns, socioeconomic factors, and healthy neighborhoods. The international cardiovascular community has been responsive to a burgeoning cardiovascular disease burden in South Asia. Several collaborations have formed between the West (North America in particular) and South Asia to catalyze evidence-based and data-driven changes in the federal health policy in this part of the world to promote cardiovascular health and mitigate cardiovascular risk.
... According to the Global Atmosphere Watch, Asian megacities are experiencing air pollution levels that are now high enough to adversely affect the human population and ecosystems and, the large numbers of motor vehicles and poor road infrastructure are considered to be some of the major contributing factors to this pollution [1,2]. The Global Burden of Disease assessment identified air pollution as among the top ten health risks in India [3]. Thirty-seven Indian cities have been documented in the world's top hundred cities with very high levels of PM 10 [4]. ...
Data on the status of air quality are presented for two locations in Delhi, the capital city of India, for 2013. Our study revealed that the levels of oxides of nitrogen (NO x), particulate matter of 10 or <10 μm aerodynamic diameter (PM 10) and benzene exceeded the maximum permissible limits laid down in the National Ambient Air Quality Standards (NAAQS). On most of the monitoring days, the concentrations of PM 10 also exceeded the limits for 24 h averages stipulated by the NAAQS. This study also demonstrated that the concentration of pollutants varied with the season, peaking in dry season (winter) mainly because of the relatively stable meteorological conditions and recording the lowest values in the wet season (the rainy season) because of turbulence, strong winds, and rains. The post-monsoon season showed the contribution of local sources. The strong correlation among NO x , PM 10 , and benzene strongly suggests that motor vehicles are the major contributor to this pollution. Intervention by regulatory agencies is essential to improve the air quality of Delhi.
... These and other nfectous dseases cause a sgnfcant amount of mortalty. However, the occurrence of Noncommuncable Dseases (NCDs) s ncreasngly recognsed as causng the hghest levels of mortalty n Nepal (IHME, 2013). NCDs are dsease processes that are nether contagous nor transferable from one human to another. ...
Nepal, like many other low-income countries, is facing an increasing burden of disease and deaths from Noncommunicable Diseases (NCDs). The main NCDs causing some of the highest mortality in Nepal are cardiovascular diseases (CVD), cancers, chronic obstructive pulmonary disorder (COPD) and chronic respiratory diseases and diabetes. When compared, these NCDs share some common modifiable risk
factors of tobacco use, physical inactivity, alcohol use, unhealthy diet, and obesity. To address the common risk factors sustainably, one of the first actions Nepal can implement is to raise awareness of NCD risk factors. Achieving this goal is a daunting task as Nepal has a large proportion of its population living in rural and remote areas with limited access to health care services. As a way forward to addressing
NCD risk factors, a scalable communication strategy combined with mobile health (mHealth) technologies can help to deliver innovative low-cost solutions. Many of these mHealth strategies can augment the World Health Organization’s ‘best buy’ health care initiatives. Mobile health holds much promise to improve health care by tackling the emerging burden of NCDs in Nepal.
... The analysis we presented in this study points to the importance of age, gender, marital status, socioeconomic circumstances , individuals' health behaviors and perceived community health problems as key determinants of poor Table 2Logistic regression results of determinants of poor self-rated health among adults, Health Barometer, Maputo Metropolitan Area, Mozambique, 2015 (Odds Ratio) (Continued) self-rated health in Maputo metropolitan area. Given the growing number of adult and older people in sub- Saharan Africa [17, 18] and the rising importance of non-communicable diseases such as stroke and diabetes in the region [50] more studies that may lead to a better understanding of determinants of poor self-rated health among adults in sub-Saharan Africa are still needed. Our study attempted to contribute for filling the gap of knowledge on this important population health issue in sub-Saharan Africa. ...
Background:
Self-rated health is a measure expressing the general condition of health of individuals. Self-rated health studies are common in developed countries and in some developing regions. Despite increasing proportion of adult and older population in sub-Saharan Africa and poor population health indicators, there is a dearth of studies on self-rated health in the region. This study examines factors associated with poor self-rated health among adult individuals in Maputo metropolitan area in Mozambique.
Methods:
Data for this study come from a survey of 1768 individuals aged 18 years or more carried out in Maputo metropolitan area, Mozambique, in 2015. Employing multiple logistic regression, the study used a subsample of 677 female and male respondents aged 40 years or more to estimate the determinants of poor self-rated health.
Results:
About 54 % of respondents aged 40 years or more believed that their health status was poor. Female respondents [Odds Ratios (OR) = 3.43, p <0.01], single (OR = 4.71, p < 0.05), widow (OR = 1.81, p < 0.05), separated or divorced (OR = 2.08, p < 0.05) and those believing that hypertension or heart problem was a major community health problem (OR = 1.56, p < 0.05) displayed higher odds of reporting poor health than their peers, net of other factors. Furthermore, individuals aged 40-49 years (OR = 0.45, p < 0.01), or 50-59 years (OR = 0.59, p < 0.05), those whose work involves intensive physical activity (OR = 0.60, p < 0.05) and those from households treating drinking water (OR = 0.49, p < 0.01) showed lower odds of reporting poor health, adjusting for other factors.
Conclusion:
Overall, the results point to the importance of age, gender, marital status, socioeconomic circumstances, individuals' health behaviors and perceived community health problems as key determinants of poor self-rated health among adults in Maputo metropolitan area. Given the growing number of adult and older people in sub-Saharan Africa, the rising importance of non-communicable diseases and the scarcity of studies on determinants of poor self-rated health among adults in the region, our findings may have implications for a better understanding of the drivers of poor health among adults in urban sub-Saharan Africa.
... It is estimated that alcohol use is the third leading risk factor for disease in Ukraine (Institute for Health Metrics andEvaluation, 2013). Indeed, alcohol abuse can lead to health and social problems; therefore, sobriety fellowships started to function in Ukraine in response to such problems beginning in 1874. ...
The purpose of this three study dissertation was to assess risk and protective factors associated with child alcohol problems. Family systems theory and Bronfenbrenner???s ecological model constituted the framework used for building and testing analytic models. Quantitative data were collected during face-to-face interviews with 320 parent-child dyads in 11 communities in Eastern, Southern and Central Ukraine. Children were 9-16 years of age and 50% were males. The first study assessed the association between parent sociodemographic variables, alcohol use, domestic violence and family cohesion and flexibility, and parenting behaviors. Results indicated that higher violence in the home, higher alcohol use and unbalanced family functioning were related to more frequent use of negative parenting and less frequent use of positive parenting practices. Additionally, lower parent education was associated with negative parenting. The second study estimated the relationship between parenting practices and child externalizing behaviors, such as aggression, delinquency and attention problems. Results revealed that positive parenting, child monitoring and avoidance of corporal punishments were associated with fewer child externalizing symptoms. Results also indicated that child male gender, parent unemployment and single parenting had significant and positive association with child externalizing behaviors. The third, final study assessed child alcohol problems and their association with child gender and age, externalizing behaviors, parental IPV, parenting practices, and peer and parent alcohol use. Children reported that they had alcohol related problems in multiple areas of life and mostly alcohol use affected their relationships with other people, school life and led to rule-breaking behaviors. Alcohol problems were more prevalent among males than among females. Results also revealed that children???s alcohol problems were significantly related with older child age, higher peer drinking and more symptoms of externalizing behavior. This dissertation made an important contribution to the global psychosocial research on children and families. These findings can be used to design alcohol prevention programs and policies in Ukraine.
The paper examines a large-scale mandatory food labeling regulation to identify its effects on consumer behavior.
It is incumbent upon medical geology practitioners to reach out to students, science faculties, decision makers, and the biomedical/public health communities to promote this emerging discipline. Perhaps the most successful of these efforts have taken place in Turkey where medical geology courses have been offered in four medical and ten engineering faculties. As a result of these outreach efforts by the Turkish medical geology community for the past decade, there has been robust interactions with scientists from many disciplines and collaborative research on groundwater quality, asbestos, radon, arsenic, mesothelioma, fluorosis, etc.
Significance
To the best of our knowledge, this is the first prediction of child anthropometric failure estimates for 597,121 villages—the smallest local governance unit—in India. While prior child nutrition policies and programs in India focused on districts for planning, implementation, and monitoring, we highlight that a majority of the geographic variation in child anthropometric failures occur at the micro geographic level of villages followed by the macro administrative level of states. Precision mapping of health data at the village level can enable more informed and effective local politics in India.
Air contamination influenced the human health and environmental well-being of the ecosystem. Particulate matter is a series of issues from major air pollutants in atmosphere. The aim of the review was to analyses the influence of particulate matter on human health and estimate the number of populations exposed to air pollution. The data analysed using the Environmental Benefits Mapping Analysis program model to selected African provinces. The review used 15% rollback data from the global burden disease and 5.8 µg/m³ the concentration of air pollutants from 1990 to 2013 years. The main findings of the study revealed that about 370 million (36.6%) population affected by air pollution. Besides, the risk factor associated with a population was 53,000 deaths per total population and 50,000 life-year losses. The economic value estimated to avoid a single case of particular matter on human health effect were estimated 14 billion dollars (US 2011). Priorities should be given to air quality management to improve the human and environmental health of ecosystems to reduce the global burden of disease of Africa regions.
Cities in the United States have announced initiatives to become more sustainable, healthy, resilient, livable, and environmentally friendly. However, indicators for measuring all outcomes related to these targets and the synergies between them have not been well defined or studied. One such relationship is the linkage between air quality with emotional well-being (EWB) and neighborhood infrastructure. Here, regulatory monitoring, low-cost sensors (LCSs), and air quality modeling were combined to assess exposures to PM 2.5 and traffic-related NO x in 6 Minneapolis, MN, neighborhoods of varying infrastructure parameters (median household income, urban vs suburban, and access to light rail). Residents of the study neighborhoods concurrently took real-time EWB assessments using a smart phone application, Daynamica, to gauge happiness, tiredness, stress, sadness, and pain. Both LCS PM 2.5 observations and mobile-source-simulated NO x were calibrated using regulatory observations in Minneapolis. No statistically significant (α = 0.05) PM 2.5 differences were found between urban poor and urban middle-income neighborhoods, but average mobile-source NO x was statistically significantly (α = 0.05) higher in the 4 urban neighborhoods than in the 2 suburban neighborhoods. Close proximity to light rail had no observable impact on average observed PM 2.5 or simulated mobile-source NO x . Home-based exposure assessments found that PM 2.5 was negatively correlated with positive emotions such as happiness and to net affect (the sum of positive and negative emotion scores) and positively correlated (ie, a higher PM 2.5 concentration led to higher scores) for negative emotions such as tiredness, stress, sadness, and pain. Simulated mobile-source NO x , assessed from both home-based exposures and in situ exposures, had a near-zero relationship with all EWB indicators. This was attributed to low NO x levels throughout the study neighborhoods and at locations were the EWB-assessed activities took place, both owing to low on-road mobile-source NO x impacts. Although none of the air quality and EWB responses were determined to be statistically significant (α = 0.05), due in part to the relatively small sample size, the results are suggestive of linkages between air quality and a variety of EWB outcomes.
Purpose
The aim of this study was to develop a cardiovascular health behavior scale for children and to assess its psychometric properties.
Design and method
A cross-sectional, methodological, descriptive, and correlational study design was conducted. The study sample consisted of 745 children between the ages of 10 to 15 years. The content validity of the scale was assessed by consulting 13 experts in pediatrics and cardiovascular health. Numbers, percentages, t-test, correlation analysis, Cronbach's α reliability coefficient and factor analysis were used for data analysis.
Results
The Cronbach's alpha coefficient for the overall scale was 0.83, and the Cronbach's alpha values for the subscales were 0.70–0.79. The item-total score correlations ranged from 0.354 to 0.637 (p < .05). The exploratory factor analysis showed that the scale explained 54.65% of the total variance, and the factor loadings of items ranged from 0.48 to 0.84. The confirmatory factor analysis also showed that the factor loadings of the scale ranged from.30 to.83. GFI, NFI, NNFI, CFI were found to be >0.90, and RMSA was found to be <0.080.
Conclusion
All the statistical procedures performed in the validity and reliability stages of the study show that the scale is a valid, reliable measurement tool for the Turkish culture.
Practice implications
The scale can be used as a measurement tool in experimental studies about cardiovascular health and can easily be adapted for use in other societies because of its universal items regarding cardiovascular health and its user-friendly structure.
https://www.slu.se/centrumbildningar-och-projekt/futurefood/forskning/-rapporter/
The role of dairy and plant based dairy alternatives in sustainable diets
Publ. 2018. Del 3 i serien Future Food Reports. Hållbara dieter som är näringsriktiga, miljövänliga, ekonomiskt bärkraftiga och socialt och kulturellt acceptabelt blir allt mer efterfrågade. Fokus har länge varit om köttets roll och mindre på mejeriprodukter. Nu finns en uppsjö av växtbaserade mjölkalternativ av soja, baljväxter, frön, nötter eller spannmål. De här produkterna har potentiellt lägre negativa effekter än mejeriprodukter men olika näringsprofiler, något som väcker oro. I den här rapporten undersöks olika aspekter av växtbaserade mjölkalternativ.
https://www.slu.se/globalassets/ew/org/centrb/fu-food/forskning/rapporter/future-food-reports-3-web.pdf
Objectives
To investigate the association between air pollution and out-of-hospital cardiac arrest (OHCA) incidence in Singapore.
Design
A time-stratified case-crossover design study.
Setting
OHCA incidences of all etiology in Singapore.
Participants
8589 OHCA incidences reported to Pan-Asian Resuscitation Outcomes Study (PAROS) registry in Singapore between 2010 and 2015.
Main outcome measures
A conditional Poisson regression model was applied to daily OHCA incidence that included potential confounders such as daily temperature, rainfall, wind speed, Pollutant Standards Index (PSI) and age. All models were adjusted for over-dispersion, autocorrelation and population at risk. We assessed the relationship with OHCA incidence and PSI in the entire cohort and in predetermined subgroups of demographic and clinical characteristics.
Results
334 out of 8589 (3.89%) cases survived. Moderate (Risk ratio/RR = 1.1, 95% CI = 1.07–1.15) and unhealthy (RR =1.37, 95% CI = 1.2–1.56) levels of PSI showed significant association with increased OHCA occurrence. Sub-group analysis based on individual demographic and clinical features showed generally significant association between OHCA incidence and moderate/unhealthy PSI, except in age < 65, Malay and other ethnicity, traumatic arrests and history of heart disease and diabetes. The association was most pronounced among cases age > 65, male, Indian and non-traumatic. Each increment of 30 unit in PSI on the same day and previous 1–5 days was significantly associated with 5.8–8.1% increased risk of OHCA (p < 0.001).
Conclusions
We found a transient effect of short-term air pollution on OHCA incidence after adjusting for meteorological indicators and individual characteristics. These finding have public health implications for prevention of OHCA and emergency health services during haze.
We take advantage of the gradual implementation of a comprehensive mandatory food labeling regulation introduced in Chile to identify its effects on consumer behavior. Using individual-level scandata from transactions in a big-box supermarket, we estimate a demand model for differentiated products in which a food label indicator captures the warning label effect. We find sizable effects on juices and cereals, but no impact on chocolates & candies and cookies. Our results are consistent with the information disclosure being effective only when information is unexpected.
Background:
The lack of research regarding the current profile of adolescent depression in the Arab countries in general, and Jordan in particular, makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression in the region. The purpose of this study was to estimate a national prevalence of depressive symptoms among adolescents in Jordan, and to identify characteristics associated with severity of depression.
Methods:
A descriptive, cross-sectional, nationally representative school survey was utilized. A total of 2,349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included the Beck Depression Inventory-II and measures of sociodemographics and health history. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region.
Results:
The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD = 11.2, 95% CI = 15.8-16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with low monthly incomes; and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help.
Conclusions:
Our findings should serve as an alarm, particularly given that rates of depression in the Arab countries are expected to increase rapidly in the context of the Arab Spring. Healthcare providers, researchers, and educators should focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression.
Objectives
This prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi.
Setting
Data were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre.
Participants
Children under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge.
Primary and secondary outcome measures
The primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients.
Results
Total costs in 2014 US65.33, 8.89, 60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%.
Conclusion
This study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness.
There is an increasing recognition of the need to understand and address risks of various kinds in African cities. However, there have been very few explicit examinations of the way in which the specific characteristics of African urbanisation and urbanism drive risk, or the way in which responses to risk should take these characteristics into account. This paper presents a critical review of the key features of African urban experiences, and analyses the implications for the creation and reduction of diverse risks, from the everyday to the extensive. It argues that the physical forms, social structures, economic pathways, and governance systems of cities on the continent shape their risk profiles. Of particular importance are the nature of spatial expansion, the demographic profiles of cities, and the prevalence of informal economies and settlements; while the reform of governance systems will be critical to enable risk reduction. The paper concludes that urban development actors need to consider the consequences of their actions for risk, while risk reduction practitioners will need to engage with all elements of urban development, including informality, urban poverty, infrastructure and service provision, land management, and local governance capacity.
Objective
A systematic review was undertaken examining the impact of comorbid osteoarthritis on health outcomes for people aged 50 years or older with cardiovascular disease, diabetes or obesity.
Design
The protocol is registered in PROSPERO (CRD42015023417). Relevant electronic databases and grey literature were systematically searched for studies published in English between January 2005 and December 2016. Two reviewers independently screened studies for selection using predetermined inclusion and exclusion criteria, and independently completed methodological quality review. Data was extracted at study level by one reviewer and independently checked by a second reviewer, using a standardized form. The results across studies were qualitatively synthesized with outcomes described and summarized.
Results
Of 1456 articles, we identified 15 relevant studies, with nine good to high quality studies describing significant negative impact of osteoarthritis on outcomes for cardiovascular diseases. There were too few studies focusing on diabetes and obesity to make conclusions in regard to these diseases.
Conclusions
This review provides evidence that osteoarthritis should not be overlooked when impacts of chronic disease on health outcomes and related health service use are considered. There is a clear need for more studies that consider the impacts of osteoarthritis on comorbid disease, especially those that consider the impact of osteoarthritis beyond the morbidity impacts. The management of comorbid osteoarthritis should be addressed for those with cardiovascular disease, and treatment choices considered given this association.
Background:
Alcohol consumption is of global concern. However, drinking patterns and associated factors remain under-investigated, especially among low socioeconomic groups such as street laborers.
Objective:
Using the social cognitive model as a framework for the study we aimed to identify factors associated with risky alcohol consumption.
Methods:
In a cross-sectional study using structured questionnaires, 450 male street laborers searching for casual works in Hanoi, Vietnam were interviewed. A logistic regression was applied in order to detect predictors of risky alcohol drinking.
Results:
During the last month, 45% of the participants reported daily consumption while the other 55% consumed weekly or less. Among the drinkers (416 out of 450, 92%), 27% were identified as high-risk drinkers who reported more than 14 standard drinks per week, while only 8% were lifetime abstainers. The multivariable logistic regression showed that older age, higher income were positively associated with a higher likelihood of drinking alcohol, while high school level negatively. The environmental predictor was the higher level of peer connection. The association between drinking and risky behavior was found positive with regards to the number of sexual partners.
Conclusions:
The study suggests that male street laborers are vulnerable to health risks. Decision makers should note that a significant proportion of this target group exceeds the guidelines for alcohol use and this should be included in future interventions or further research. A multisectoral approach together with an important strategy of education is needed to control alcohol use.
Background:
The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore.
Methods:
We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization.
Results:
Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization.
Conclusion:
Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting.
Introdução: A Diabetes é uma doença com grande prevalência e mortalidade na população
portuguesa. O seu impacte no internamento hospitalar é elevado, estando presente em quase
15% do total de internamentos. A inexistência de informação acerca dos internamentos
hospitalares causados pela Diabetes no que respeita a indicadores de produção hospitalar levou
à realização do presente estudo. Propõe-se a análise da variabilidade dos hospitais e regiões
geográficas em relação a vários indicadores de produção hospitalar. Pretende-se também uma
análise à qualidade dos dados utilizados para a realização do trabalho.
Metodologia: Utiliza-se o sistema de classificação Disease Staging para calcular o índice de
Severidade, as COC e Readmissões não planeadas a partir da BDRA, sendo estes comparados
a nível hospitalar. Calcula-se também a demora média por hospital. Os indicadores referidos são
analisados globalmente e por níveis de gravidade, definidos a partir da escala de gravidade do
Disease Staging. São calculadas taxas padronizadas por sexo e idade para os indicadores para
os tornar comparáveis. A nível geográfico a unidade de análise é o distrito, sendo comparadas
globalmente as taxas de internamento com/por Diabetes e como doença responsável pelo
internamento também por níveis de gravidade. A avaliação da qualidade dos dados efetua-se
através da comparação de complicações da Diabetes (EAM) com poucos casos relativamente à
sua frequência absoluta classificada como doença principal em pessoas com Diabetes. Cruzase
também o Disease Staging e os GDH, identificando casos de GDH com CC em que a Diabetes
foi a única co-morbilidade para a classificação em nível baixo de gravidade.
Resultados: Verificam-se diferenças significativas entre hospitais em todos os indicadores
analisados. Destaca-se as COC que apresentam valores médios muito elevados (40
complicações por 100 episódios). As readmissões têm valores médios inferiores ao contexto
internacional, mas apresentam em vários casos demoras médias de internamento elevadas. A
análise desagregada por níveis de gravidade que esta aumenta os valores dos indicadores. A
distribuição distrital apresenta diferenças, que são mais evidentes na desagregação por níveis
de gravidade. Parecem existir problemas de codificação inadequada, com os EAM por Diabetes
a ser em número muito reduzido (16 casos), o que sugere omissão de códigos e com hospitais
a revelar elevado número de classificações de Diabetes como co-morbilidade em situações de
baixa gravidade, sem influência no internamento.
Conclusão: Os indicadores de produção hospitalar divergem entre hospitais,
independentemente do nível de gravidade analisado. Os doentes tiveram elevado número de
COC, o que revela os riscos do internamento hospitalar. Existem distritos onde ocorrem
predominantemente internamentos de baixa gravidade ou elevada gravidade, o que sugere
critérios de internamento diversos. As práticas de codificação parecem ser diferentes, revelando
a possibilidade de ocorrência de subcodificação e DRG Creep ou Sobrecodificação.
Objective:
Road traffic injuries are a leading cause of disability and death in Cambodia. Economic development has long been associated with rapid increases in road traffic injuries and fatalities. Drink driving is of particular concern in Cambodia. In 2014, the percentage of fatal crashes involving alcohol rose to 17.5% (n = 381), representing a 34.9% (n = 253) increase from 2012. This study aims to illustrate current knowledge, attitudes and practices (KAP) around drinking and driving in three Cambodian provinces.
Methods:
A roadside survey of randomly selected road users (aged 18 years and older) was conducted in Phnom Penh, Kandal, and Kampong Speu, Cambodia, between November 2010 and May 2012. Data were collected for five-day periods every 6 months. A survey was administered to assess prevailing knowledge, attitudes, and practices surrounding drink driving.
Results:
A total of 1187 road users responded to the KAP survey, the majority (49.6%, n = 585) of whom were from Phnom Penh. Males accounted for 96.2% (n = 1142) of respondents; the majority (63.8%, n = 757) were aged 34 years and younger. Despite the belief that drinking and driving would increase the risk of a crash, a significant proportion of respondents (37.1%, n = 438) reported driving within 2 h of drinking alcohol at least once in the 30 days preceding the survey. This proportion was particularly high among males aged 25-34 years at 49.2% (n = 208). Of those who reported drinking and driving, 76.5% (n = 335) indicated they 'felt conscious enough' to drive at the time and 34.0% (n = 149) reported having 'no other available transportation options'.
Conclusions:
This study shows that, in general, drinking and driving remains a problem in Cambodia. A multi-pronged, coordinated approach is needed to effectively address this issue. Such an approach ought to include social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or those that provide alternatives to drinking and driving.
In this report, YCEMP presents a new vision for essential medicines policies. We argue that if essential drugs are not made available to all people in need, the essential medicines concept does not realise its full potential. Our report is an evidence-based perspective from a group of young health professionals, practitioners, and students on essential medicines. Our recommendations are rooted in a shared global vision for equity in access to medicines worldwide, prioritization of the human right to health, progress towards achieving the Sustainable Development Agenda and demand for stakeholder accountability to ensure delivery of essential medicines. Our focus is forward-looking, arguing that longterm, sustainable solutions must replace current fragmentized efforts, seen as the country by country and drug by drug initiatives, to truly realise the potential of essential medicines looking towards 2035. We highlight four main recommendations and opportunities for decision makers and leaders to act upon.
Background: Tobacco use, alcohol use and Socioeconomic status (SES) are all strongly associated with mortality. These risk factors however, are also strongly associated with each other. The effect of the interrelationship between these risk factors on mortality has not been examined in India. Objectives: To study tobacco and alcohol associated Hazard Ratios (HRs) stratified by SES. Methods: A cohort of 34,055 men (age>=45 years) was recruited through house visits and information collected through face-to-face interviews during 1994 to 1997. During 1999 to 2003, follow-up through repeat house visits was conducted and deaths were recorded. Education level was used as proxy for SES. Cox proportional hazards model provided HRs and 95% Confidence Intervals (CIs) for tobacco/alcohol associated mortality adjusted for alcohol/tobacco and other confounders. Additionally, HRs was stratified by SES for their individual (tobacco, alcohol use) and their joint effect on mortality. Results: For tobacco associated mortality, stratification by SES showed higher HRs for high SES bidi smokers (HR=2.01) compared to corresponding low SES bidi smokers (HR=1.41). For alcohol associated mortality, HRs were higher among high SES 'country/desi' drinkers (HR=1.56) compared to corresponding low SES counterpart (HR=1.31). After adjusting for alcohol exposure, the highest attenuation of HRs (>20%) for tobacco associated mortality was observed for deaths from tuberculosis and digestive system diseases (mainly liver diseases) among various forms of tobacco users. Conclusions: The examination of differences in mortality risks by SES, showing higher HRs among high SES bidi smokers and high SES 'country/desi' drinkers, have implications for public health policies.
Open Municipal Solid Waste (MSW)-burning is a major source of particulate matter emissions in developing world cities. Despite a legal ban, MSW burning is observed ubiquitously in Indian cities with little being known
about the factors shaping it. This study seeks to uncover social and infrastructural factors that affect MSW-burning at the neighborhood level. We couple physical assessments of the infrastructure provision and the
MSW-burning incidences in three different neighborhoods of varying socioeconomic status in Delhi, with an accompanying study of the social actors (interviews of waste handlers and households) to explore the extent to
which, and potential reasons why, MSW-burning occurs. The observed differences in MSW-burning incidences range from 130/km2-day in low income to 30/km2-day in the high income areas. However, two high income areas neighborhoods with functional infrastructure service also showed statistical differences in MSW-burning incidences. Our interviews revealed that while the waste handlers were aware of the health risks associated with MSW-burning, it was not a high priority in the context of the other difficulties they faced. The awareness of the legal ban on MSW burning was low among both waste handlers and households. In addition to providing infrastructure for waste pickup, informal restrictions from residents and neighborhood associations can play significant role in restricting MSW-burning at the neighborhood scale. A more efficient management of MSW requires a combined effort that involves interplay of both social and infrastructural systems.
Almost 670 million people comprising 54.5% of our population reside in regions that do not meet the Indian NAAQS for fine particulate matter. Numerous studies have revealed a consistent correlation for particulate matter concentration with health than any other air pollutant. Aurangabad city a rapidly growing city with population of 1.5 million is home to five major industrial areas, the city is also known for its historical monuments which might also be adversely affected from air pollution. Therefore, this research aims at estimating PM10 concentrations at several locations across Aurangabad. The concentration of PM10 was highest at the Railway Station followed by Waluj (an industrial zone) and City chowk is the centre of the city which has high population, tall buildings, few open spaces which causes high congestion and does not allow the particulates to disperse. Other locations with high concentrations of PM are Mill corner, Harsul T-point, Kranti Chowk, Seven Hill, TV centre and Beed Bye pass. All these locations have narrow roads, high traffic density, poor road condition with pot holes and few crossing points which cause congestion and vehicle idling which are responsible for high pollution. Therefore, it is evident that air pollution is a serious issue in the city which may be further aggravated if it is not brought under control. Hence, strategies have to be adopted for combating the menace of air pollution.INTERNATIONAL JOURNAL OF ENVIRONMENTVolume-5, Issue-2, March-May 2016, Page :61-74
ABSTRACT
The Lancet Youth Commission on Essential Medicines Policies (YCEMP) was convened in March 2015 to examine access and promotion policies for Essential Medicines worldwide through a youth lens. YCEMP is comprised of 17 young professionals from 15 different countries, representing every region in the world.
We believe medicines should be available to all who need them, for both individuals and societies to realize their full potential, and to realize the human right to health and the right to science and culture, as recognised in the United Nations International Covenant on Economic, Social and Cultural Rights. This makes sense from both a public health perspective, and an economic perspective.
To achieve this, scientific progress and knowledge should be acknowledged as global public goods. This has significant implications for the current intellectual property and trade system, which places a disproportionate emphasis on the rights of innovators. Although those who develop drugs should benefit from their work, this cannot be at the expense of human lives. We can no longer tolerate a situation wherein the majority of the world does not have the opportunity to benefit from these developments. Indeed, the problems in the current systems restricting access to medicines, such as unaffordability, will increasingly apply to all countries as costs of healthcare continue to rise dramatically, and new drugs are created.
In this submission, we outline specific recommendations for the High Level Panel to consider for Member States. We recommend:
1. To implement research and development (R&D) models that incentivize innovation based on global health need and facilitate access to knowledge; and
2. For Member States to develop and implement legislation mandating transparency of R&D costs and prices associated with pharmaceutical, diagnostics, and vaccine research, development, and production.
Our environment plays a pivotal daily role in our health and well-being. The air we breathe, the water we drink, the noise levels we're exposed to, and the weather we experience, all directly affect us in terms of our quality of life, our life expectancy, and the prevalence of certain diseases or other aspects of our personal health.
Noise annoyance (NA) might lead to behavioral patterns not captured by noise levels, which could reduce physical activity (PA) either directly or through impaired sleep and constitute a noise pathway towards cardiometabolic diseases. We investigated the association of long-term transportation NA and its main sources (aircraft, road, and railway) at home with PA levels. We assessed 3842 participants (aged 37–81) that attended the three examinations (SAP 1, 2, and 3 in years 1991, 2001 and 2011, respectively) of the population-based Swiss cohort on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Participants reported general 24-h transportation NA (in all examinations) and source-specific NA at night (only SAP 3) on an ICBEN-type 11-point scale. We assessed moderate, vigorous, and total PA from a short-questionnaire (SAP 3). The main outcome was moderate PA (active/inactive: cut-off≥150min/week). We used logistic regression including random effects by area and adjusting for age, sex, socioeconomic status, and lifestyles (main model) and evaluated potential effect modifiers. We analyzed associations with PA at SAP 3 a) cross-sectionally: for source-specific and transportation NA in the last year (SAP 3), and b) longitudinally: for 10-y transportation NA (mean of SAP 1+2), adjusting for prior PA (SAP 2) and changes in NA (SAP 3-2). Reported NA (score≥5) was 16.4%, 7.5%, 3%, and 1.1% for 1-year transportation, road, aircraft, and railway at SAP 3, respectively. NA was greater in the past, reaching 28.5% for 10-y transportation NA (SAP 1+2). The 10-y transportation NA was associated with a 3.2% (95% CI: 6%–0.2%) decrease in moderate PA per 1-NA rating point and was related to road and aircraft NA at night in cross-sectional analyses. The longitudinal association was stronger for women, reported daytime sleepiness or chronic diseases and it was not explained by objectively modeled levels of road traffic noise at SAP 3. In conclusion, long-term NA (related to psychological noise appraisal) reduced PA and could represent another noise pathway towards cardiometabolic diseases.
The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios-OR = 1.31; 95% confidence interval-95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies.
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