The methodology of population surveys of headache prevalence, burden and cost

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Stovner, Lars Jacob; Al Jumah, Mohammed; Birbeck, Gretchen L

2014-01-01

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against...... to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe...... the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most...

The prevalence and burden of mental and substance use disorders in Australia: Findings from the Global Burden of Disease Study 2015.

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Ciobanu, Liliana G; Ferrari, Alize J; Erskine, Holly E; Santomauro, Damian F; Charlson, Fiona J; Leung, Janni; Amare, Azmeraw T; Olagunju, Andrew T; Whiteford, Harvey A; Baune, Bernhard T

2018-05-01

Timely and accurate assessments of disease burden are essential for developing effective national health policies. We used the Global Burden of Disease Study 2015 to examine burden due to mental and substance use disorders in Australia. For each of the 20 mental and substance use disorders included in Global Burden of Disease Study 2015, systematic reviews of epidemiological data were conducted, and data modelled using a Bayesian meta-regression tool to produce prevalence estimates by age, sex, geography and year. Prevalence for each disorder was then combined with a disorder-specific disability weight to give years lived with disability, as a measure of non-fatal burden. Fatal burden was measured as years of life lost due to premature mortality which were calculated by combining the number of deaths due to a disorder with the life expectancy remaining at the time of death. Disability-adjusted life years were calculated by summing years lived with disability and years of life lost to give a measure of total burden. Uncertainty was calculated around all burden estimates. Mental and substance use disorders were the leading cause of non-fatal burden in Australia in 2015, explaining 24.3% of total years lived with disability, and were the second leading cause of total burden, accounting for 14.6% of total disability-adjusted life years. There was no significant change in the age-standardised disability-adjusted life year rates for mental and substance use disorders from 1990 to 2015. Global Burden of Disease Study 2015 found that mental and substance use disorders were leading contributors to disease burden in Australia. Despite several decades of national reform, the burden of mental and substance use disorders remained largely unchanged between 1990 and 2015. To reduce this burden, effective population-level preventions strategies are required in addition to effective interventions of sufficient duration and coverage.

The burden of premature mortality in Spain using standard expected years of life lost: a population-based study

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Álvarez-Martín Elena

2011-10-01

Full Text Available Abstract Background Measures of premature mortality have been used to guide debates on future health priorities and to monitor the population health status. Standard expected years of life lost (SEYLL is one of the methods used to assess the time lost due to premature death. This article affords an overview of premature mortality in Spain for the year 2008. Methods A population-based study was conducted estimating SEYLL by sex and age groups. SEYLL, a key component of the disability-adjusted life years measure of disease burden, was calculated using Princeton West standard life tables with life expectancy at birth fixed at 80 years for males and 82.5 years for females. Population data and specific death records were obtained from the official registers of the National Institute of Statistics. All data were analysed and prepared in GesMor and Epidat software packages. Results The burden of premature mortality was estimated at 2.1 million SEYLL when age at death is taken into account. Males lost 60.9% and females lost 39.1% of total SEYLL. Malignant tumors (34.5% and cardiovascular diseases (24.0% were the leading categories in terms of SEYLL. Ischaemic heart disease (8.5% and lung cancers (8.0% were the most common specific causes of SEYLL followed by cerebrovascular diseases (5.9%, colorectal cancer (4.1%, road traffic accidents (3.5%, Alzheimer and other dementias (2.9%, chronic obstructive pulmonary disease (2.8%, breast cancer (2.8% and suicides (2.6%. Conclusions In Spain, premature mortality was essentially due to chronic non-communicable diseases. Data provided in this study are relevant for a more balanced health agenda aimed at reducing the burden of premature mortality. This study also represents a first step in estimating the overall burden of disease in terms of premature death and disability.

Burden of chronic kidney disease in resource-limited settings from Peru: a population-based study.

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Francis, Elizabeth R; Kuo, Chin-Chi; Bernabe-Ortiz, Antonio; Nessel, Lisa; Gilman, Robert H; Checkley, William; Miranda, J Jaime; Feldman, Harold I

2015-07-24

The silent progression of chronic kidney diseases (CKD) and its association with other chronic diseases, and high treatment costs make it a great public health concern worldwide. The population burden of CKD in Peru has yet to be fully described. We completed a cross sectional study of CKD prevalence among 404 participants (total study population median age 54.8 years, 50.2 % male) from two sites, highly-urbanized Lima and less urbanized Tumbes, who were enrolled in the population-based CRONICAS Cohort Study of cardiopulmonary health in Peru. Factors potentially associated with the presence of CKD were explored using Poisson regression, a statistical methodology used to determine prevalence ratios. In total, 68 participants (16.8 %, 95 % CI 13.5-20.9 %) met criteria for CKD: 60 (14.9%) with proteinuria, four (1%) with eGFR diabetes and hypertension was 19.1 % and 42.7 %, respectively. After multivariable adjustment, CKD was associated with older age, female sex, greater wealth tertile (although all wealth strata were below the poverty line), residence in Lima, and presence of diabetes and hypertension. The high prevalence rates of CKD identified in Lima and Tumbes are similar to estimates from high-income settings. These findings highlight the need to identify occult CKD and implement strategies to prevent disease progression and secondary morbidity.

Contact sensitization to fragrances in the general population: a Koch's approach may reveal the burden of disease

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Thyssen, J P; Menné, T; Linneberg, A

2009-01-01

subjects were tested in total. The median prevalence of FM and MP sensitization among adults was 2.3% (women, 1.7%; men, 1.3%) and 1.1% (women, 1.4%; men, 0%), respectively. CONCLUSIONS: Based on the reliability of patch test data from the general population and exposure data obtained from patients...... the prevalence of fragrance sensitization in the general population, and to suggest how future population-based studies and questionnaires should be constructed, better to assess the prevalence and burden of fragrance sensitization. This is of relevance as it is often difficult to establish causality...... in biological systems. METHODS: A systematic review of the literature was carried out by searching Pubmed-Medline, Biosis and contact dermatitis textbooks. RESULTS: Nineteen studies were identified, of which 13 were performed among adults. Sample sizes varied between 82 and 2545 tested subjects, and 11 648...

Measuring the Environmental Burden of Disease in South Korea: A Population-Based Study

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Seok-Jun Yoon

2015-07-01

Full Text Available Background: This study attempted to measure the environmental burden of disease by examining mortality and disability rates in South Korea, permitting international comparisons. Methods: Disability-adjusted life years (DALY was used to analyze data from public records. Years of life lost (YLL and years lost to disability (YLD were measured in terms of incidence rate and number of deaths. Attributable risks were based on those for WHO Western Pacific Regions. For air pollution, attributable risk was calculated using local PM10 levels and relative risk. Results: The total Korean environmental burden of disease was 17.98 per 1000 persons and the most serious risk factor was air pollution, at 6.89per1000 persons. Occupation was the second highest contributing factor, at 3.29 per 1000 persons, followed by indoor air pollution at 2.91 per 1000 persons. The DALY of air-pollution (indoor and outdoor was 9.80 per 1000 persons, accounting for more than half of the total environmental burden of disease. The burden of chronic obstructive pulmonary disease, lung cancer, and asthma were 4.07, 3.16, and 1.96 per 1000 persons, respectively. Conclusions: Respiratory illnesses comprised most of the disease burden, the majority of which was linked to air pollution. The present results are important as they could be used to make evidence-based decisions regarding the management of diseases and environmental-risk factors.

Diagnosis, prevalence estimation and burden measurement in population surveys of headache

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Steiner, Timothy J; Gururaj, Gopalakrishna; Andrée, Colette

2014-01-01

in population-based studies in China, Ethiopia, India, Nepal, Pakistan, Russia, Saudi Arabia, Zambia and 10 countries in the European Union. The resultant evolution of this instrument was reviewed by an expert consensus group drawn from all world regions. The final output was the Headache-Attributed Restriction......The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking...

The economic burden of prematurity in Canada.

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Johnston, Karissa M; Gooch, Katherine; Korol, Ellen; Vo, Pamela; Eyawo, Oghenowede; Bradt, Pamela; Levy, Adrian

2014-04-05

Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants. The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec. Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants, $52,796 for moderate preterm infants, and $10,010 for late preterm infants. Based on population sizes this corresponds to total national costs of $123.3 million for early preterm infants, $255.6 million for moderate preterm infants, $208.2 million for late preterm infants, and $587.1 million for all infants. Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is

Burden of gout in the Nordic region, 1990-2015: findings from the Global Burden of Disease Study 2015.

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Kiadaliri, A A; Uhlig, T; Englund, M

2018-01-29

To explore the burden of gout in the Nordic region, with a population around 27 million in 2015 distributed across six countries. We used the findings of the 2015 Global Burden of Diseases study to report prevalence and disability associated with gout in the Nordic region. From 1990 to 2015, the number of prevalent gout cases rose by 30% to 252 967 [95% uncertainty interval (UI) 223 478‒287 288] in the Nordic region. In 2015, gout contributed to 7982 (95% UI 5431‒10 800) years lived with disability (YLDs) in the region, an increase of 29% (95% UI 24‒35%) from 1990. While the crude YLD rate of gout increased by 12.9% (95% UI 7.8‒18.1%) between 1990 and 2015, the age-standardized YLD rate remained stable. Gout was ranked as the 63rd leading cause of total YLDs in the region in 2015, with the highest rank in men aged 55-59 years (38th leading cause of YLDs). The corresponding rank at the global level was 94. Of 195 countries studied, four Nordic countries [Greenland (2nd), Iceland (12th), Finland (14th), and Sweden (15th)] were among the top 15 countries with the highest age-standardized YLD rate of gout. The burden of gout is rising in the Nordic region. Gout's contribution to the total burden of diseases in the region is more significant than the global average. Expected increases in gout burden owing to population growth and ageing call for stronger preventive and therapeutic strategies for gout management in Nordic countries.

Economic burden of disease-associated malnutrition in China.

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Linthicum, Mark T; Thornton Snider, Julia; Vaithianathan, Rhema; Wu, Yanyu; LaVallee, Chris; Lakdawalla, Darius N; Benner, Jennifer E; Philipson, Tomas J

2015-05-01

Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available. © 2014 APJPH.

The burden of disease in Zimbabwe in 1997 as measured by disability-adjusted life years lost

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Chapman, Glyn; Hansen, Kristian Schultz; Jelsma, Jennifer

2006-01-01

Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods Epidemiological information was derived from multiple sources. Population size and total number of deaths by age and sex for the ...... pattern of Zimbabwe differed substantially from regional estimates for sub-Saharan Africa justifying the need for countries to develop their own burden of disease estimates.......Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods Epidemiological information was derived from multiple sources. Population size and total number of deaths by age and sex...... for the year 1997 were taken from a nationwide census. The cause of death pattern was determined based on data from the Vital Registration System, which was adjusted for underreporting of human immunodeficiency virus (HIV) and reallocation of ill-defined causes. Non-fatal disease figures were estimated based...

Population: Census Bureau Total Estimates (2010-2012)

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Earth Data Analysis Center, University of New Mexico — Total population estimates are estimates of the total number of residents living in an area on July 1 of each year. The Census Bureau’s Population Division produces...

Distribution of major health risks: findings from the Global Burden of Disease study.

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Anthony Rodgers

2004-10-01

Full Text Available Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness.For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median.Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.

Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire.

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Steiner, Timothy J; Gururaj, Gopalakrishna; Andrée, Colette; Katsarava, Zaza; Ayzenberg, Ilya; Yu, Sheng-Yuan; Al Jumah, Mohammed; Tekle-Haimanot, Redda; Birbeck, Gretchen L; Herekar, Arif; Linde, Mattias; Mbewe, Edouard; Manandhar, Kedar; Risal, Ajay; Jensen, Rigmor; Queiroz, Luiz Paulo; Scher, Ann I; Wang, Shuu-Jiun; Stovner, Lars Jacob

2014-01-08

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking initiatives to improve and standardize methods in use for cross-sectional studies. One requirement is for a survey instrument with proven cross-cultural validity. This report describes the development of such an instrument. Two of the authors developed the initial version, which was used with adaptations in population-based studies in China, Ethiopia, India, Nepal, Pakistan, Russia, Saudi Arabia, Zambia and 10 countries in the European Union. The resultant evolution of this instrument was reviewed by an expert consensus group drawn from all world regions. The final output was the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, designed for application by trained lay interviewers. HARDSHIP is a modular instrument incorporating demographic enquiry, diagnostic questions based on ICHD-3 beta criteria, and enquiries into each of the following as components of headache-attributed burden: symptom burden; health-care utilization; disability and productive time losses; impact on education, career and earnings; perception of control; interictal burden; overall individual burden; effects on relationships and family dynamics; effects on others, including household partner and children; quality of life; wellbeing; obesity as a comorbidity. HARDSHIP already has demonstrated validity and acceptability in multiple languages and cultures. Modules may be included or not, and others (e.g., on additional comorbidities) added, according to the purpose of the study and resources (especially time) available.

How abnormal is binge eating? 18-Year time trends in population prevalence and burden.

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Mitchison, D; Touyz, S; González-Chica, D A; Stocks, N; Hay, P

2017-08-01

Although findings suggest that binge eating is becoming increasingly normative, the 'clinical significance' of this behaviour at a population level remains uncertain. We aimed to assess the time trends in binge-eating prevalence and burden over 18 years. Six cross-sectional face-to-face surveys of the Australian adult population were conducted in 1998, 2005, 2008, 2009, 2014, and 2015 (N total = 15 126). Data were collected on demographics, 3-month prevalence of objective binge eating (OBE), health-related quality of life, days out of role, and distress related to OBE. The prevalence of OBE increased six-fold from 1998 (2.7%) to 2015 (13.0%). Health-related quality of life associated with OBE improved from 1998 to 2015, where it more closely approximated population norms. Days out of role remained higher among participants who reported OBE, although decreased over time. Half of participants who reported weekly (56.6%) and twice-weekly (47.1%) OBE reported that they were not distressed by this behaviour. However, the presence of distress related to OBE in 2015 was associated with greater health-related quality-of-life impairment. As the prevalence of binge eating increases over time, associated disability has been decreasing. Implications for the diagnosis of disorders associated with binge eating are discussed. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The burden of stomach cancer in indigenous populations: a systematic review and global assessment.

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Arnold, Melina; Moore, Suzanne P; Hassler, Sven; Ellison-Loschmann, Lis; Forman, David; Bray, Freddie

2014-01-01

Stomach cancer is a leading cause of cancer death, especially in developing countries. Incidence has been associated with poverty and is also reported to disproportionately affect indigenous peoples, many of whom live in poor socioeconomic circumstances and experience lower standards of health. In this comprehensive assessment, we explore the burden of stomach cancer among indigenous peoples globally. The literature was searched systematically for studies on stomach cancer incidence, mortality and survival in indigenous populations, including Indigenous Australians, Maori in New Zealand, indigenous peoples from the circumpolar region, native Americans and Alaska natives in the USA, and the Mapuche peoples in Chile. Data from the New Zealand Health Information Service and the Surveillance Epidemiology and End Results (SEER) Program were used to estimate trends in incidence. Elevated rates of stomach cancer incidence and mortality were found in almost all indigenous peoples relative to corresponding non-indigenous populations in the same regions or countries. This was particularly evident among Inuit residing in the circumpolar region (standardised incidence ratios (SIR) males: 3.9, females: 3.6) and in Maori (SIR males: 2.2, females: 3.2). Increasing trends in incidence were found for some groups. We found a higher burden of stomach cancer in indigenous populations globally, and rising incidence in some indigenous groups, in stark contrast to the decreasing global trends. This is of major public health concern requiring close surveillance and further research of potential risk factors. Given evidence that improving nutrition and housing sanitation, and Helicobacter pylori eradication programmes could reduce stomach cancer rates, policies which address these initiatives could reduce inequalities in stomach cancer burden for indigenous peoples.

ESTIMATION OF THE BURDEN OF PESTICIDE RESIDUES IN SLOVAK POPULATION

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Jozef Sokol

2010-07-01

Full Text Available Pesticides used in the agriculture have to be applied according to the requirements of good agricultural practice and appropriate law. Pesticides leave detectable residues in agricultural crops, raw materials and ecosystem components. Pesticides reach the human population through the food chain. Information on the type and concentration of pesticide residues in food is in Slovakia collected trough the monitoring programs. Health risks associated with pesticides contaminants in human nutrition are very important and are recently studied by several expert groups. Prerequisite programs are necessary to protect public health. Risk analysis and monitoring of the population burden by pesticide contaminants have to be performed in expert level. The general strategy for assessment of toxicity of pesticides is listed by the World health Organisation. Scientific risk assessment is the basis for taking action and making the legislation at national and European community level.doi:10.5219/69

The Burden of Tick-Borne Encephalitis in Disability-Adjusted Life Years (DALYs) for Slovenia.

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Šmit, Renata; Postma, Maarten J

2015-01-01

Tick-borne encephalitis (TBE) presents an increasing burden in many parts of Europe, Asian Russia, Siberia, Asian former USSR and Far East. Incidence can be considered as one way to express the burden. A more comprehensive measure concerns disability-adjusted life years (DALYs), better characterizing the full burden of TBE. TBE burden in DALYs has not yet been estimated, nor has it been specified by the Global Burden of Disease (GBD) studies. The purpose of the present study is to estimate the burden of TBE in Slovenia, expressed in DALYs, both from the population and individual perspectives. We discuss the impact of TBE burden on public health and potential strategies to reduce this burden in Slovenia. The burden of TBE is estimated by using the updated DALYs' methodology first introduced in the GBD project. The DALYs᾽ calculations are based on the health outcomes of the natural course of the disease being modelled. Corrections for under-reporting and under-ascertainment are applied. The impact of uncertainty in parameters in the model was assessed using sensitivity analyses. From the population perspective, total DALYs amount to 3,450 (167.8 per 100,000 population), while from the individual perspective they amount to 3.1 per case in 2011. Notably, the consequences of TBE present a larger burden than TBE itself. TBE presents a relatively high burden expressed in DALYs compared with estimates for other infectious diseases from the GBD 2010 study for Slovenia. Raising awareness and increasing vaccination coverage are needed to reduce TBE and its consequences.

Improving quality in population surveys of headache prevalence, burden and cost

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Steiner, Timothy J; Stovner, Lars Jacob; Al Jumah, Mohammed

2013-01-01

Population-based studies of headache disorders are important. They inform needs assessment and underpin service policy for a set of disorders that are a public-health priority. On the one hand, our knowledge of the global burden of headache is incomplete, with major geographical gaps; on the other...... issues, and areas where studies might fail. Members had competence and practical experience in headache epidemiology or epidemiology in general, and were drawn from all WHO world regions. We reviewed the relevant literature, and supplemented the knowledge gathered from this exercise with experience...... gained from recent Global Campaign population-based studies, not all yet published. We extracted methodological themes and identified issues within them that were of key importance.We found wide variations in methodology. The themes within which methodological shortcomings had adverse impact on quality...

The Spanish Burden of Disease 2010: Neurological, mental and substance use disorders.

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Lara, Elvira; Garin, Noé; Ferrari, Alize J; Tyrovolas, Stefanos; Olaya, Beatriz; Sànchez-Riera, Lidia; Whiteford, Harvey A; Haro, Josep Maria

2015-01-01

We used data from the Global Burden of Disease, Injuries, and Risk Factors Study 2010 to report on the burden of neuropsychiatric disorders in Spain. The summary measure of burden used in the study was the disability-adjusted life-year (DALY), which sums of the years of life lost due to premature mortality (YLLs) and the years lived with disability (YLDs). DALYs were adjusted for comorbidity and estimated with 95% uncertainty intervals. The burden of neuropsychiatric disorders accounted for 18.4% of total all-cause DALYs generated in Spain for 2010. Within this group, the top five leading causes of DALYs were: depressive disorders, Alzheimer's disease, migraine, substance-use disorders, and anxiety disorder, which accounted for 70.9% of all DALYs due to neuropsychiatric disorders. Neurological disorders represented 5.03% of total all cause YLLs, whereas mental and substance-use disorders accounted for 0.8%. Mental and substance-use disorders accounted for 22.4% of total YLDs, with depression being the most disabling disorder. Neurological disorders represented 8.3% of total YLDs. Neuropsychiatric disorders were one of the leading causes of disability in 2010. This finding contributes to our understanding of the burden of neuropsychiatric disorders in the Spanish population and highlights the importance of prioritising neuropsychiatric disorders in the Spanish public health system. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Economic burden of malignant blood disorders across Europe: a population-based cost analysis.

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Burns, Richeal; Leal, Jose; Sullivan, Richard; Luengo-Fernandez, Ramon

2016-08-01

Malignant blood disorders are a leading contributor to cancer incidence and mortality across Europe. Despite their burden, no study has assessed the economic effect of blood cancers in Europe. We aimed to assess the economic burden of malignant blood disorders across the 28 countries in the European Union (EU), Iceland, Norway, and Switzerland. Malignant blood disorder-related costs were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary, outpatient, emergency, inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. For countries in the EU, malignant blood disorders were compared with the economic burden of overall cancer. Malignant blood disorders cost the 31 European countries €12 billion in 2012. Health-care cost €7·3 billion (62% of total costs), productivity losses cost €3·6 billion (30%), and informal care cost €1 billion (8%). For the EU countries, malignant blood disorders cost €6·8 billion (12%) of the total health-care expenditure on cancer (€57 billion), with this proportion being second only to breast cancer. In terms of total cancer costs in the EU (€143 billion), malignant blood disorders cost €12 billion (8%). Malignant blood disorders represent a leading cause of death, health-care service use, and costs, not only to European health-care systems, but to society overall. Our results add to essential public health knowledge needed for effective national cancer-control planning and priorities for public research funding. European Hematology Association. Copyright © 2016 Elsevier Ltd. All rights reserved.

Estimating the burden of paratyphoid a in Asia and Africa.

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Michael B Arndt

2014-06-01

Full Text Available Despite the increasing availability of typhoid vaccine in many regions, global estimates of mortality attributable to enteric fever appear stable. While both Salmonella enterica serovar Typhi (S. Typhi and serovar Paratyphi (S. Paratyphi cause enteric fever, limited data exist estimating the burden of S. Paratyphi, particularly in Asia and Africa. We performed a systematic review of both English and Chinese-language databases to estimate the regional burden of paratyphoid within Africa and Asia. Distinct from previous reviews of the topic, we have presented two separate measures of burden; both incidence and proportion of enteric fever attributable to paratyphoid. Included articles reported laboratory-confirmed Salmonella serovar classification, provided clear methods on sampling strategy, defined the age range of participants, and specified the time period of the study. A total of 64 full-text articles satisfied inclusion criteria and were included in the qualitative synthesis. Paratyphoid A was commonly identified as a cause of enteric fever throughout Asia. The highest incidence estimates in Asia came from China; four studies estimated incidence rates of over 150 cases/100,000 person-years. Paratyphoid A burden estimates from Africa were extremely limited and with the exception of Nigeria, few population or hospital-based studies from Africa reported significant Paratyphoid A burden. While significant gaps exist in the existing population-level estimates of paratyphoid burden in Asia and Africa, available data suggest that paratyphoid A is a significant cause of enteric fever in Asia. The high variability in documented incidence and proportion estimates of paratyphoid suggest considerable geospatial variability in the burden of paratyphoid fever. Additional efforts to monitor enteric fever at the population level will be necessary in order to accurately quantify the public health threat posed by S. Paratyphi A, and to improve the prevention

Economic burden of non-malignant blood disorders across Europe: a population-based cost study.

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Luengo-Fernandez, Ramon; Burns, Richeal; Leal, Jose

2016-08-01

Blood disorders comprise a wide range of diseases including anaemia, malignant blood disorders, and haemorrhagic disorders. Although they are a common cause of disease, no systematic cost-of-illness studies have been done to assess the economic effect of non-malignant blood disorders in Europe. We aimed to assess the economic burden of non-malignant blood disorders across the 28 countries of the European Union (EU), Iceland, Norway, and Switzerland. Non-malignant blood disorder-related costs (WHO International Classification of Diseases, 10th revision [ICD] D50-89) were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary care, outpatient care, emergency care, hospital inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. To these costs we added those due to malignant blood disorders (ICD-10 C81-96 and D47) as estimated in a Burns and colleagues' companion Article to obtain the total costs of blood disorders. Non-malignant disorders of the blood cost the 31 European countries €11 billion in 2012. Health-care costs accounted for €8 billion (75% of total costs), productivity losses for €2 billion (19%), and informal care for less than €1 billion (6%). Averaged across the European population studied, non-malignant disorders of the blood represented an annual health-care cost of €159 per ten citizens. Combining malignant and non-malignant blood disorders, the total cost of blood disorders was €23 billion in 2012. Our study highlights the economic burden that non-malignant blood disorders place on European health-care systems and societies. Our study also shows that blood disorder costs were evenly distributed between malignant and non

The burden of acute respiratory infections in Ecuador 2011-2015.

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Chicaiza-Ayala, Wilson; Henríquez-Trujillo, Aquiles R; Ortiz-Prado, Esteban; Douce, Richard W; Coral-Almeida, Marco

2018-01-01

Burden of disease studies intend to improve public health decision-making and to measure social and economic impact in population. The objective of this study was to describe the burden of acute respiratory infections (ARI) in Ecuador between 2011 and 2015. Five-year period morbidity and mortality data available from national agencies of statistics was analyzed to estimate the burden of disease attributable to acute respiratory infections. Cases and deaths registered were grouped according to their ICD-10 code into three diagnostic groups: Acute upper respiratory infections (J00-J06), Influenza and pneumonia (J09-J18), and Bronchitis and other acute lower respiratory infections (J20-J22, J85, J86). Disability-adjusted life years stratified by diagnostic and age group were calculated using the "DALY" package for R. The productivity loss in monetary terms was estimated using the human capital method. Over the 5-year period studied there were a total of 14.84 million cases of acute respiratory infections, with 17 757 deaths reported (0.12%). The yearly burden of disease ranged between 98 944 to 118 651 disability-adjusted life years, with an estimated average loss of productivity of US$152.16 million (±19.6) per year. Approximately 99% of the burden can be attributed to years life lost due to premature mortality in population under 5 years old and over 60 years-old. The burden of acute respiratory infections remained steady during the analyzed period. Evidence-based prevention and control policies to tackle acute respiratory infections in Ecuador should focus on the population at extreme ages of life.

Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study.

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Zafar, S Yousuf; McNeil, Rebecca B; Thomas, Catherine M; Lathan, Christopher S; Ayanian, John Z; Provenzale, Dawn

2015-03-01

The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics. In a national, prospective, observational, population- and health care systems-based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7.3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics. Among 1,000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n = 889) were cancer free, and 11% (n = 111) had advanced cancer. Overall, 48% (n = 482) reported difficulties living on their household income, and 41% (n = 396) believed their health care to be "excellent." High financial burden was associated with lower household income (adjusted odds ratio [OR] = 0.61 per $20k per year, P financial burden was also associated with poorer quality of life (adjusted beta = -0.06 per burden category; P Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden. Copyright © 2014 by American Society of Clinical Oncology.

Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population.

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Lòpez-De Fede, Ana; Stewart, John E; Hardin, James W; Mayfield-Smith, Kathy

2016-06-10

Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

Global economic burden of schizophrenia: a systematic review

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Chong HY

2016-02-01

Full Text Available Huey Yi Chong,1 Siew Li Teoh,1 David Bin-Chia Wu,1 Surachai Kotirum,1 Chiun-Fang Chiou,2 Nathorn Chaiyakunapruk1,3–5 1School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; 2Janssen Pharmaceutical Companies Asia Pacific, Singapore; 3Center of Pharmaceutical Outcomes Research (CPOR, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 4School of Pharmacy, University of Wisconsin, Madison, WI, USA; 5School of Population Health, University of Queensland, Brisbane, Australia Background: Schizophrenia is one of the top 25 leading causes of disability worldwide in 2013. Despite its low prevalence, its health, social, and economic burden has been tremendous, not only for patients but also for families, caregivers, and the wider society. The magnitude of disease burden investigated in an economic burden study is an important source to policymakers in decision making. This study aims to systematically identify studies focusing on the economic burden of schizophrenia, describe the methods and data sources used, and summarize the findings of economic burden of schizophrenia. Methods: A systematic review was performed for economic burden studies in schizophrenia using four electronic databases (Medline, EMBASE, PsycINFO, and EconLit from inception to August 31, 2014. Results: A total of 56 articles were included in this review. More than 80% of the studies were conducted in high-income countries. Most studies had undertaken a retrospective- and prevalence-based study design. The bottom-up approach was commonly employed to determine cost, while human capital method was used for indirect cost estimation. Database and literature were the most commonly used data sources in cost estimation in high-income countries, while chart review and interview were the main data sources in low and middle-income countries. Annual costs for the schizophrenia population in the country ranged from US$94

Understanding differences in the body burden-age relationships of bioaccumulating contaminants based on population cross sections versus individuals.

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Quinn, Cristina L; Wania, Frank

2012-04-01

Body burdens of persistent bioaccumulative contaminants estimated from the cross-sectional biomonitoring of human populations are often plotted against age. Such relationships have previously been assumed to reflect the role of age in bioaccumulation. We used a mechanistic modeling approach to reproduce concentration-versus-age relationships and investigate factors that influence them. CoZMoMAN is an environmental fate and human food chain bioaccumulation model that estimates time trends in human body burdens in response to time-variant environmental emissions. Trends of polychlorinated biphenyl (PCB) congener 153 concentrations versus age for population cross sections were estimated using simulated longitudinal data for individual women born at different times. The model was also used to probe the influence of partitioning and degradation properties, length of emissions, and model assumptions regarding lipid content and liver metabolism on concentration-age trends of bioaccumulative and persistent contaminants. Body burden-age relationships for population cross sections and individuals over time are not equivalent. The time lapse between the peak in emissions and sample collection for biomonitoring is the most influential factor controlling the shape of concentration-age trends for chemicals with human metabolic half-lives longer than 1 year. Differences in observed concentration-age trends for PCBs and polybrominated diphenyl ethers are consistent with differences in emission time trends and human metabolic half-lives. Bioaccumulation does not monotonically increase with age. Our model suggests that the main predictors of cross-sectional body burden trends with age are the amount of time elapsed after peak emissions and the human metabolic and environmental degradation rates.

The burden of disease due to tuberculosis in the state of Santa Catarina, Brazil.

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Ferrer, Glênio César Nunes; da Silva, Rosemeri Maurici; Ferrer, Kelian Tenfen; Traebert, Jefferson

2014-01-01

To estimate the burden of disease due to tuberculosis in the state of Santa Catarina, Brazil, in 2009. This was an epidemiological study with an ecological design. Data on tuberculosis incidence and mortality were collected from specific Brazilian National Ministry of Health databases. The burden of disease due to tuberculosis was based on the calculation of disability-adjusted life years (DALYs). The DALYs were estimated by adding the years of life lost (YLLs) and years lived with disability (YLDs). Absolute values were transformed into rates per 100,000 population. The rates were calculated by gender, age group, and health care macroregion. The burden of disease due to tuberculosis was 5,644.27 DALYs (92.25 DALYs/100,000 population), YLLs and YLDs respectively accounting for 78.77% and 21.23% of that total. The highest rates were found in males in the 30-44 and 45-59 year age brackets, although that was not true in every health care macroregion. Overall, the highest estimated burden was in the Planalto Norte macroregion (179.56 DALYs/100,000 population), followed by the Nordeste macroregion (167.07 DALYs/100,000 population). In the majority of the health care macroregions of Santa Catarina, the burden of disease due to tuberculosis was concentrated in adult males, the level of that concentration varying among the various macroregions.

The burden of disease due to tuberculosis in the state of Santa Catarina, Brazil

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Glenio Cesar Nunes Ferrer

2014-01-01

Full Text Available OBJECTIVE: To estimate the burden of disease due to tuberculosis in the state of Santa Catarina, Brazil, in 2009. METHODS: This was an epidemiological study with an ecological design. Data on tuberculosis incidence and mortality were collected from specific Brazilian National Ministry of Health databases. The burden of disease due to tuberculosis was based on the calculation of disability-adjusted life years (DALYs. The DALYs were estimated by adding the years of life lost (YLLs and years lived with disability (YLDs. Absolute values were transformed into rates per 100,000 population. The rates were calculated by gender, age group, and health care macroregion. RESULTS: The burden of disease due to tuberculosis was 5,644.27 DALYs (92.25 DALYs/100,000 population, YLLs and YLDs respectively accounting for 78.77% and 21.23% of that total. The highest rates were found in males in the 30-44 and 45-59 year age brackets, although that was not true in every health care macroregion. Overall, the highest estimated burden was in the Planalto Norte macroregion (179.56 DALYs/100,000 population, followed by the Nordeste macroregion (167.07 DALYs/100,000 population. CONCLUSIONS: In the majority of the health care macroregions of Santa Catarina, the burden of disease due to tuberculosis was concentrated in adult males, the level of that concentration varying among the various macroregions.

Seasonal Variation of Total Mercury Burden in the American Alligator (Alligator Mississippiensis) at Merritt Island National Wildlife Refuge (MINWR), Florida

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Nilsen, Frances M.; Dorsey, Jonathan E.; Long, Stephen E.; Schock, Tracey B.; Bowden, John A.; Lowers, Russell H.; Guillette, Louis J., Jr.

2016-01-01

Seasonal variation of mercury (Hg) is not well studied in free-ranging wildlife. Atmospheric deposition patterns of Hg have been studied in detail and have been modeled for both global and specific locations with great accuracy and correlates to environment impact. However, monitoring these trends in wildlife is complicated due to local environmental parameters (e.g., rainfall, humidity, pH, bacterial composition) that can affect the transformation of atmospheric Hg to the biologically available forms. Here, we utilized an abundant and healthy population of American alligators (Alligator mississippiensis) at Merritt Island National Wildlife Refuge (MINWR), FL, and assessed Hg burden in whole blood samples over a span of 7 years (2007 2014; n 174) in an effort to assess seasonal variation of total [Hg]. While the majority of this population is assumed healthy, 18 individuals with low body mass indices (BMI, defined in this study) were captured throughout the 7 year sampling period. These individual alligators exhibited [Hg] that were not consistent with the observed overall seasonal [Hg] variation, and were statistically different from the healthy population of alligators. The alligators with low BMI had elevated concentrations of Hg compared to their age/sex/season matched counterparts with normal BMI. Statistically significant differences were found between the winter and spring seasons for animals with normal BMI. The data in this report supports the conclusion that organismal total [Hg] do fluctuate directly with seasonal deposition rates as well as other seasonal environmental parameters, such as average rainfall and prevailing wind direction. This study highlights the unique environment of MINWR to permit annual assessment of apex predators, such as the American alligator, to determine detailed environmental impact of contaminants of concern.

The impact of individual-level heterogeneity on estimated infectious disease burden: a simulation study.

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McDonald, Scott A; Devleesschauwer, Brecht; Wallinga, Jacco

2016-12-08

Disease burden is not evenly distributed within a population; this uneven distribution can be due to individual heterogeneity in progression rates between disease stages. Composite measures of disease burden that are based on disease progression models, such as the disability-adjusted life year (DALY), are widely used to quantify the current and future burden of infectious diseases. Our goal was to investigate to what extent ignoring the presence of heterogeneity could bias DALY computation. Simulations using individual-based models for hypothetical infectious diseases with short and long natural histories were run assuming either "population-averaged" progression probabilities between disease stages, or progression probabilities that were influenced by an a priori defined individual-level frailty (i.e., heterogeneity in disease risk) distribution, and DALYs were calculated. Under the assumption of heterogeneity in transition rates and increasing frailty with age, the short natural history disease model predicted 14% fewer DALYs compared with the homogenous population assumption. Simulations of a long natural history disease indicated that assuming homogeneity in transition rates when heterogeneity was present could overestimate total DALYs, in the present case by 4% (95% quantile interval: 1-8%). The consequences of ignoring population heterogeneity should be considered when defining transition parameters for natural history models and when interpreting the resulting disease burden estimates.

Estimating the Burden of Serious Fungal Infections in Uruguay

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Marina Macedo-Viñas

2018-03-01

Full Text Available We aimed to estimate for the first time the burden of fungal infections in Uruguay. Data on population characteristics and underlying conditions were extracted from the National Statistics Institute, the World Bank, national registries, and published articles. When no data existed, risk populations were used to estimate frequencies extrapolating from the literature. Population structure (inhabitants: total 3,444,006; 73% adults; 35% women younger than 50 years. Size of populations at risk (total cases per year: HIV infected 12,000; acute myeloid leukemia 126; hematopoietic stem cell transplantation 30; solid organ transplants 134; COPD 272,006; asthma in adults 223,431; cystic fibrosis in adults 48; tuberculosis 613; lung cancer 1400. Annual incidence estimations per 100,000: invasive aspergillosis, 22.4; candidemia, 16.4; Candida peritonitis, 3.7; Pneumocystis jirovecii pneumonia, 1.62; cryptococcosis, 0.75; severe asthma with fungal sensitization, 217; allergic bronchopulmonary aspergillosis, 165; recurrent Candida vaginitis, 6323; oral candidiasis, 74.5; and esophageal candidiasis, 25.7. Although some under and overestimations could have been made, we expect that at least 127,525 people suffer from serious fungal infections each year. Sporothrichosis, histoplasmosis, paracoccidioidomycosis, and dermatophytosis are known to be frequent but no data are available to make accurate estimations. Given the magnitude of the burden of fungal infections in Uruguay, efforts should be made to improve surveillance, strengthen laboratory diagnosis, and warrant access to first line antifungals.

The predictive factors for perceived social support among cancer patients and caregiver burden of their family caregivers in Turkish population.

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Oven Ustaalioglu, Basak; Acar, Ezgi; Caliskan, Mecit

2018-03-01

We aimed to identify the predictive factors for the perceived family social support among cancer patients and caregiver burden of their family caregivers. Participants were 302 cancer patients and their family caregivers. Family social support scale was used for cancer patients, burden interview was used for family caregivers.All subjects also completed Beck depression invantery. The related socio-demographical factors with perceived social support (PSS) and caregiver burden were evaluated by correlation analysis. To find independent factors predicting caregiver burden and PSS, logistic regression analysis were conducted. Depression scores was higher among patients than their family caregivers (12.5 vs. 8). PSS was lower in depressed patients (p Family caregiver burden were also higher in depressive groups (p family caregiver role was negatively correlated (p caregiver burden. Presence of depression was the independent predictor for both, lower PSS for patients and higher burden for caregivers. The results of this study is noteworthy because it may help for planning any supportive care program not only for patients but together with their caregiver at the same time during chemotherapy period in Turkish population.

Measuring Burden of Diseases in a Rapidly Developing Economy: State of Qatar

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Bener, Abdulbari; Zirie, Mahmoud A.; Kim, Eun-Jung; Buz, Rama Al; Zaza, Mouayyad; Al-Nufal, Mohammed; Basha, Basma; Hillhouse, Edward W; Riboli, Elio

2013-01-01

Background: The Global Burden of Disease (GBD) study has provided a conceptual and methodological framework to quantify and compare the health of populations. Aim: The objective of the study was to assess the national burden of disease in the population of Qatar using the disability-adjusted life year (DALYs) as a measure of disability. Methods: We adapted the methodology described by the World Health Organization for conducting burden of disease to calculate years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability adjusted life years (DALYs). The study was conducted during the period from November 2011 to October 2012. Results:: The study findings revealed that ischemic heart disease (11.8%) and road traffic accidents (10.3%) were the two leading causes of burden of diseases in Qatar in 2010. The burden of diseases among men (222.04) was found three times more than of women's (71.85). Of the total DALYs, 72.7% was due to non fatal health outcomes and 27.3% was due to premature death. For men, chronic diseases like ischemic heart disease (15.7%) and road traffic accidents (13.7%) accounted great burden and an important source of lost years of healthy life. For women, birth asphyxia and birth trauma (12.6%) and abortion (4.6%) were the two leading causes of disease burden. Conclusion:: The results of the study have shown that the national health priority areas should cover cardiovascular diseases, road traffic accidents and mental health. The burden of diseases among men was three times of women's. PMID:23445701

Estimating Cryptosporidium and Giardia disease burdens for children drinking untreated groundwater in a rural population in India.

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Daniels, Miles E; Smith, Woutrina A; Jenkins, Marion W

2018-01-01

In many low-income settings, despite improvements in sanitation and hygiene, groundwater sources used for drinking may be contaminated with enteric pathogens such as Cryptosporidium and Giardia, which remain important causes of childhood morbidity. In this study, we examined the contribution of diarrhea caused by Cryptosporidium and Giardia found in groundwater sources used for drinking to the total burden of diarrheal disease among children cause (i.e., all fecal-oral enteric pathogens and exposure pathways) child diarrhea prevalence rates observed in the study population during two monsoon seasons (2012 and 2013). We used site specific and regional studies to inform assumptions about the human pathogenicity of the Cryptosporidium and Giardia species present in local groundwater. In all three human pathogenicity scenarios evaluated, the mean daily risk of Cryptosporidium or Giardia infection (0.06-1.53%), far exceeded the tolerable daily risk of infection from drinking water in the US (water was as high as 6.5% or as low as cause diarrhea disease burden measured in children causing diarrhea than did Giardia. Diarrhea prevalence estimates for waterborne Cryptosporidium infection appeared to be most sensitive to assumptions about the probability of infection from ingesting a single parasite (i.e. the rate parameter in dose-response model), while Giardia infection was most sensitive to assumptions about the viability of parasites detected in groundwater samples. Protozoa in groundwater drinking sources in rural India, even at low concentrations, especially for Cryptosporidium, may account for a significant portion of child diarrhea morbidity in settings were tubewells are used for drinking water and should be more systematically monitored. Preventing diarrheal disease burdens in Puri District and similar settings will benefit from ensuring water is microbiologically safe for consumption and consistent and effective household water treatment is practiced.

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013

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Cassini, Alessandro; Colzani, Edoardo; Pini, Alessandro; Mangen, Marie-Josee J; Plass, Dietrich; McDonald, Scott A; Maringhini, Guido; van Lier, Alies; Haagsma, Juanita A; Havelaar, Arie H; Kramarz, Piotr; Kretzschmar, Mirjam E

2018-01-01

Background and aims The Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25–1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control. PMID:29692315

Estimating Cryptosporidium and Giardia disease burdens for children drinking untreated groundwater in a rural population in India.

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Miles E Daniels

2018-01-01

Full Text Available In many low-income settings, despite improvements in sanitation and hygiene, groundwater sources used for drinking may be contaminated with enteric pathogens such as Cryptosporidium and Giardia, which remain important causes of childhood morbidity. In this study, we examined the contribution of diarrhea caused by Cryptosporidium and Giardia found in groundwater sources used for drinking to the total burden of diarrheal disease among children < 5 in rural India.We studied a population of 3,385 children < 5 years of age in 100 communities of Puri District, Odisha, India. We developed a coupled quantitative microbial risk assessment (QMRA and susceptible-infected-recovered (SIR population model based on observed levels of Cryptosporidium and Giardia in improved groundwater sources used for drinking and compared the QMRA-SIR estimates with independently measured all-cause (i.e., all fecal-oral enteric pathogens and exposure pathways child diarrhea prevalence rates observed in the study population during two monsoon seasons (2012 and 2013. We used site specific and regional studies to inform assumptions about the human pathogenicity of the Cryptosporidium and Giardia species present in local groundwater. In all three human pathogenicity scenarios evaluated, the mean daily risk of Cryptosporidium or Giardia infection (0.06-1.53%, far exceeded the tolerable daily risk of infection from drinking water in the US (< 0.0001%. Depending on which protozoa species were present, median estimates of daily child diarrhea prevalence due to either Cryptosporidium or Giardia infection from drinking water was as high as 6.5% or as low as < 1% and accounted for at least 2.9% and as much as 65.8% of the all-cause diarrhea disease burden measured in children < 5 during the study period. Cryptosporidium tended to account for a greater share of estimated waterborne protozoa infections causing diarrhea than did Giardia. Diarrhea prevalence estimates for waterborne

Factors affecting burden on caregivers of stroke survivors: Population-based study in Mumbai (India

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Madhumita Bhattacharjee

2012-01-01

Full Text Available Background: Caring for stroke patients leads to caregiver (CG strain. The aims of this study are to identify factors related to increased CG burden in stroke survivors in a census-defined population and to assess the relationship between patient characteristics and CG stress. Materials and Methods: In a prospective population-based study, 223 first ever stroke (FES were identified over a 1-year period. At 28 days, 127 (56.9% were alive and 79 (35% died, and 17 were lost to follow-up. One hundred and eleven CGs of 127 FES survivors agreed to participate. The level of stress was assessed by two scales: Oberst Caregiving Burden Scale (OCBS and the Caregivers Strain Index (CSI in CGs of survivors with mild stroke Modified Rankin Scale (MRS 1-2 and in those with significant disability (MRS 3-5. Results: The mean age of CGs was 45.6 years, approximately 22 years younger than that of the patients (67.5 years. Eighty-nine (80% of the CGs were females and only 22 (20% were males. Urinary incontinence (P=0.000008, morbidity at 28 days by MRS (P=0.0051, female gender (P=0.0183 and moderate to severe neurological deficit by National Institute of Health Stroke Scale (NIHSS on admission (P=0.0254 were factors in FES cases leading to major CGs stress. CG factors responsible for major stress were long caregiving hours (P≤0.000001, anxiety (P≤0.000001, disturbed night sleep ( P≤0.000001, financial stress (P=0.0000108, younger age (P=0.0021 and CGs being daughter-in-laws (P=0.012. Conclusion: Similar studies using uniform methodologies would help to identify factors responsible for major CG stress. Integrated stroke rehabilitation services should address CG issues to local situations and include practical training in simple nursing skills and counseling sessions to help reduce CG burden.

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

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Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-12-01

The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes. We classified the reasons for readmissions as either procedure- or medical-related. Cost-to-charge ratios supplied with the Nationwide Readmissions Database were used to compute the individual per-patient cost of 90-day readmissions as a continuous variable in separate general linear models for THA and TKA. Payer, patient, clinical, and hospital factors were treated as covariates. We estimated the national burden of readmissions by payer and by the reason for readmission. The national rates of 30- and 90-day readmissions after THA were 4% (95% confidence interval [CI], 4.2%-4.5%) and 8% (95% CI, 7.5%-8.1%), respectively. The national rates of 30- and 90-day readmissions after primary TKA were 4% (95% CI, 3.8%-4.0%) and 7% (95% CI, 6.8%-7.2%), respectively. The five most important variables responsible for the cost of 90-day THA readmissions (in rank order, based

Economic burden of sarcoidosis in a commercially-insured population in the United States.

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Rice, J Bradford; White, Alan; Lopez, Andrea; Conway, Alexandra; Wagh, Aneesha; Nelson, Winnie W; Philbin, Michael; Wan, George J

2017-10-01

Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis. To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US. Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 ("index date") were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date ("outcome period"). A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p economic burden to payers in the first year following diagnosis.

Disease burden of methylmercury in the German birth cohort 2014.

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Julia Lackner

Full Text Available This study aimed to estimate the disease burden of methylmercury for children born in Germany in the year 2014. Humans are mainly exposed to methylmercury when they eat fish or seafood. Prenatal methylmercury exposure is associated with IQ loss. To quantify this disease burden, we used Monte Carlo simulation to estimate the incidence of mild and severe mental retardation in children born to mothers who consume fish based on empirical data. Subsequently, we calculated the disease burden with the disability-adjusted life years (DALY-method. DALYs combine mortality and morbidity in one measure and quantify the gap between an ideal situation, where the entire population experiences the standard life expectancy without disease and disability, and the actual situation. Thus, one DALY corresponds to the loss of one year of life in good health. The methylmercury-induced burden of disease for the German birth cohort 2014 was an average of 14,186 DALY (95% CI 12,915-15,440 DALY. A large majority of the DALYs was attributed to morbidity as compared to mortality. Of the total disease burden, 98% were attributed to mild mental retardation, which only leads to morbidity. The remaining disease burden was a result of severe mental retardation with equal proportions of premature death and morbidity.

[Estimation on the indirect economic burden of disease-related premature deaths in China, 2012].

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Yang, Juan; Feng, Luzhao; Zheng, Yaming; Yu, Hongjie

2014-11-01

To estimate the indirect economic burden of disease-related premature deaths in China, 2012. Both human capital approach and friction cost methods were used to compute the indirect economic burden of premature deaths from the following sources: mortality from the national disease surveillance system in 2012, average annual income per capita from the China Statistic Yearbook in 2012, population size from the 2010 China census, and life expectancy in China from the World Health Organization life table. Data from the Human Capital Approach Estimates showed that the indirect economic burden of premature deaths in China was 425.1 billion in 2012, accounting for 8‰ of the GDP. The indirect economic burden of chronic non-communicable diseases associated premature deaths was accounted for the highest proportion(67.1%, 295.4 billion), followed by those of injuries related premature deaths (25.6% , 108.9 billion), infectious diseases, maternal and infants diseases, and malnutrition related deaths (6.4% , 26.9 billion). The top five premature deaths that cause the indirect economic burden were malignancy, cardiovascular diseases, unintentional injuries, intentional injuries, and diseases of the respiratory system. The indirect economic burden of premature deaths mainly occurred in the population of 20-59 year-olds. Under the Friction Cost method, the estimates appeared to be 0.11%-3.49% of the total human capital approach estimates. Premature death caused heavy indirect economic burden in China. Chronic non-communicable diseases and injuries seemed to incur the major disease burden. The indirect economic burden of premature deaths mainly occurred in the working age group.

Estimating the burden of disease attributable to diabetes in South Africa in 2000.

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Bradshaw, Debbie; Norman, Rosana; Pieterse, Desiréé; Levitt, Naomi S

2007-08-01

To estimate the burden of disease attributable to diabetes by sex and age group in South Africa in 2000. The framework adopted for the most recent World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies used to derive the prevalence of diabetes by population group were weighted proportionately for a national estimate. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. South Africa. Adults 30 years and older. Mortality and disability-adjusted life years (DALYs) for ischaemic heart disease (IHD), stroke, hypertensive disease and renal failure. Of South Africans aged >or= 30 years, 5.5% had diabetes which increased with age. Overall, about 14% of IHD, 10% of stroke, 12% of hypertensive disease and 12% of renal disease burden in adult males and females (30+ years) were attributable to diabetes. Diabetes was estimated to have caused 22,412 (95% uncertainty interval 20,755 - 24,872) or 4.3% (95% uncertainty interval 4.0 - 4.8%) of all deaths in South Africa in 2000. Since most of these occurred in middle or old age, the loss of healthy life years comprises a smaller proportion of the total 258,028 DALYs (95% uncertainty interval 236,856 - 290,849) in South Africa in 2000, accounting for 1.6% (95% uncertainty interval 1.5 - 1.8%) of the total burden. Diabetes is an important direct and indirect cause of burden in South Africa. Primary prevention of the disease through multi-level interventions and improved management at primary health care level are needed.

Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.

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Allen, Harris; Rogers, William H; Bunn, William B; Pikelny, Dan B; Naim, Ahmad B

2012-08-01

To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010.

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Chatham-Stephens, Kevin; Caravanos, Jack; Ericson, Bret; Sunga-Amparo, Jennifer; Susilorini, Budi; Sharma, Promila; Landrigan, Philip J; Fuller, Richard

2013-07-01

Prior calculations of the burden of disease from toxic exposures have not included estimates of the burden from toxic waste sites due to the absence of exposure data. We developed a disability-adjusted life year (DALY)-based estimate of the disease burden attributable to toxic waste sites. We focused on three low- and middle-income countries (LMICs): India, Indonesia, and the Philippines. Sites were identified through the Blacksmith Institute's Toxic Sites Identification Program, a global effort to identify waste sites in LMICs. At least one of eight toxic chemicals was sampled in environmental media at each site, and the population at risk estimated. By combining estimates of disease incidence from these exposures with population data, we calculated the DALYs attributable to exposures at each site. We estimated that in 2010, 8,629,750 persons were at risk of exposure to industrial pollutants at 373 toxic waste sites in the three countries, and that these exposures resulted in 828,722 DALYs, with a range of 814,934-1,557,121 DALYs, depending on the weighting factor used. This disease burden is comparable to estimated burdens for outdoor air pollution (1,448,612 DALYs) and malaria (725,000 DALYs) in these countries. Lead and hexavalent chromium collectively accounted for 99.2% of the total DALYs for the chemicals evaluated. Toxic waste sites are responsible for a significant burden of disease in LMICs. Although some factors, such as unidentified and unscreened sites, may cause our estimate to be an underestimate of the actual burden of disease, other factors, such as extrapolation of environmental sampling to the entire exposed population, may result in an overestimate of the burden of disease attributable to these sites. Toxic waste sites are a major, and heretofore underrecognized, global health problem.

Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire

OpenAIRE

Steiner, Timothy J; Gururaj, Gopalakrishna; Andrée, Colette; Katsarava, Zaza; Ayzenberg, Ilya; Yu, Sheng-Yuan; Al Jumah, Mohammed; Tekle-Haimanot, Redda; Birbeck, Gretchen L; Herekar, Arif; Linde, Mattias; Mbewe, Edouard; Manandhar, Kedar; Risal, Ajay; Jensen, Rigmor

2014-01-01

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking initiatives to improve and standardize methods in use for cross-sectional studies. One requirement is for a survey instrument with proven cross-cultural validity. This report describes the developme...

Model-based estimation of finite population total in stratified sampling

African Journals Online (AJOL)

The work presented in this paper concerns the estimation of finite population total under model – based framework. Nonparametric regression approach as a method of estimating finite population total is explored. The asymptotic properties of the estimators based on nonparametric regression are also developed under ...

The burden of occupationally-related cutaneous malignant melanoma in Britain due to solar radiation.

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Rushton, Lesley; J Hutchings, Sally

2017-02-14

Increasing evidence highlights the association of occupational exposure and cutaneous malignant melanoma (CMM). We estimated the burden of CMM and total skin cancer burden in Britain due to occupational solar radiation exposure. Attributable fractions (AF) and numbers were estimated for CMM mortality and incidence using risk estimates from the published literature and national data sources for proportions exposed. We extended existing methods to account for the exposed population age structure. The estimated total AF for CMM is 2.0% (95% CI: 1.4-2.7%), giving 48 (95% CI: 33-64) deaths in (2012) and 241 (95% CI: 168-325) registrations (in 2011) attributable to occupational exposure to solar radiation. Higher exposure and larger numbers exposed led to much higher numbers for men than women. Industries of concern are construction, agriculture, public administration and defence, and land transport. These results emphasise the urgent need to develop appropriate strategies to reduce this burden.

Burden of Sexual Dysfunction.

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Balon, Richard

2017-01-02

Similar to the burden of other diseases, the burden of sexual dysfunction has not been systematically studied. However, there is growing evidence of various burdens (e.g., economic, symptomatic, humanistic) among patients suffering from sexual dysfunctions. The burden of sexual dysfunction has been studied a bit more often in men, namely the burden of erectile dysfunction (ED), premature ejaculation (PE) and testosterone deficiency syndrome (TDS). Erectile dysfunction is frequently associated with chronic conditions such as cardiovascular disease, diabetes, and depression. These conditions could go undiagnosed, and ED could be a marker of those diseases. The only available report from the United Kingdom estimated the total economic burden of ED at £53 million annually in terms of direct costs and lost productivity. The burden of PE includes significant psychological distress: anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, and interpersonal difficulties. Some suggest that increase in female sexual dysfunction is associated with partner's PE, in addition to significant interpersonal difficulties. The burden of TDS includes depression, sexual dysfunction, mild cognitive impairment, and osteoporosis. One UK estimate of the economic burden of female sexual dysfunctions demonstrated that the average cost per patient was higher than the per annum cost of ED. There are no data on burden of paraphilic disorders. The burden of sexual dysfunctions is underappreciated and not well studied, yet it is significant for both the patients and the society.

Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level.

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Kearns, Karen; Dee, Anne; Fitzgerald, Anthony P; Doherty, Edel; Perry, Ivan J

2014-02-10

Overweight and obesity prevalence has risen dramatically in recent decades. While it is known that overweight and obesity is associated with a wide range of chronic diseases, the cumulative burden of chronic disease in the population associated with overweight and obesity is not well quantified. The aims of this paper were to examine the associations between BMI and chronic disease prevalence; to calculate Population Attributable Fractions (PAFs) associated with overweight and obesity; and to estimate the impact of a one unit reduction in BMI on the population prevalence of chronic disease. A cross-sectional analysis of 10,364 adults aged ≥18 years from the Republic of Ireland National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007) was performed. Using binary regression, we examined the relationship between BMI and the selected chronic diseases. In further analyses, we calculated PAFs of selected chronic diseases attributable to overweight and obesity and we assessed the impact of a one unit reduction in BMI on the overall burden of chronic disease. Overweight and obesity prevalence was higher in men (43.0% and 16.1%) compared to women (29.2% and 13.4%), respectively. The most prevalent chronic conditions were lower back pain, hypertension, and raised cholesterol. Prevalence of chronic disease generally increased with increasing BMI. Compared to normal weight persons, the strongest associations were found in obese women for diabetes (RR 3.9, 95% CI 2.5-6.3), followed by hypertension (RR 2.9, 95% CI 2.3-3.6); and in obese men for hypertension (RR 2.1, 95% CI 1.6-2.7), followed by osteoarthritis (RR 2.0, 95% CI 1.2-3.2). Calculated PAFs indicated that a large proportion of chronic disease is attributable to increased BMI, most noticeably for diabetes in women (42%) and for hypertension in men (30%). Overall, a one unit decrease in BMI results in 26 and 28 fewer cases of chronic disease per 1,000 men and women, respectively. Overweight and obesity are

The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations.

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Ramirez-Zea, Manuel; Kroker-Lobos, Maria F; Close-Fernandez, Regina; Kanter, Rebecca

2014-12-01

As the prevalence of obesity increases in developing countries, the double burden of malnutrition (DBM) has become a public health problem, particularly in countries such as Guatemala with a high concentration of indigenous communities where the prevalence of stunting remains high. The aim was to describe and analyze the prevalence of DBM over time (1998-2008) in indigenous and nonindigenous Guatemalan populations. We used 3 National Maternal and Child Health Surveys conducted in Guatemala between 1998 and 2008 that include anthropometric data from children aged 0-60 mo and women of reproductive age (15-49 y). We assessed the prevalence of childhood stunting and both child and adult female overweight and obesity between 1998 and 2008. For the year 2008, we assessed the prevalence of DBM at the household (a stunted child and an overweight mother) and individual (stunting/short stature and overweight or anemia and overweight in the same individual) levels and compared the expected and observed prevalence rates to test if the coexistence of the DBM conditions corresponded to expected values. Between 1998 and 2008, the prevalence of childhood stunting decreased in both indigenous and nonindigenous populations, whereas overweight and obesity in women increased faster in indigenous populations than in nonindigenous populations (0.91% compared with 0.38%/y; P-trend < 0.01). In 2008, the prevalence of stunted children was 28.8 percentage points higher and of overweight women 4.6 percentage points lower in indigenous compared with nonindigenous populations (63.7% compared with 34.9% and 46.7% compared with 51.3%, respectively). DBM at the household and individual levels was higher in indigenous populations and was higher in geographic areas in which most of the population was indigenous, where there was also a greater prevalence of stunting and DBM at the individual level, both in women and children. In Guatemala, DBM is more prevalent in indigenous than in nonindigenous

Disease burden in four populations of dog and cat breeds compared to mixed-breed dogs and European shorthair cats.

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Keijser, S F A; Meijndert, L E; Fieten, H; Carrière, B J; van Steenbeek, F G; Leegwater, P A J; Rothuizen, J; Nielen, M

2017-05-01

Current public and professional opinion is that many dog breeds suffer from health issues related to inherited diseases or extreme phenotypes. The aim of this historical comparative observational study was to evaluate the breed-related disease burden in three purebred dog populations (Chihuahua, French bulldog, Labrador retriever) and one purebred cat breed (Persian cats) in the Netherlands by comparison to a control population of mixed-breed dogs and European Shorthair cats. A qualitative query was performed, consisting of a literature review and collecting the expert opinions of University veterinary specialists, to gather insight into potential diseases of the study population. Next, a referral clinic case control study of the patients referred to specific medical disciplines in the University Clinic was performed. The odds ratio (OR) was calculated to determine the likelihood of a patient referred to a particular medical discipline being a certain breed. Together, the qualitative query and the case control study resulted in a list of potentially relevant diseases limited to five organ systems per breed. These were analysed in data from primary practices. Patient files from ten primary practices over a period of two years were manually extracted and examined. Four-hundred individual patient records per breed as well as 1000 non-breed records were randomly selected from the 10 practices, weighted per practice size. Records were then examined and the presence or absence of certain diseases was identified. To evaluate the disease burden per breed, proportional difference (PD) was estimated, as well as the animal's age at presentation in months. The results of the referral clinic case control study showed an overrepresentation (Odds Ratio>1.5) of the selected breeds in several medical specialties, while median age at presentation was in some cases significantly lower than in the non-breed animals. Results of the practice-based extended cross-sectional study showed

The Global Burden of Potential Productivity Loss from Uncorrected Presbyopia.

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Frick, Kevin D; Joy, Susan M; Wilson, David A; Naidoo, Kovin S; Holden, Brien A

2015-08-01

The onset of presbyopia in middle adulthood results in potential losses in productivity among otherwise healthy adults if uncorrected or undercorrected. The economic burden could be significant in lower-income countries, where up to 94% of cases may be uncorrected or undercorrected. This study estimates the global burden of potential productivity lost because of uncorrected functional presbyopia. Population data from the US Census Bureau were combined with the estimated presbyopia prevalence, age of onset, employment rate, gross domestic product (GDP) per capita in current US dollars, and near vision impairment disability weights from the Global Burden of Disease 2010 study to estimate the global loss of productivity from uncorrected and undercorrected presbyopia in each country in 2011. To allow comparison with earlier work, we also calculated the loss with the conservative assumption that the contribution to productivity extends only up to 50 years of age. The economic modeling did not require the use of subjects. We estimated the number of cases of uncorrected or undercorrected presbyopia in each country among the working-age population. The number of working-age cases was multiplied by the labor force participation rate, the employment rate, a disability weight, and the GDP per capita to estimate the potential loss of GDP due to presbyopia. The outcome being measured is the lost productivity in 2011 US dollars resulting from uncorrected or undercorrected presbyopia. There were an estimated 1.272 billion cases of presbyopia worldwide in 2011. A total of 244 million cases, uncorrected or undercorrected among people aged productivity loss of US $11.023 billion (0.016% of global GDP). If all those people aged productive, the potential productivity loss would be US $25.367 billion or 0.037% of global GDP. Correcting presbyopia to the level achieved in Europe would reduce the burden to US $1.390 billion (0.002% of global GDP). Even with conservative assumptions

Seroprevalence and disease burden of acute hepatitis A in adult population in South Korea.

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Jin Gu Yoon

Full Text Available Adult seroprevalence of HAV is decreasing in developed countries including South Korea, due to general sanitation improvement. Although hepatitis A vaccination was introduced in South Korea more than 20 years ago, recent infection rates have not decreased. In this study, we investigate the seroprevalence of anti-HAV IgG, and estimate the national disease burden of acute hepatitis A in adult population.Seroprevalence data were collected from health promotion center of Korea University Guro Hospital, in Seoul, Korea from 2010 to 2014. Data from adults (≥20-years being tested for anti-HAV IgG were included. In addition, epidemiological and clinical data of patients diagnosed with acute hepatitis A from 2009 to 2013, were collected from Korean Statistical Information Service (KOSIS and the National Health Insurance Service (NHIS database. Data were stratified and compared by age groups.A total of 11,177 subjects were tested for anti-HAV IgG from 2010 to 2014. Age-related seroprevalence showed relatively low seropositivity in young adults. Incidence of acute hepatitis A was highest in 2009 and lowest in 2013. When categorized by age group, adults in their 20s and 30s had more HAV infections and related-admissions than older adults. However, ICU admission rate and average insurance-covered cost was high in older adults.The anti-HAV IgG seropositivity in Korean younger adult population was low while the incidence of acute hepatitis A was high, especially in the 20-39 aged. However, a substantial number of older adults were infected, and required more intensive procedures and incurred higher insurance-covered medical costs.

Cost and disease burden of Dengue in Cambodia

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Beauté Julien

2010-08-01

Full Text Available Abstract Background Dengue is endemic in Cambodia (pop. estimates 14.4 million, a country with poor health and economic indicators. Disease burden estimates help decision makers in setting priorities. Using recent estimates of dengue incidence in Cambodia, we estimated the cost of dengue and its burden using disability adjusted life years (DALYs. Methods Recent population-based cohort data were used to calculate direct and productive costs, and DALYs. Health seeking behaviors were taken into account in cost estimates. Specific age group incidence estimates were used in DALYs calculation. Results The mean cost per dengue case varied from US$36 - $75 over 2006-2008 respectively, resulting in an overall annual cost from US$3,327,284 in 2008 to US$14,429,513 during a large epidemic in 2007. Patients sustain the highest share of costs by paying an average of 78% of total costs and 63% of direct medical costs. DALY rates per 100,000 individuals ranged from 24.3 to 100.6 in 2007-2008 with 80% on average due to premature mortality. Conclusion Our analysis confirmed the high societal and individual family burden of dengue. Total costs represented between 0.03 and 0.17% of Gross Domestic Product. Health seeking behavior has a major impact on costs. The more accurate estimate used in this study will better allow decision makers to account for dengue costs particularly among the poor when balancing the benefits of introducing a potentially effective dengue vaccine.

Health and economic burden of obesity in Brazil.

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Ketevan Rtveladze

Full Text Available INTRODUCTION: Higher and lower-middle income countries are increasingly affected by obesity. Obesity-related diseases are placing a substantial health and economic burden on Brazil. Our aim is to measure the future consequences of these trends on the associated disease burden and health care costs. METHOD: A previously developed micro-simulation model is used to project the extent of obesity, obesity-related diseases and associated healthcare costs to 2050. In total, thirteen diseases were considered: coronary heart disease, stroke, hypertension, diabetes, osteoarthritis, and eight cancers. We simulated three hypothetical intervention scenarios: no intervention, 1% and 5% reduction in body mass index (BMI. RESULTS: In 2010, nearly 57% of the Brazilian male population was overweight or obese (BMI ≥25 kg/m(2, but the model projects rates as high as 95% by 2050. A slightly less pessimistic picture is predicted for females, increasing from 43% in 2010 to 52% in 2050. Coronary heart disease, stroke, hypertension, cancers, osteoarthritis and diabetes prevalence cases are projected to at least double by 2050, reaching nearly 34,000 cases of hypertension by 2050 (per 100,000. 1% and 5% reduction in mean BMI will save over 800 prevalence cases and nearly 3,000 cases of hypertension by 2050 respectively (per 100,000. The health care costs will double from 2010 ($5.8 billion in 2050 alone ($10.1 billion. Over 40 years costs will reach $330 billion. However, with effective interventions the costs can be reduced to $302 billion by 1% and to $273 billion by 5% reduction in mean BMI across the population. CONCLUSION: Obesity rates are rapidly increasing creating a high burden of disease and associated costs. However, an effective intervention to decrease obesity by just 1% will substantially reduce obesity burden and will have a significant effect on health care expenditure.

Economic burden of stroke in a large county in Sweden

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Persson Josefine

2012-09-01

Full Text Available Abstract Background Stroke remains to be a major burden of disease, often causing death or physical impairment or disability. This paper estimates the economic burden of stroke in a large county of 1.5 million inhabitants in western Sweden. Methods The economic burden of stroke was estimated from a societal perspective with an incidence approach. Data were collected from clinical registries and 3,074 patients were included. In the cost calculations, both direct and indirect costs were estimated and were based on costs for 12 months after a first-ever stroke. Results The total excess costs in the first 12 months after the first-ever stroke for a population of 1.5 million was 629 million SEK (€69 million. Men consumed more acute care in hospitals, whereas women consumed more rehabilitation and long-term care provided by the municipalities. Younger patients brought a significantly higher burden on society compared with older patients due to the loss of productivity and the increased use of resources in health care. Conclusions The results of this cost-of-illness study were based on an improved calculation process in a number of fields and are consistent with previous studies. In essence, 50% of costs for stroke care fall on acute care hospital, 40% on rehabilitation and long-time care and informal care and productivity loss explains 10% of total cost for the stroke disease. The result of this study can be used for further development of the methods for economic analyses as well as for analysis of improvements and investments in health care.

Economic burden and cost determinants of coronary heart disease in rural southwest China: a multilevel analysis.

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Le, C; Fang, Y; Linxiong, W; Shulan, Z; Golden, A R

2015-01-01

To estimate the economic burden of coronary heart disease (CHD) in a given year (2010), including direct and indirect costs, and examine the impact of contextual and individual socio-economic (SES) predictors on the costs of CHD among adults in rural southwest China. Cross-sectional community survey. In total, 4595 adults (aged ≥18 years) participated in this study. A prevalence-based cost-of-illness approach was used to estimate the economic burden of CHD. Information on demographic characteristics of the study population and the economic consequences of CHD was obtained using a standard questionnaire. Multilevel linear regression was used to model the variation in costs of CHD. In the study population, the overall prevalence of CHD was 2.9% (3.5% for males, 2.3% for females). The total cost of CHD was estimated to be US$17 million. Inpatient hospitalizations represented the main component of direct costs of CHD, and direct costs accounted for the greatest proportion of the economic burden of CHD. Males were more likely to have a higher economic burden of CHD than females. A positive association was found between the individual's level of education and the economic burden of CHD. Residence in a higher-income community was associated with higher costs related to CHD. This study found that both contextual and individual SES were closely associated with the costs of CHD. Future strategies for CHD interventions and improved access to affordable medications to treat and control CHD should focus on less-educated individuals and communities with lower SES. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Estimation of the burden of chronic and allergic pulmonary aspergillosis in India.

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Ritesh Agarwal

Full Text Available It would be of considerable interest to clinicians if the burden of chronic pulmonary aspergillosis (CPA and allergic bronchopulmonary aspergillosis (ABPA in India were known. Herein, we estimate the burden of CPA following pulmonary tuberculosis (PTB, and ABPA (and severe asthma with fungal sensitization [SAFS] complicating asthma.We used the population estimates for India from the 2011 census data. The burden of asthma was estimated using three different methods (Global Initiative against Asthma [GINA] report statement, World Health Survey [WHS] estimates, Indian study on the epidemiology of asthma and chronic bronchitis [INSEARCH]. Global and India-specific figures were used for calculating the prevalence of ABPA and SAFS. The World Health Organization estimates were used for calculating PTB rates while the frequency of CPA was assessed from a previously published scoping review. Sensitivity analysis was performed to determine the burden in various scenarios.The total Indian population in 2011 was 1.2 billion. The asthma prevalence in adults was estimated at about 27.6 (range, 17-30 million. The burden of ABPA ranged from 0.12-6.09 million with different assumptions (best estimate, 1.38 [range, 0.86-1.52] million. The prevalence of SAFS was approximated at about 0.52-1.21 million (best estimate, 0.96 [range, 0.6-1.06] million. The incident TB cases were about 2.1 million while the annual incidence of CPA varied 27,000-0.17 million cases, with different estimates. If the mortality of CPA is estimated as 15% annually, the 5-year prevalence of CPA was placed at 290,147 cases with 5-year prevalence rate being 24 per 100,000.There is a significant burden of ABPA, SAFS and CPA in India. Prospective community-based studies are required to accurately determine the prevalence of these disorders.

Burden of Disease Attributable to Suboptimal Breastfeeding in Iran during 1990-2010; Findings from the Global Burden of Disease Study 2010

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Roya Kelishadi

2016-09-01

Full Text Available Background: This study uses data of the global burden of diseases (GBD study 2010 to report death, disability-adjusted life year (DALYs, years of life lived with disability (YLDs and years of life lost due to premature mortality (YLLs, attributed to suboptimal breastfeeding by age and gender during 1990 to 2010 in Iran. Materials and Methods:The GBD assessments were used, together with estimates of death and DALYs due to specific risk factors to calculate the attributed burden of each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of mortality attributable and burden and were presented as 95 % uncertainty interval (UI. Results:In both genders, the age standardized DALYs rates and the age standardized death rate [(from 5 (95% UI: 2-8 to 1 (95% UI: 0-2 per 100,000 populations], attributed to breastfeeding, had a decreasing trends. The age standardized YLD rate increased from 7 (95% UI: 2-15 to 10 (95% UI: 3-23 per 100,000 populations in boys and, from 7(95% UI: 2-16 to 11(95% UI: 3-26 per 100,000 populations in girls. The YLD changes showed some variation according to age categories. For both genders, the age standardizes YLL rate decreased from 395 (95% UI: 185-681 per 100,000 populations to 111(95% UI: 42-213 per 100,000 populations. Conclusion: The burden attributed to suboptimal breastfeeding had a considerable reduction rate from 1990 to 2010. Additional studies on burden of exclusive breastfeeding with more accurate data are recommended for policies make decision.

Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level

OpenAIRE

Kearns, Karen; Dee, Anne; Fitzgerald, Anthony P; Doherty, Edel; Perry, Ivan J

2014-01-01

Background: Overweight and obesity prevalence has risen dramatically in recent decades. While it is known that overweight and obesity is associated with a wide range of chronic diseases, the cumulative burden of chronic disease in the population associated with overweight and obesity is not well quantified. The aims of this paper were to examine the associations between BMI and chronic disease prevalence; to calculate Population Attributable Fractions (PAFs) associated with overweight and obe...

Psychometric properties of the Zarit Caregiver Burden Interview administered to caregivers to patients with Duchenne muscular dystrophy: a Rasch analysis.

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Landfeldt, Erik; Mayhew, Anna; Straub, Volker; Bushby, Katharine; Lochmüller, Hanns; Lindgren, Peter

2017-12-18

To explore the psychometric properties of the full 22-item English (UK and US) version of the Zarit Caregiver Burden Interview administered to caregivers to patients with Duchenne muscular dystrophy. Caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States, recruited through the TREAT-NMD network, completed the Zarit Caregiver Burden Interview online. The psychometric properties of the Zarit Caregiver Burden Interview were examined using Rasch analysis. A total of 475 caregivers completed the Zarit Caregiver Burden Interview. Model misfit was identified for 9 of 22 items (mean item fit residual 0.061, SD: 2.736) and 13 of 22 items displayed disordered thresholds. The overall item-trait interaction chi-square value was 499 (198 degrees of freedom, p Interview fails to fully operationalize a quantitative conceptualization of caregiver burden among caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States. Further research is needed to understand the psychometric properties of the Zarit Caregiver Burden Interview in other populations and settings. Implications for Rehabilitation Duchenne muscular dystrophy is a terminal disease characterized by progressive muscle degeneration resulting in substantial disability and a significant burden on family caregivers. The Zarit Caregiver Burden Interview is one of the most widely applied measures of caregiver burden. Our Rasch analysis suggests that the Zarit Caregiver Burden Interview is not fit for purpose to measure burden in UK and US caregivers to patients with Duchenne muscular dystrophy. Clinicians and decision-makers should interpret Zarit Caregiver Burden Interview data from these populations with caution.

Economic Burden of Human Papillomavirus-Related Diseases in Italy

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Baio, Gianluca; Capone, Alessandro; Marcellusi, Andrea; Mennini, Francesco Saverio; Favato, Giampiero

2012-01-01

Introduction Human papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection. Methods For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection. Results The total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1–686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5–315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy. Conclusions The results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention. PMID:23185412

The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010.

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Erskine, Holly E; Ferrari, Alize J; Polanczyk, Guilherme V; Moffitt, Terrie E; Murray, Christopher J L; Vos, Theo; Whiteford, Harvey A; Scott, James G

2014-04-01

The Global Burden of Disease Study 2010 (GBD 2010) is the first to include conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) for burden quantification. A previous systematic review pooled the available epidemiological data for CD and ADHD, and predicted prevalence by country, region, age and sex for each disorder. Prevalence was then multiplied by a disability weight to calculate years lived with disability (YLDs). As no evidence of deaths resulting directly from either CD or ADHD was found, no years of life lost (YLLs) were calculated. Therefore, the number of disability-adjusted life years (DALYs) was equal to that of YLDs. Globally, CD was responsible for 5.75 million YLDs/DALYs with ADHD responsible for a further 491,500. Collectively, CD and ADHD accounted for 0.80% of total global YLDs and 0.25% of total global DALYs. In terms of global DALYs, CD was the 72nd leading contributor and among the 15 leading causes in children aged 5-19 years. Between 1990 and 2010, global DALYs attributable to CD and ADHD remained stable after accounting for population growth and ageing. The global burden of CD and ADHD is significant, particularly in male children. Appropriate allocation of resources to address the high morbidity associated with CD and ADHD is necessary to reduce global burden. However, burden estimation was limited by data lacking for all four epidemiological parameters and by methodological challenges in quantifying disability. Future studies need to address these limitations in order to increase the accuracy of burden quantification. © 2014 The Authors. Journal of Child Psychology and Psychiatry © 2014 Association for Child and Adolescent Mental Health.

Managing the changing burden of cancer in Asia

OpenAIRE

Sankaranarayanan, Rengaswamy; Ramadas, Kunnambath; Qiao, You-lin

2014-01-01

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and bu...

Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010.

Directory of Open Access Journals (Sweden)

Alize J Ferrari

2013-11-01

Full Text Available Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.Burden was calculated for major depressive disorder (MDD and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs and disability adjusted life years (DALYs. Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8% of global YLDs and dysthymia for 1.4% (0.9%-2.0%. Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2% of global DALYs and dysthymia for 0.5% (0.3%-0.6%. There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8% to 3.8% (3.0%-4.7% of global DALYs.GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing

The total satellite population of the Milky Way

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Newton, Oliver; Cautun, Marius; Jenkins, Adrian; Frenk, Carlos S.; Helly, John C.

2018-05-01

The total number and luminosity function of the population of dwarf galaxies of the Milky Way (MW) provide important constraints on the nature of the dark matter and on the astrophysics of galaxy formation at low masses. However, only a partial census of this population exists because of the flux limits and restricted sky coverage of existing Galactic surveys. We combine the sample of satellites recently discovered by the Dark Energy Survey (DES) survey with the satellites found in Sloan Digital Sky Survey (SDSS) Data Release 9 (together these surveys cover nearly half the sky) to estimate the total luminosity function of satellites down to MV = 0. We apply a new Bayesian inference method in which we assume that the radial distribution of satellites independently of absolute magnitude follows that of subhaloes selected according to their peak maximum circular velocity. We find that there should be at least 124^{+40}_{-27}(68% CL, statistical error) satellites brighter than MV = 0 within 300kpc of the Sun. As a result of our use of new data and better simulations, and a more robust statistical method, we infer a much smaller population of satellites than reported in previous studies using earlier SDSS data only; we also address an underestimation of the uncertainties in earlier work by accounting for stochastic effects. We find that the inferred number of faint satellites depends only weakly on the assumed mass of the MW halo and we provide scaling relations to extend our results to different assumed halo masses and outer radii. We predict that half of our estimated total satellite population of the MW should be detected by the Large Synoptic Survey Telescope (LSST). The code implementing our estimation method is available online.†

Study on the trend and disease burden of injury deaths in Chinese population, 2004-2010.

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Lijuan Zhang

Full Text Available Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs system, as injury deaths are classified based on the International Classification of Disease-10(th Revision (ICD-10. We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004-2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79-38.47% of all injury deaths and suicides (16.20-22.01% were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004-2010. The burden of injury among men (72.11% was about three times more than that of women's (28.89%. This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.

Investing in improved performance of national tuberculosis programs reduces the tuberculosis burden: analysis of 22 high-burden countries, 2002-2009.

Science.gov (United States)

Akachi, Yoko; Zumla, Alimuddin; Atun, Rifat

2012-05-15

To assess the impact of investment in national tuberculosis programs (NTPs) on NTP performance and tuberculosis burden in 22 high-burden countries, as determined by the World Health Organization (WHO). Estimates of annual tuberculosis burden and NTP performance indicators and control variables during 2002-2009 were obtained from the Organization for Economic Cooperation and Development, the WHO, the World Bank, and the Penn World Table for the 22 high-burden countries. Panel data analysis was performed using the outcome variables tuberculosis incidence, prevalence, and mortality and the key explanatory variables Partnership case detection rate and treatment success rate, controlling for gross domestic product per capita, population structure, and human immunodeficiency virus (HIV) prevalence. A $1 per capita (general population) higher NTP budget (including domestic and external sources) was associated with a 1.9% (95% confidence interval, .12%-3.6%) higher estimated case detection rate the following year for the 22 high-burden countries between 2002 and 2009. In the final models, which corrected for autocorrelation and heteroskedasticity, achieving the STOP TB Partnership case detection rate target of >70% was associated with significantly (P < .01) lower tuberculosis incidence, prevalence, and mortality the following year, even when controlling for general economic development and HIV prevalence as potential confounding variables. Increased investment in NTPs was significantly associated with improved performance and with a downward trend in the tuberculosis burden in the 22 high-burden countries during 2002-2009.

The economic burden of schizophrenia in Malaysia.

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Teoh, Siew Li; Chong, Huey Yi; Abdul Aziz, Salina; Chemi, Norliza; Othman, Abdul Razak; Md Zaki, Nurzuriana; Vanichkulpitak, Possatorn; Chaiyakunapruk, Nathorn

2017-01-01

Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.

Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study.

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López-Ortega, Mariana; García-Peña, Carmen; Granados-García, Víctor; García-González, José Juan; Pérez-Zepeda, Mario Ulises

2013-02-08

The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to

'Known unknowns - examining the burden of neurocognitive impairment in the end-stage renal failure population'.

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Wilson, Scott; Dhar, Arup; Tregaskis, Peter; Lambert, Gavin; Barton, David; Walker, Rowan

2018-01-18

The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains which are associated with hospitalisation, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggests that dialysis patients manifest NCI at rates 3-5 fold higher than the general population with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalise care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space. This article is protected by copyright. All rights reserved.

Burden of Stroke in Qatar.

Science.gov (United States)

Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

2015-12-01

Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

[Direct economic burden of cerebrovascular disease, during 1993-2008 in China].

Science.gov (United States)

Lu, Jing; Xu, Ling; Zhai, Yi; Zhang, Yaoguang; Lyu, Yuebin; Shi, Xiaoming

2014-11-01

To evaluate the status and trend of direct economic burden on cerebrovascular disease, from 1993 to 2008 in China. Using two-step model to calculate the economic cost with related trend of cerebrovascular disease within the population among the over 30-year-olds, from 1993 to 2008. Data was gathered from the National Health Service Surveys Analysis Reports of 1993, 1998, 2003 and 2008, that including both direct outpatient and inpatient cost. There appeared a significant increase on the burden of cerebrovascular diseases in the period of 15 years, with direct economic cost increasing from 8.473 billion to 103.125 billion RMB. In fact, the actual increase was 5.3 times, without the influence of the price. The average annual growth rate was 13.1%, exceeding the rate of total expenditure on health and GDP during the same time span. In addition, the growth rate in 2003-2008 was the fastest, which appeared to be 19.8%. Burden that caused by cerebrovascular disease on individuals and the whole society was heavy which warrented further theoratical and practical studies on it.

Implementation of Department of Defense Survey Burden Action Plan - Reducing Survey Burden, Cost and Duplication

Science.gov (United States)

2017-08-23

vulnerable populations (e.g., minors); or 3) sensitive topics (e.g., gender relations, discrimination , UCMJ violations) to improve tracking of survey...e.g., gender relations, discrimination , UCMJ violations) to improve tracking of survey burden. The applicable ISSCC-member Survey Office will...their families per year; or 2) vulnerable populations (e.g., minors); or 3) sensitive topics (e.g., gender relations, discrimination , UCMJ violations

Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years.

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Paul R Torgerson

Full Text Available Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in terms of Disability Adjusted Life Years (DALYs available.We utilised the results of a parallel publication that reported global estimates of morbidity and mortality due to leptospirosis. We estimated Years of Life Lost (YLLs from age and gender stratified mortality rates. Years of Life with Disability (YLDs were developed from a simple disease model indicating likely sequelae. DALYs were estimated from the sum of YLLs and YLDs. The study suggested that globally approximately 2.90 million DALYs are lost per annum (UIs 1.25-4.54 million from the approximately annual 1.03 million cases reported previously. Males are predominantly affected with an estimated 2.33 million DALYs (UIs 0.98-3.69 or approximately 80% of the total burden. For comparison, this is over 70% of the global burden of cholera estimated by GBD 2010. Tropical regions of South and South-east Asia, Western Pacific, Central and South America, and Africa had the highest estimated leptospirosis disease burden.Leptospirosis imparts a significant health burden worldwide, which approach or exceed those encountered for a number of other zoonotic and neglected tropical diseases. The study findings indicate that highest burden estimates occur in resource-poor tropical countries, which include regions of Africa where the burden of leptospirosis has been under-appreciated and possibly misallocated to other febrile illnesses such as malaria.

Population dynamics of active and total ciliate populations in arable soil amended with wheat

DEFF Research Database (Denmark)

Ekelund, F.; Frederiksen, Helle B.; Ronn, R.

2002-01-01

of the population may be encysted. The factors governing the dynamics of active and encysted cells in the soil are not well understood. Our objective was to determine the dynamics of active and encysted populations of ciliates during the decomposition of freshly added organic material. We monitored, in soil...... microcosms, the active and total populations of ciliates, their potential prey (bacteria and small protozoa), their potential competitors (amoebae, flagellates, and nematodes), and their potential predators (nematodes). We sampled with short time intervals (2 to 6 days) and generated a data set, suitable...

Socioeconomic differences in the burden of disease in Sweden

DEFF Research Database (Denmark)

Ljung, Rickard; Peterson, Stefan; Hallqvist, Johan

2005-01-01

OBJECTIVE: We sought to analyse how much of the total burden of disease in Sweden, measured in disability-adjusted life years (DALYs), is a result of inequalities in health between socioeconomic groups. We also sought to determine how this unequal burden is distributed across different disease...... of disease that take both mortality and morbidity into account can help policy-makers understand the magnitude of inequalities in health for different disease groups....... groups and socioeconomic groups. METHODS: Our analysis used data from the Swedish Burden of Disease Study. We studied all Swedish men and women in three age groups (15-44, 45-64, 65-84) and five major socioeconomic groups. The 18 disease and injury groups that contributed to 65% of the total burden...

Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population

OpenAIRE

Hay, Phillipa; Mitchison, Deborah; Collado, Abraham Ernesto Lopez; Gonz?lez-Chica, David Alejandro; Stocks, Nigel; Touyz, Stephen

2017-01-01

Background Little is known about the epidemiology and health related quality of life (HRQoL) of the new DSM-5 diagnoses, Binge Eating Disorder (BED) and Avoidant/Restrictive Food Intake Disorder (ARFID) in the Australian population. We aimed to investigate the prevalance and burden of these disorders. Methods We conducted two sequential population-based surveys including individuals aged over 15?years who were interviewed in 2014 (n?=?2732) and 2015 (n =3005). Demographic information and diag...

The humanistic burden of hereditary angioedema: Impact on health-related quality of life, productivity, and depression.

Science.gov (United States)

Lumry, William R; Castaldo, Anthony J; Vernon, Margaret K; Blaustein, Marc B; Wilson, David A; Horn, Patrick T

2010-01-01

Hereditary angioedema (HAE) is a rare, autosomal dominant disorder characterized by recurrent acute attacks of swelling of the larynx, abdomen, and periphery. This study was designed to assess the humanistic burden of illness associated with HAE. HAE burden was assessed via a web-based survey of patients that solicited information on attack characterization, treatment, side effects, pain, and functional and emotional burden of disease management. In addition to HAE-specific sections, the survey used three standardized instruments to compare HAE patient data to normative (healthy) and chronic disease populations: the 12-Item Short Form (SF-12) Health Survey, the Work Productivity and Activity Impairment-General Health (WPAI-GH) questionnaire, and the Hamilton Depression Inventory-Short Form (HDI-SF). A total of 457 HAE patients responded to the survey (response rate, ∼19%). Patients reported significantly poorer health-related quality of life versus population norms, based on the SF-12 Physical Component Summary (mean, 43.7 versus 49.6; p 8.5, indicative of depressive symptomatology. Productivity was also markedly impaired in all WPAI-GH categories, including 34% overall work impairment. Because of their most recent HAE attack, workers lost a mean of 3.3 days; students lost a mean of 1.9 days. HAE results in considerable humanistic burden to patients across physical and mental health domains; negatively impacts education, career, and work productivity; and compounds the substantial economic burdens that are reported separately.

Burden of serious fungal infections in Ukraine.

Science.gov (United States)

Osmanov, Ali; Denning, David W

2015-10-01

Ukraine has high rates of TB, AIDS and cancer. We estimated the burden of fungal disease from epidemiology papers and specific populations at risk and fungal infection frequencies. HIV/AIDS cases and deaths (2012) and tuberculosis statistics were obtained from the State Service of Ukraine, while chronic obstructive pulmonary disease (COPD) cases were from M. Miravitlles et al., Thorax 64, 863-868 (2009). Annual estimates are 893,579 Ukrainian women get recurrent vaginal thrush (≥4× per year), 50,847 cases of oral candidiasis and 13,727 cases of oesophageal candidiasis in HIV, and 101 (1%) of 10,085 new AIDS cases develop cryptococcal meningitis, 6152 cases of Pneumocystis pneumonia (13.5 cases per 100,000). Of the 29,265 cases of active respiratory TB in 2012, it is estimated that 2881 new cases of chronic pulmonary aspergillosis (CPA) occurred and that the 5-year period prevalence is 7724 cases with a total CPA burden of 10,054 cases. Assuming adult asthma prevalence is ~2.9%, 28,447 patients with allergic bronchopulmonary aspergillosis (ABPA) are likely and 37,491 with severe asthma with fungal sensitisation. We estimate 2278 cases and 376 postsurgical intra-abdominal Candida infections. Invasive aspergillosis in immunocompromised patients is estimated at 303 patients annually; 930 cases in COPD patients. Ninety cases of mucormycosis (2 per 1,000,000) are estimated. In total, ~1,000,000 (2.2%) people in Ukraine develop serious fungal infections annually. © 2015 Blackwell Verlag GmbH.

Periodontal disease burden and pathological changes in organs of dogs.

Science.gov (United States)

Pavlica, Zlatko; Petelin, Milan; Juntes, Polona; Erzen, Damjan; Crossley, David A; Skaleric, Uros

2008-06-01

Bacterial plaque associated periodontal disease is the most common chronic infection in man and dogs. In man, there is an association between periodontal disease and myocardial infarction and stroke, while in dogs it has also been associated with changes in internal organs. Inflamed periodontal tissues present a 'periodontal disease burden' to the host and the extent of this inflammatory disease burden is likely to affect the degree of associated pathological change in distant organs. This hypothesis was investigated in dogs with naturally occurring periodontal disease. Post-mortem investigations including periodontal assessment, standard necropsy, and organ histology were performed on 44 mature toy and miniature Poodles (related, periodontitis predisposed breeds) that died naturally or were euthanized based on clinical disease. Animals with gross primary organ pathology were excluded. The periodontal disease burden was estimated from the total surface area of periodontal pocket epithelium using six measurements of probing depth for each tooth and the tooth circumferences. Ordinal logistic regression (OR) analysis established that for each square centimeter of periodontal disease burden there was a 1.4-times higher likelihood of greater changes being present in the left atrio-ventricular valves (OR = 1.43), plus 1.2 and 1.4 times higher likelihoodfor greater liver and kidney pathology (OR = 1.21; OR = 1.42), respectively The results show that there is a link between the estimated 'periodontal disease burden' resulting from plaque-bacteria associated periodontal disease and the level of internal pathology in this population, implying that periodontitis might contribute to the development of systemic pathology in dogs.

Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach.

Science.gov (United States)

Desai, Kamal; Gupta, Swati B; Dubberke, Erik R; Prabhu, Vimalanand S; Browne, Chantelle; Mast, T Christopher

2016-06-18

Despite a large increase in Clostridium difficile infection (CDI) severity, morbidity and mortality in the US since the early 2000s, CDI burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs. A decision-analytic model incorporating key input parameters important in CDI epidemiology was developed to estimate the annual number of initial and recurrent CDI cases, attributable and all-cause deaths, economic burden in the general population, and specific number of high-risk patients in different healthcare settings and the community in the US. Economic burden was calculated adopting a societal perspective using a bottom-up approach that identified healthcare resources consumed in the management of CDI. Annually, a total of 606,058 (439,237 initial and 166,821 recurrent) episodes of CDI were predicted in 2014: 34.3 % arose from community exposure. Over 44,500 CDI-attributable deaths in 2014 were estimated to occur. High-risk susceptible individuals representing 5 % of the total hospital population accounted for 23 % of hospitalized CDI patients. The economic cost of CDI was $5.4 billion ($4.7 billion (86.7 %) in healthcare settings; $725 million (13.3 %) in the community), mostly due to hospitalization. A modeling framework provides more comprehensive and detailed national-level estimates of CDI cases, recurrences, deaths and cost in different patient groups than currently available from separate individual studies. As new treatments for CDI are developed, this model can provide reliable estimates to better focus healthcare resources to those specific age-groups, risk-groups, and care settings in the US where they are most needed. (Trial Identifier ClinicaTrials.gov: NCT01241552).

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study.

Science.gov (United States)

Wang, Qun; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2016-09-01

Evidence from population-based studies on the economic burden imposed by chronic non-communicable diseases (CNCDs) is still sparse in Sub-Saharan Africa. Our study aimed to fill this existing gap in knowledge by estimating both the household direct, indirect, and total costs incurred due to CNCDs and the economic burden households bear as a result of these costs in Malawi. The study used data from the first round of a longitudinal household health survey conducted in 2012 in three rural districts in Malawi. A cost-of-illness method was applied to estimate the economic burden of CNCDs. Indicators of catastrophic spending and impoverishment were used to estimate the economic burden imposed by CNCDs on households. A total 475 out of 5643 interviewed individuals reported suffering from CNCDs. Mean total costs of all reported CNCDs were 1,040.82 MWK, of which 56.8 % was contributed by direct costs. Individuals affected by chronic cardiovascular conditions and chronic neuropsychiatric conditions bore the highest levels of direct, indirect, and total costs. Using a threshold of 10 % of household non-food expenditure, 21.3 % of all households with at least one household member reporting a CNCD and seeking care for such a condition incurred catastrophic spending due to CNCDs. The poorest households were more likely to incur catastrophic spending due to CNCDs. An additional 1.7 % of households reporting a CNCD fell under the international poverty line once considering direct costs due to CNCDs. Our study showed that the economic burden of CNCDs is high, causes catastrophic spending, and aggravates poverty in rural Malawi, a country where in principle basic care for CNCDs should be offered free of charge at point of use through the provision of an Essential Health Package (EHP). Our findings further indicated that particularly high direct, indirect, and total costs were linked to specific diagnoses, although costs were high even for conditions targeted by the EHP. Our

Intrinsic bacterial burden associated with intensive care unit hospital beds: effects of disinfection on population recovery and mitigation of potential infection risk.

Science.gov (United States)

Attaway, Hubert H; Fairey, Sarah; Steed, Lisa L; Salgado, Cassandra D; Michels, Harold T; Schmidt, Michael G

2012-12-01

Commonly touched items are likely reservoirs from which patients, health care workers, and visitors may encounter and transfer microbes. A quantitative assessment was conducted of the risk represented by the intrinsic bacterial burden associated with bed rails in a medical intensive care unit (MICU), and how disinfection might mitigate this risk. Bacteria present on the rails from 36 patient beds in the MICU were sampled immediately before cleaning and at 0.5, 2.5, 4.5, and 6.5 hours after cleaning. Beds were sanitized with either a bottled disinfectant (BD; CaviCide) or an automated bulk-diluted disinfectant (ABDD; Virex II 256). The majority of bacteria recovered from the bed rails in the MICU were staphylococci, but not methicillin-resistant Staphylococcus aureus. Vancomycin-resistant enterococci were recovered from 3 beds. Bottled disinfectant reduced the average bacterial burden on the rails by 99%. However, the burden rebounded to 30% of that found before disinfection by 6.5 hours after disinfection. ABDD reduced the burden by an average of 45%, but levels rebounded within 2.5 hours. The effectiveness of both disinfectants was reflected in median reductions to burden of 98% for BD and 95% for ABDD. Cleaning with hospital-approved disinfectants reduced the intrinsic bacterial burden on bed rail surfaces by up to 99%, although the population, principally staphylococci, rebounded quickly to predisinfection levels. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia

Directory of Open Access Journals (Sweden)

Mohammad Akhtar Hussain

2016-10-01

Full Text Available Background: In Indonesia, coronary heart disease (CHD and stroke are estimated to cause more than 470 000 deaths annually. In order to inform primary prevention policies, we estimated the sex- and age-specific burden of CHD and stroke attributable to five major and modifiable vascular risk factors: cigarette smoking, hypertension, diabetes, elevated total cholesterol, and excess body weight. Methods: Population attributable risks for CHD and stroke attributable to these risk factors individually were calculated using summary statistics obtained for prevalence of each risk factor specific to sex and to two age categories (<55 and ≥55 years from a national survey in Indonesia. Age- and sex-specific relative risks for CHD and stroke associated with each of the five risk factors were derived from prospective data from the Asia-Pacific region. Results: Hypertension was the leading vascular risk factor, explaining 20%–25% of all CHD and 36%–42% of all strokes in both sexes and approximately one-third of all CHD and half of all strokes across younger and older age groups alike. Smoking in men explained a substantial proportion of vascular events (25% of CHD and 17% of strokes. However, given that these risk factors are likely to be strongly correlated, these population attributable risk proportions are likely to be overestimates and require verification from future studies that are able to take into account correlation between risk factors. Conclusions: Implementation of effective population-based prevention strategies aimed at reducing levels of major cardiovascular risk factors, especially blood pressure, total cholesterol, and smoking prevalence among men, could reduce the growing burden of CVD in the Indonesian population.

Measuring the burden of neglected tropical diseases: the global burden of disease framework.

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Colin D Mathers

2007-11-01

Full Text Available Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY.This paper describes key features of the Global Burden of Disease analytic approach, which provides a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and a systematic approach to the evaluation of data. The paper describes the evolution of the GBD, starting from the first study for the year 1990, summarizes the methodological improvements incorporated into GBD revisions for the years 2000-2004 carried out by the World Health Organization, and examines priorities and issues for the next major GBD study, funded by the Bill & Melinda Gates Foundation, and commencing in 2007.The paper presents an overview of summary results from the Global Burden of Disease study 2002, with a particular focus on the neglected tropical diseases, and also an overview of the comparative risk assessment for 26 global risk factors. Taken together, trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, Japanese encephalitis, dengue, and leprosy accounted for an estimated 177,000 deaths worldwide in 2002, mostly in sub-Saharan Africa, and about 20 million DALYs, or 1.3% of the global burden of disease and injuries. Further research is currently underway to revise and update these estimates.

Lifetime Economic Burden of Rape Among U.S. Adults.

Science.gov (United States)

Peterson, Cora; DeGue, Sarah; Florence, Curtis; Lokey, Colby N

2017-06-01

This study estimated the per-victim U.S. lifetime cost of rape. Data from previous studies was combined with current administrative data and 2011 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Rape was defined as any lifetime completed or attempted forced penetration or alcohol- or drug-facilitated penetration, measured among adults not currently institutionalized. Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Average age at first rape was assumed to be 18 years. Future costs were discounted by 3%. The main outcome measures were the average per-victim (female and male) and total population discounted lifetime cost of rape. Secondary outcome measures were marginal outcome probabilities among victims (e.g., suicide attempt) and perpetrators (e.g., incarceration) and associated costs. Analysis was conducted in 2016. The estimated lifetime cost of rape was $122,461 per victim, or a population economic burden of nearly $3.1 trillion (2014 U.S. dollars) over victims' lifetimes, based on data indicating >25 million U.S. adults have been raped. This estimate included $1.2 trillion (39% of total) in medical costs; $1.6 trillion (52%) in lost work productivity among victims and perpetrators; $234 billion (8%) in criminal justice activities; and $36 billion (1%) in other costs, including victim property loss or damage. Government sources pay an estimated $1 trillion (32%) of the lifetime economic burden. Preventing sexual violence could avoid substantial costs for victims, perpetrators, healthcare payers, employers, and government payers. These findings can inform evaluations of interventions to reduce sexual violence. Published by Elsevier Inc.

The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm

DEFF Research Database (Denmark)

Razavi, H; Waked, I; Sarrazin, C

2014-01-01

The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total...... number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries...

Discrimination, domestic violence, abuse, and other adverse life events in people with epilepsy: Population-based study to assess the burden of these events and their contribution to psychopathology.

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Nimmo-Smith, Victoria; Brugha, Traolach S; Kerr, Michael P; McManus, Sally; Rai, Dheeraj

2016-11-01

To quantify the experience of discrimination, domestic violence, abuse, and other stressful life events in people with epilepsy in comparison with the general population and people with other chronic conditions. To assess whether any excess relative burden of these adversities could explain the higher rates of depression in people with epilepsy. The Adult Psychiatric Morbidity Survey 2007 used comprehensive interviews with 7,403 individuals living in private residences in England. Doctor-diagnosed epilepsy and other chronic conditions were established by self-report. Discrimination, domestic violence, physical and sexual abuse, and other stressful life events were assessed using computerized self-completion and a face-to-face interview, respectively. People with epilepsy were sevenfold more likely to have reported experiencing discrimination due to health problems (adjusted odds ratio [OR] 7.1; 95% confidence interval [CI] 3.1-16.3), than the general population without epilepsy. This estimate was substantially greater in people with epilepsy than for people with other chronic conditions. People with epilepsy also had greater odds of experiencing domestic violence and sexual abuse than the general population, although these associations were also found in people with other chronic conditions. There was less evidence of an association between epilepsy and a history of physical abuse or having a greater burden of other stressful life events. In exploratory analyses, assuming they lie on the causal pathway, discrimination, domestic violence, and sexual abuse explained 42.7% of the total effect of the relationship between epilepsy and depression or anxiety disorders. People with epilepsy can face a range of psychosocial adversities and extensively report feeling discriminated against as compared to the general population. In addition, if confirmed in longitudinal studies, the results suggest that these psychosocial adversities may have a significant role in the

[Ranking of radionuclides and pathways according to their contribution to the dose burden to the population resulting from NPP releases].

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Spiridonov, S I; Karpenko, E I; Sharpan, L A

2013-01-01

Approaches are described towards estimating the consequences of radioactive contamination of ecosystems by nuclear fuel cycle enterprises with the rationale for the optimal specification level for nuclear power plants (NPP) operating in the normal mode. Calculations are made based on the initial data of the IAEA project, INPRO ENV, dealing with the ranking of radionuclides escaping to the environment from the operating NPPs. Influence of various factors on rankings of radionuclides and pathways of public exposure is demon- strated. An important factor is the controlled radionuclide composition of atmospheric NPP releases. It has been found that variation in the dose coefficients for some radionuclides leads to significant changes not only in the ranking results but also in the estimates of total dose burdens. Invariability is shown of the estimation concerning the greatest contribution of the peroral route to the population dose of irradiation in the situation considered. A conclusion was drawn on the need of taking into consideration uncertainties of different factors when comparing effects on the environment from enterprises of conventional and innovative nuclear fuel cycles.

Burden of serious fungal infections in Guatemala.

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Medina, N; Samayoa, B; Lau-Bonilla, D; Denning, D W; Herrera, R; Mercado, D; Guzmán, B; Pérez, J C; Arathoon, E

2017-06-01

Guatemala is a developing country in Central America with a high burden of HIV and endemic fungal infections; we attempted to estimate the burden of serious fungal infections for the country. A full literature search was done to identify epidemiology papers reporting fungal infections from Guatemala. We used specific populations at risk and fungal infection frequencies in the population to estimate national rates. The population of Guatemala in 2013 was 15.4 million; 40% were younger than 15 and 6.2% older than 60. There are an estimated 53,000 adults with HIV infection, in 2015, most presenting late. The estimated cases of opportunistic fungal infections were: 705 cases of disseminated histoplasmosis, 408 cases of cryptococcal meningitis, 816 cases of Pneumocystis pneumonia, 16,695 cases of oral candidiasis, and 4,505 cases of esophageal candidiasis. In the general population, an estimated 5,568 adult asthmatics have allergic bronchopulmonary aspergillosis (ABPA) based on a 2.42% prevalence of asthma and a 2.5% ABPA proportion. Amongst 2,452 pulmonary tuberculosis patients, we estimated a prevalence of 495 for chronic pulmonary aspergillosis in this group, and 1,484 for all conditions. An estimated 232,357 cases of recurrent vulvovaginal candidiasis is likely. Overall, 1.7% of the population are affected by these conditions. The true fungal infection burden in Guatemala is unknown. Tools and training for improved diagnosis are needed. Additional research on prevalence is needed to employ public health measures towards treatment and improving the reported data of fungal diseases.

Alcohol and burden of disease in Australia: the challenge in assessing consumption.

Science.gov (United States)

Ogeil, Rowan P; Room, Robin; Matthews, Sharon; Lloyd, Belinda

2015-04-01

Alcohol consumption is one of the major avoidable risk factors for disease, illness and injury in the Australian community. Population health scientists and economists use estimates of alcohol consumption in burden of disease frameworks to estimate the impact of alcohol on disease, illness and injury. This article highlights challenges associated with estimating alcohol consumption in these models and provides a series of recommendations to improve estimates. Key challenges in measuring alcohol consumption at the population level are identified and discussed with respect to how they apply to burden of disease frameworks. Methodological advances and limitations in the estimation of alcohol consumption are presented with respect to use of survey data, population distributions of alcohol consumption, consideration of 'patterns' of alcohol use including 'bingeing', and capping exposure. Key recommendations for overcoming these limitations are provided. Implications and conclusion: Alcohol-related burden has a significant impact on the health of the Australian population. Improving estimates of alcohol related consumption will enable more accurate estimates of this burden to be determined to inform future alcohol policy by legislators. © 2015 Public Health Association of Australia.

Estimating alcohol-related premature mortality in san francisco: use of population-attributable fractions from the global burden of disease study

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Reiter Randy B

2010-11-01

Full Text Available Abstract Background In recent years, national and global mortality data have been characterized in terms of well-established risk factors. In this regard, alcohol consumption has been called the third leading "actual cause of death" (modifiable behavioral risk factor in the United States, after tobacco use and the combination of poor diet and physical inactivity. Globally and in various regions of the world, alcohol use has been established as a leading contributor to the overall burden of disease and as a major determinant of health disparities, but, to our knowledge, no one has characterized alcohol-related harm in such broad terms at the local level. We asked how alcohol-related premature mortality in San Francisco, measured in years of life lost (YLLs, compares with other well-known causes of premature mortality, such as ischemic heart disease or HIV/AIDS. Methods We applied sex- and cause-specific population-attributable fractions (PAFs of years of life lost (YLLs from the Global Burden of Disease Study to 17 comparable outcomes among San Francisco males and females during 2004-2007. We did this in three ways: Method 1 assumed that all San Franciscans drink like populations in developed economies. These estimates were limited to alcohol-related harm. Method 2 modified these estimates by including several beneficial effects. Method 3 assumed that Latino and Asian San Franciscans drink alcohol like populations in the global regions related to their ethnicity. Results By any of these three methods, alcohol-related premature mortality accounts for roughly a tenth of all YLLs among males. Alcohol-related YLLs among males are comparable to YLLs for leading causes such as ischemic heart disease and HIV/AIDS, in some instances exceeding them. Latino and black males bear a disproportionate burden of harm. Among females, for whom estimates differed more by method and were smaller than those for males, alcohol-related YLLs are comparable to leading

Burden of Clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study.

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Yu, Holly; Baser, Onur; Wang, Li

2016-11-25

Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs). This was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS) (2008-10). NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI. Among 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI) were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P CDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.

The burden of child maltreatment in the East Asia and Pacific region.

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Fang, Xiangming; Fry, Deborah A; Brown, Derek S; Mercy, James A; Dunne, Michael P; Butchart, Alexander R; Corso, Phaedra S; Maynzyuk, Kateryna; Dzhygyr, Yuriy; Chen, Yu; McCoy, Amalee; Swales, Diane M

2015-04-01

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region's per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US $151 billion, accounting for 1.88% of the region's GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally. Copyright © 2015 Elsevier Ltd. All rights reserved.

The burden of child maltreatment in the East Asia and Pacific region☆

Science.gov (United States)

Fang, Xiangming; Fry, Deborah A.; Brown, Derek S.; Mercy, James A.; Dunne, Michael P.; Butchart, Alexander R.; Corso, Phaedra S.; Maynzyuk, Kateryna; Dzhygyr, Yuriy; Chen, Yu; McCoy, Amalee; Swales, Diane M.

2015-01-01

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US $151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally. PMID:25757367

The Burden of Leprosy in Cameroon: Fifteen Years into the Post-elimination Era.

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Tabah, Earnest Njih; Nsagha, Dickson Shey; Bissek, Anne-Cecile Zoung-Kanyi; Bratschi, Martin W; Njamnshi, Theophilus Ngeh; Plushke, Gerd; Njamnshi, Alfred Kongnyu

2016-10-01

Cameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014. We obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme. Cameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014. The leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country.

Comparing contemporary revision burden among hip and knee joint replacement registries

Directory of Open Access Journals (Sweden)

Brian J. McGrory, MD, MS

2016-06-01

Conclusions: Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

The effects of spatial population dataset choice on estimates of population at risk of disease

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Gething Peter W

2011-02-01

Full Text Available Abstract Background The spatial modeling of infectious disease distributions and dynamics is increasingly being undertaken for health services planning and disease control monitoring, implementation, and evaluation. Where risks are heterogeneous in space or dependent on person-to-person transmission, spatial data on human population distributions are required to estimate infectious disease risks, burdens, and dynamics. Several different modeled human population distribution datasets are available and widely used, but the disparities among them and the implications for enumerating disease burdens and populations at risk have not been considered systematically. Here, we quantify some of these effects using global estimates of populations at risk (PAR of P. falciparum malaria as an example. Methods The recent construction of a global map of P. falciparum malaria endemicity enabled the testing of different gridded population datasets for providing estimates of PAR by endemicity class. The estimated population numbers within each class were calculated for each country using four different global gridded human population datasets: GRUMP (~1 km spatial resolution, LandScan (~1 km, UNEP Global Population Databases (~5 km, and GPW3 (~5 km. More detailed assessments of PAR variation and accuracy were conducted for three African countries where census data were available at a higher administrative-unit level than used by any of the four gridded population datasets. Results The estimates of PAR based on the datasets varied by more than 10 million people for some countries, even accounting for the fact that estimates of population totals made by different agencies are used to correct national totals in these datasets and can vary by more than 5% for many low-income countries. In many cases, these variations in PAR estimates comprised more than 10% of the total national population. The detailed country-level assessments suggested that none of the datasets was

The Burden of Cholera in Uganda

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Bwire, Godfrey; Malimbo, Mugagga; Maskery, Brian; Kim, Young Eun; Mogasale, Vittal; Levin, Ann

2013-01-01

Introduction In 2010, the World Health Organization released a new cholera vaccine position paper, which recommended the use of cholera vaccines in high-risk endemic areas. However, there is a paucity of data on the burden of cholera in endemic countries. This article reviewed available cholera surveillance data from Uganda and assessed the sufficiency of these data to inform country-specific strategies for cholera vaccination. Methods The Uganda Ministry of Health conducts cholera surveillance to guide cholera outbreak control activities. This includes reporting the number of cases based on a standardized clinical definition plus systematic laboratory testing of stool samples from suspected cases at the outset and conclusion of outbreaks. This retrospective study analyzes available data by district and by age to estimate incidence rates. Since surveillance activities focus on more severe hospitalized cases and deaths, a sensitivity analysis was conducted to estimate the number of non-severe cases and unrecognized deaths that may not have been captured. Results Cholera affected all ages, but the geographic distribution of the disease was very heterogeneous in Uganda. We estimated that an average of about 11,000 cholera cases occurred in Uganda each year, which led to approximately 61–182 deaths. The majority of these cases (81%) occurred in a relatively small number of districts comprising just 24% of Uganda's total population. These districts included rural areas bordering the Democratic Republic of Congo, South Sudan, and Kenya as well as the slums of Kampala city. When outbreaks occurred, the average duration was about 15 weeks with a range of 4–44 weeks. Discussion There is a clear subdivision between high-risk and low-risk districts in Uganda. Vaccination efforts should be focused on the high-risk population. However, enhanced or sentinel surveillance activities should be undertaken to better quantify the endemic disease burden and high-risk populations

Comorbidity and economic burden among moderate-to-severe psoriasis and/or psoriatic arthritis patients in the US Department of Defense population.

Science.gov (United States)

Lee, Seina; Xie, Lin; Wang, Yuexi; Vaidya, Neel; Baser, Onur

2018-06-01

To examine the comorbidity and economic burden among moderate-to-severe psoriasis (PsO) and/or psoriatic arthritis (PsA) patients in the US Department of Defense (DoD) population. This retrospective cohort claims analysis was conducted using DoD data from November 2010 to October 2015. Adult patients with ≥2 diagnoses of PsO and/or PsA (cases) were identified, and the first diagnosis date from November 2011 to October 2014 was defined as the index date. Patients were considered moderate-to-severe if they had ≥1 non-topical systemic therapy or phototherapy during the 12 months pre- or 1 month post-index date. Patients without a PsO/PsA diagnosis during the study period (controls) were matched to cases on a 10:1 ratio based on age, sex, region, and index year; the index date was randomly selected. One-to-one propensity score matching (PSM) was conducted to compare study outcomes in the first year post-index date, including healthcare resource utilization (HRU), costs, and comorbidity incidence. A total of 7,249 cases and 72,490 controls were identified. The mean age was 48.1 years. After PSM, comorbidity incidence was higher among cases, namely dyslipidemia (18.3% vs 13.5%, p < .001), hypertension (13.8% vs 8.7%, p < .001), and obesity (8.8% vs 6.1%, p < .001). Case patients had significantly higher HRU and costs, including inpatient ($2,196 vs $1,642; p < .0016), ambulatory ($8,804 vs 4,642; p < .001), emergency room ($432 vs $350; p < .001), pharmacy ($6,878 vs $1,160; p < .001), and total healthcare costs ($18,311 vs $7,795; p < .001). Claims data are collected for payment purposes; therefore, such data may have limitations for clinical research. During follow-up, DoD patients with moderate-to-severe PsO and/or PsA experienced significantly higher HRU, cost, and comorbidity burden.

Recent trends in economic burden of acute myocardial infarction in South Korea.

Directory of Open Access Journals (Sweden)

Hyeyoung Seo

Full Text Available In 2010, ischemic heart disease was the leading cause of disability-adjusted life-years (DALYs worldwide. More specially, the prevalence of acute myocardial infarctions (AMI is increasing in the aged population as mortality decreases; South Korea is no exception. This study aims to examine the economic burden of AMI in the Korean population between 2007 and 2012. AMI-related costs were assessed from a societal perspective. A prevalence-based cost-of-illness framework was used for this analysis. The subjects included all South Koreans with AMI-related ICD-10 codes (I21, I22, I23, I25.0, and I25.1. Data on direct (medical and non-medical costs and indirect (productivity loss due to AMI-associated morbidity and mortality costs were collected from the Korean National Health Insurance Service's claims data. The human capital approach was used to calculate indirect costs. The total estimated cost of AMI in 2012 was $1,177,649,323 USD. The majority (52% of this amount was made up of medical costs, followed by productivity losses due to mortality and morbidity (42% of annual cost. Although the total cost declined by approximately 18% compared to 2007 ($1,427,643,854 USD, the cost of AMI in the over 60 age group amounted to 47% of the total cost of AMI in 2012. AMI led to a high economic burden in 2012. This study, which identified not only the size, but also the trends of AMI-related costs, will provide information to evaluate effects of governmental health projects and the effective allocation of public research funds.

The Productivity Burden of Diabetes at a Population Level.

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Magliano, Dianna J; Martin, Valencia J; Owen, Alice J; Zomer, Ella; Liew, Danny

2018-05-01

Recent studies suggest that diabetes may impact work productivity. In the current study, we sought to estimate the lifetime and population impact of diabetes on productivity using the novel measure of "productivity-adjusted life years" (PALYs). Using age-specific mortality rates and a productivity index attributable to diabetes (akin to the quality of life index, but which adjusts for reduction in productivity) and life table modeling, we estimated years of life and PALYs lost to diabetes among Australians with diabetes currently aged 20-65 years, with follow-up until 69 years. Life tables were first constructed for the cohort with diabetes and then repeated for the same cohort but with the assumption that they no longer had diabetes. The "nondiabetic" cohort had lower mortality rates and improved productivity. The differences in total years of life lived and PALYs lived between the two cohorts reflected the impact of diabetes. Overall, diabetes reduced total years of life lived by the cohort by 190,219 years or almost 3%. Diabetes reduced PALYs by 11.6% and 10.5% among men and women, respectively. For both sexes, the impact of diabetes on productivity was lowest in those aged 65-69 years and highest in those 20-24 years. Among the latter, PALYs were reduced by 12.2% and 11.0% for men and women, respectively. Elimination of diabetes can prolong life years lived by the whole population and increase the amount of productive years lived. Employers and government should be aware that having diabetes affects work force productivity and implement prevention programs to reduce the impact of diabetes on the workforce. © 2018 by the American Diabetes Association.

[Burden of salmonellosis and shigellosis in four departments of Guatemala, 2010].

Science.gov (United States)

Díaz, Sheilee L; Jarquin, Claudia; Morales, Ana Judith; Morales, Melissa; Valenzuela, Claudia

2015-10-01

Estimate the burden of disease from Salmonella spp. and Shigella spp. in four departments of Guatemala in 2010. Burden of disease study based on document analysis of published population surveys, laboratory files, and surveillance data from the Health Management Information System (SIGSA) in four departments of Guatemala: Huehuetenango, Jutiapa, Quetzaltenango, and Santa Rosa, in 2010. Information was supplemented by a laboratory survey. Burden of disease was estimated using methodology adapted by the World Health Organization from the United States Centers for Disease Control and Prevention. Surveillance data yielded 72 salmonellosis and 172 shigellosis cases. According to population surveys, the percentage of the population that consults health services for diarrhea is 64.7% (95% CI: 60.6%-68.7%) in Quetzaltenango and 61.0% (95% CI: 56.0%-66.0%) in Santa Rosa. In the 115 laboratories that answered the survey (72.8% response rate), 6 051 suspected samples were collected for stool culture and 3 290 for hemoculture; 39.4% and 100.0% of them were processed, respectively. In all, 85 Salmonella spp. and 113 Shigella spp. strains were isolated. For each reported case of salmonellosis and shigellosis, it was estimated that 40 cases are not reported in Quetzaltenango, 55 in Huehuetenango, 345 in Santa Rosa, and 466 in Jutiapa. Estimated burden of disease ranged from 5 to 2 230 cases per 100 000 population for salmonellosis and from 60 to 1 195 cases per 100 000 population for shigellosis. Salmonellosis and shigellosis are a major public health problem in the departments studied and in Guatemala. Burden of disease from these pathogens is higher than that reported by SIGSA.

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts.

Science.gov (United States)

Marlow, Mariel A; Maciel, Ethel Leonor Noia; Sales, Carolina Maia Martins; Gomes, Teresa; Snyder, Robert E; Daumas, Regina Paiva; Riley, Lee W

2015-08-01

To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or "DALY-gap." Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4%. DALY-gap was highest for males 40-59 years of age (501 DALYs/100,000) and in census tracts with <60% electricity (12,327 DALYs/100,000). DALY-gap comparison revealed spatial and quantitative differences in TB burden between slum vs non-slum census tracts that were not apparent using traditional measures of incidence and mortality. This metric could be applied to compare TB burden or burden for other diseases in mega-cities with large informal settlements for more targeted resource allocation and evaluation of intervention programs.

The ageing of Croatian population.

Science.gov (United States)

Murgić, Jure; Jukić, Tomislav; Tomek-Roksandić, Spomenka; Ljubicić, Mate; Kusić, Zvonko

2009-06-01

With a share of people older than 65 years of 16.64 per cent in total population, Croatia is considered a very old country regarding it's population. This percentage is one of the highest in already old Europe. Demographic projections reveal a further increase of share of people older than 65 years in future. There are many causes of this condition. This fact carries negative economic and health care implications which burden Croatia. Many administrative reforms are necessary to resolve this issue and to avoid economy problems and intergenerational conflicts.

Burden of diseases estimates associated to different red meat cooking practices

DEFF Research Database (Denmark)

Berjia, Firew Lemma; Poulsen, Morten; Nauta, Maarten

2014-01-01

. The aim of this study is to compare the burden of disease estimate attributed to red meat consumption processed using different cooking practices.The red meat cooking practices were categorized into three: (A) barbecuing/grilling; (B) frying/broiling and (C) roasting/baking. The associated endpoints......, affected population, intake and dose–response data are obtained by literature survey. The selected endpoints are four types of cancer: colorectal, prostate, breast and pancreatic. The burden of disease per cooking practice, endpoint, sex and age is estimated in the Danish population, using disability...... adjusted life years (DALY) as a common health metric.The results reveal that the consumption of barbecued red meat is associated with the highest disease burden, followed by fried red meat and roasted red meat.The method used to quantify the difference in disease burden of different cooking practices can...

The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache

Science.gov (United States)

2014-01-01

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against Headache to improve and standardize methods in use for cross-sectional studies, the most important is the production of consensus-based methodological guidelines. This report describes the development of detailed principles and recommendations. For this purpose we brought together an expert consensus group to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most of all, these recommendations seek to encourage collaborations between specialists in headache disorders and epidemiologists. The focus is on migraine, tension-type headache and medication-overuse headache, but they are not intended to be exclusive to these. The burdens arising from secondary headaches are, in the majority of cases, more correctly attributed to the underlying disorders. Nevertheless, the principles outlined here are relevant for epidemiological studies on secondary headaches, provided that adequate definitions can be not only given but also applied in questionnaires or other survey instruments. PMID:24467862

Patients' self-perceived burden, caregivers' burden and quality of life for amyotrophic lateral sclerosis patients: a cross-sectional study.

Science.gov (United States)

Geng, Dan; Ou, RuWei; Miao, XiaoHui; Zhao, LiHong; Wei, QianQian; Chen, XuePing; Liang, Yan; Shang, HuiFang; Yang, Rong

2017-10-01

This study surveys the quality of life of amyotrophic lateral sclerosis patients and the factors associated with amyotrophic lateral sclerosis patients' self-perceived burden and their caregivers' burden. Burdens of patients with amyotrophic lateral sclerosis and their caregivers in Chinese population are largely unknown. A cross-sectional study was conducted among 81 pairs of amyotrophic lateral sclerosis patients and their caregivers. Amyotrophic lateral sclerosis patients' self-perceived burden and caregivers' burden were assessed by the Self-Perceived Burden Scale and Zarit-Burden Interview, respectively. Quality of life of amyotrophic lateral sclerosis patients was measured using the World Health Organization Quality of Life-Bref. The amyotrophic lateral sclerosis Functional Rating Scale-Revised questionnaire was used to estimate patients' physical function. Both patients and caregivers reported a mild to moderate burden. The World Health Organization quality of life-Bref scores were decreased in respondents with lower amyotrophic lateral sclerosis Functional Rating Scale-Revised, higher Self-Perceived Burden Scale and higher Zarit-Burden Interview scores. Self-Perceived Burden Scale scores were associated with patients' knowledge of amyotrophic lateral sclerosis, respiratory function and female sex. Zarit-Burden Interview scores were associated with caregivers' age, patients' motor function and out-of-pocket payment. With increase in amyotrophic lateral sclerosis patients' self-perceived burden and caregivers' burden, quality of life of amyotrophic lateral sclerosis patients decreased. Female patients, who had known more about the disease, and those with severe respiratory dysfunction were subject to higher self-perceived burden. Older caregivers and caregivers of patients with severe motor dysfunction and more out-of-pocket payment experienced more care burdens. Our study suggests that paying more attention to female amyotrophic lateral sclerosis patients

Approaches to Refining Estimates of Global Burden and Economics of Dengue

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Shepard, Donald S.; Undurraga, Eduardo A.; Betancourt-Cravioto, Miguel; Guzmán, María G.; Halstead, Scott B.; Harris, Eva; Mudin, Rose Nani; Murray, Kristy O.; Tapia-Conyer, Roberto; Gubler, Duane J.

2014-01-01

Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools

Burden of Hemoglobinopathies (Thalassemia, Sickle Cell Disorders and G6PD Deficiency) in Iran, 1990-2010: findings from the Global Burden of Disease Study 2010.

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Rezaei, Nazila; Naderimagham, Shohreh; Ghasemian, Anoosheh; Saeedi Moghaddam, Sahar; Gohari, Kimia; Zareiy, Saeid; Sobhani, Sahar; Modirian, Mitra; Kompani, Farzad

2015-08-01

Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Disease Study 2010 (GBD 2010). GBD 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of GBD 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1% to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the

Alternative population futures.

Science.gov (United States)

1980-01-01

The Philippines is now passing through a late demographic transitional period in which the death rate declines while the birth rate remains at a relatively high level; the population of young people under 15 rises to about 45% of the population while proportions of people of working age and old people decline. In 1970, 4 of the Philippine's 12 regions had a birth rate exceeding 40/1000; life expectancy at birth in these regions ranged from 57-64 years and population growth rates ranged from 2.6-4.2% annually. Also in 1970 40-49% of all 12 regional populations were young (under 15) and only 2-5% were old. In this transitional period there are a greater number of children in each household and thus heavier social and economic burdens occur; also the burden of youth dependency increases by more than 1/3. In the modern population structure, family burdens diminish as the average number of children surviving to age 20 becomes identical with the number of children born and great improvements in the quality of life are allowed. Population projections are based on the following assumptions: 1) decrease in mortality, either rapid or slow, 2) increase in age at marriage, 3) decline in fertility will remain at 0.7% annually, and 4) migration trends will stay the same as during the 1960-75 period. Total population is expected to reach 83.8 million by 2000, a 98% increase from 1975; a low estimate, assuming lower fertility and nuptiality, is 64.1 million, a 52% increase from 1975. The urban population will more than double its size by the year 2000 and rural population will grow from 22-65% with the fastest urbanizing regions being the Central and Southern Luzon. From 1975-2000 a 3-fold increase is expected in the number of families in Metro Manila. By 2000 a national labor force of 27.5 million is expected, more than double the 1970 level, with late entry into the labor force and declines in participation by elderly males. The various regions will see lower economic activity

The personal financial burden of chronic rhinosinusitis: A Canadian perspective.

Science.gov (United States)

Yip, Jonathan; Vescan, Allan D; Witterick, Ian J; Monteiro, Eric

2017-07-01

Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia.

Science.gov (United States)

Sadat-Ali, Mir; Al-Dakheel, Dakheel A; Azam, Md Q; Al-Bluwi, Mohammed T; Al-Farhan, Mohammed F; AlAmer, Hussein A; Al-Meer, Zakaria; Al-Mohimeed, Abdallah; Tabash, Ibrahim K; Karry, Maher O; Rassasy, Yaseen M; Baragaba, Mohammed A; Amer, Ahmed S; AlJawder, Abdallah; Al-Bouri, Kamil M; ElTinay, Mohammed; Badawi, Hamed A; Al-Othman, Abdallah A; Tayara, Badar K; Al-Faraidy, Moaad H; Amin, Ahmed H

2015-01-01

The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended. Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia. The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site. Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can

Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

Science.gov (United States)

Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

2014-01-01

Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

The economic burden of tuberculosis in Indonesia.

Science.gov (United States)

Collins, D; Hafidz, F; Mustikawati, D

2017-09-01

Indonesia has a high prevalence of tuberculosis (TB) and is one of the 22 countries with the highest TB burdens in the world. To understand the economic burden of TB in Indonesia. TB data for 2015 were combined with cost data using a simple type of cost-benefit analysis in a decision tree model to show the economic burden under different scenarios. In Indonesia, there were an estimated 1 017 378 new active TB cases in 2015, including multidrug-resistant TB. It is estimated that 417 976 of these cases would be treated and cured, 160 830 would be unsuccessfully treated and would die, 131 571 would be untreated and would achieve cure spontaneously, and 307 000 would be untreated and would die. The total economic burden related to treated and untreated cases would be approximately US$6.9 billion. Loss of productivity due to premature death would be by far the largest element, comprising US$6.0 billion (discounted), which represents 86.6% of the total cost. Loss of productivity due to illness would be US$700 million (10.1%), provider medical costs US$156 million (2.2%), and direct non-medical costs incurred by patients and their households US$74 million (1.1%). The economic burden of TB in Indonesia is extremely high. Detecting and treating more cases would result not only in major reductions in suffering but also in economic savings to society.

National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens

Directory of Open Access Journals (Sweden)

Shama Virani

2017-08-01

Full Text Available In Thailand, five cancer types—breast, cervical, colorectal, liver and lung cancer—contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC: 3.1% and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1% are increasing while cervical cancer (AAPC: −4.4% is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.

[Disease burden on road injury in the Chinese population, in 1990 and 2013].

Science.gov (United States)

Wang, Y; Ye, P P; Jin, Y; Er, Y L; Deng, X; Gao, X; Ji, C R; Yang, L; Wang, W; Duan, L L; Wang, L H

2017-10-10

Objective: To explore the disease burden of road injuries in China. Methods: The results of Global Burden of Disease 2013 including death rate, disability-adjusted of life years (DALY), years of life lost due to premature mortality (YLL), years lived with disability (YLD), were used to describe the burden caused by road injuries in 2013 and the trends from 1990 to 2013, in China. Results: In 2013, there were 313 676 deaths caused by traffic accidents in China. Death rate, rates on DALY, YLL and YLD were 22.52 per 100 000, 1 076.54 per 100 000, 971.21 per 100 000 and 105.34 per 100 000, respectively. Rates on deaths, YLL and YLD appeared higher in males, pedestrians than in females and other types of road travelers. Burden of injuries caused by traffic accidents was seen higher in those aged 15 to 49-year-old. From 1990 to 2013, the overall death rate on road injuries increased by 0.54 per 100 000 in China, with an increase of 2.34 per 100 000 and 0.81 per 100 000, respectively in males and pedestrians. The rates on DALY, YLL and YLD decreased by 164.21 per 100 000, 115.06 per 100 000 and 49.06 per 100 000, respectively. Conclusions: During the past 20 years, achievements had been made on road injury prevention and control, with the decrease of disease burden caused by road accidents. Males, young adults and pedestrians should be called for more attention to prevent road injuries.

Burden of poor oral health in older age: findings from a population-based study of older British men.

Science.gov (United States)

Ramsay, S E; Whincup, P H; Watt, R G; Tsakos, G; Papacosta, A O; Lennon, L T; Wannamethee, S G

2015-12-29

Evidence of the extent of poor oral health in the older UK adult population is limited. We describe the prevalence of oral health conditions, using objective clinical and subjective measures, in a population-based study of older men. Cross-sectional study. A representative sample of men aged 71-92 years in 2010-2012 from the British Regional Heart Study, initially recruited in 1978-1980 from general practices across Britain. Physical examination among 1660 men included the number of teeth, and periodontal disease in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding). Postal questionnaires (completed by 2147 men including all participants who were clinically examined) included self-rated oral health, oral impacts on daily life and current perception of dry mouth experience. Among 1660 men clinically examined, 338 (20%) were edentulous and a further 728 (43%) had 5.5 mm) affecting 1-20% of sites while 303 (24%) had >20% sites affected. The prevalence of gingival bleeding was 16%. Among 2147 men who returned postal questionnaires, 35% reported fair/poor oral health; 11% reported difficulty eating due to oral health problems. 31% reported 1-2 symptoms of dry mouth and 20% reported 3-5 symptoms of dry mouth. The prevalence of edentulism, loss of attachment, or fair/poor self-rated oral health was greater in those from manual social class. These findings highlight the high burden of poor oral health in older British men. This was reflected in both the objective clinical and subjective measures of oral health conditions. The determinants of these oral health problems in older populations merit further research to reduce the burden and consequences of poor oral health in older people. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Global burden of disease--a race against time

DEFF Research Database (Denmark)

Meyrowitsch, Dan W; Bygbjerg, Ib Christian

2007-01-01

Low-income communities will within the next decades undergo rapid changes. The burden of non-communicable diseases (NCDs), such as diabetes, cardio-vascular disease and cancer, will comprise an increasing proportion of the total disease burden. The results of projections indicate that the already...... constrained health systems will face a double burden of disease, in which HIV/AIDS and other common infectious diseases will co-exist with the new NCDs. In order for preventive measures directed towards NCD to be cost-effective, these have to be implemented within the next 10-20 years....

Burden of road traffic accidents in Nepal by calculating disability-adjusted life years

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Ling Huang

2017-10-01

Full Text Available Objective: To calculate the burden of road traffic accidents in Kathmandu Valley and then extrapolate this to the national level. Methods: A prospective study was performed to compute the burden of road traffic accidents by quantification of disability-adjusted life years (DALYs using the Global Burden of Disease Study method on the basis of 1-year data from nine hospitals in Nepal and the Department of Forensic Medicine and cross-checked with the Nepal Traffic Directorate. Multiple methods were applied to the extrapolated population metrics of the burden of road traffic accidents in Nepal. Results: The total number of years of life lived in disability, years of life lost, and DALYs in Nepal were 38,848±194, 119,935±1464, and 158,783±1658 (95% confidence interval respectively. The number of years lost because of morbidity and death was similar in Kathmandu Valley. Most (75% of the DALYs resulted from years of life lost in Nepal. Males accounted for 73% of DALYs. Almost half (44% of the DALYs were contributed by the group aged 15–29 years. Conclusion: This study is the first to calculate the burden of road traffic accidents in Nepal using Nepal’s own data. Nepal needs to develop and enhance its own system to identify significant public health issues so as to set national priorities for prevention of road traffic accidents.

A systematic analysis of global anemia burden from 1990 to 2010

Science.gov (United States)

Jasrasaria, Rashmi; Naghavi, Mohsen; Wulf, Sarah K.; Johns, Nicole; Lozano, Rafael; Regan, Mathilda; Weatherall, David; Chou, David P.; Eisele, Thomas P.; Flaxman, Seth R.; Pullan, Rachel L.; Brooker, Simon J.; Murray, Christopher J. L.

2014-01-01

Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9%, causing 68.36 (95% uncertainty interval [UI], 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7%]). Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron-deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease–related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010. PMID:24297872

[Psychoneuroimmunological predictors for burden in older caregivers of patients with Alzheimer's disease].

Science.gov (United States)

Corazza, Danilla I; Pedroso, Renata V; Andreatto, Carla A A; Scarpari, Lais; Garuffi, Marcelo; Costa, José L R; Santos-Galduróz, Ruth F

2014-01-01

The responsibility of giving care to patients with Alzheimer's disease (AD) may result in health changes in the older caregiver. It is important to explore the factors which influence the presence of care burden and to create strategies to face this condition. In this context, the aims of present study were to investigate the relationships between psychoneuroimmunological parameters and determine the predictors to burden in older caregivers of patients with AD. A total of 30 AD older caregivers participating in the «Cognitive and Functional Kinesiotherapy Program in Elderly with Alzheimer's disease«(PRO-CDA)», de Rio Claro, SP-Brazil, were submitted to an assessment protocol to evaluate the psychoneuroimmunological parameters. A descriptive statistical analysis, Pearson correlation and multiple linear regressions were performed. The mean age of caregivers was 71.3 (±9.3), and predominantly are first-grade relatives. The caregiver burden was associated with depressive symptoms (r=0.60, P<.001), caregiver distress (r=0.68, P<.001), and neuropsychiatric disorders of AD patients (r=0.53, P<.001). The multiple regression analysis confirmed depressive symptoms and neuropsychiatric disturbances as predictors of caregiver burden. Caregiver burden is associated with, and influenced by parameters related to the caregiver psychological suffering and to characteristics inherent to AD. Thus, it is important to find strategies and implement non-pharmacological programs to provide support to older caregivers, and to assist in the treatment of patients with AD, in order to improve the integral health of this population. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

Economic Burden of Herpes Zoster (“culebrilla” in Latin America

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Emmanouil Rampakakis

2017-05-01

Conclusion: HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America.

Factor analysis of the Zarit Burden Interview in family caregivers of patients with amyotrophic lateral sclerosis.

Science.gov (United States)

Oh, Juyeon; Kim, Jung A

2018-02-01

The Zarit Burden Interview has been used in many studies to assess caregiver burden in family caregivers of patients with amyotrophic lateral sclerosis, but the factor structure of the Zarit Burden Interview in the caregivers of amyotrophic lateral sclerosis patients is unknown. The aim of this study was to explore the factor structure of the Zarit Burden Interview in family caregivers of amyotrophic lateral sclerosis patients using exploratory factor analysis. The exploratory factor analysis was performed using generalized least squares with oblique rotation in a sample of 202 family caregivers. Three factors had an eigenvalue greater than 1 and accounted for 60.33% of the total variance. The three factors were named as follows: (factor 1) "Social restrictions" (items 2, 3, and 10-15); (factor 2) "Self-criticism" (items 20-21); and (factor 3) "Anger and frustration" (items 1, 4-6, 9, and 16-19). The correlation between factors 1 and 3 was much higher (r = 0.79) than that between factors 1 and 2 (r = 0.14) or factors 2 and 3 (r = 0.15). The findings of this study enriched our understanding of several meaningful dimensions of the caregiving burden in caregivers of an amyotrophic lateral sclerosis population and provided opportunities for future intervention.

[Relationship between disease burden and research funding through the Health Research Foundation in Spain].

Science.gov (United States)

Gómez-García, Teresa; Moreno-Casbas, Teresa; González-María, Esther; Fuentelsaz-Gallego, Carmen

2014-01-01

To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010. Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System. A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p<0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4€/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7€/DALY and 3,387.6€/DALY respectively, obtained the greatest funding. The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area. Copyright © 2013 Elsevier España, S.L. All rights reserved.

The economic burden of schizophrenia in Malaysia

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Teoh SL

2017-07-01

Full Text Available Siew Li Teoh,1 Huey Yi Chong,1 Salina Abdul Aziz,2 Norliza Chemi,2 Abdul Razak Othman,2 Nurzuriana Md Zaki,2 Possatorn Vanichkulpitak,3 Nathorn Chaiyakunapruk1,4–6 1School of Pharmacy, Monash University Malaysia, Selangor, 2Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, 4Center of Pharmaceutical Outcomes Research (CPOR, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 5School of Pharmacy, University of Wisconsin, Madison, WI, USA; 6Health and Well-being Cluster, Global Asia in the 21st Century (GA21 Platform, Monash University Malaysia, Selangor, MalaysiaIntroduction: Schizophrenia (SCZ is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia.Methods: A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL. The medical charts were identified electronically by matching the unique patient’s identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted.Results: The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million

Alcohol?attributed disease burden and alcohol policies in the BRICS?countries during the years 1990?2013

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Rabiee, Rynaz; Agardh, Emilie; Coates, Matthew M; Allebeck, Peter; Danielsson, Anna?Karin

2017-01-01

Background We aimed to assess alcohol consumption and alcohol?attributed disease burden by DALYs (disability adjusted life years) in the BRICS countries (Brazil, Russia, India, China and South Africa) between 1990 and 2013, and explore to what extent these countries have implemented evidence?based alcohol policies during the same time period. Methods A comparative risk assessment approach and literature review, within a setting of the BRICS countries. Participants were the total populations (...

The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya.

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Feikin, Daniel R; Olack, Beatrice; Bigogo, Godfrey M; Audi, Allan; Cosmas, Leonard; Aura, Barrack; Burke, Heather; Njenga, M Kariuki; Williamson, John; Breiman, Robert F

2011-01-18

Characterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions. From June 1, 2006 to May 31, 2008, we estimated rates of acute lower respiratory tract illness (ALRI), diarrhea and acute febrile illness (AFI) among >50,000 persons participating in population-based surveillance in impoverished, rural western Kenya (Asembo) and an informal settlement in Nairobi, Kenya (Kibera). Field workers visited households every two weeks, collecting recent illness information and performing limited exams. Participants could access free high-quality care in a designated referral clinic in each site. Incidence and longitudinal prevalence were calculated and compared using Poisson regression. INCIDENCE RATES RESULTING IN CLINIC VISITATION WERE THE FOLLOWING: ALRI--0.36 and 0.51 episodes per year for children poor Kenyan communities still suffer from a high burden of infectious diseases, which likely hampers their development. Urban slum and rural disease incidence and clinic utilization are sufficiently disparate in Africa to warrant data from both settings for estimating burden and focusing interventions.

[Economic burden of esophageal cancer in China from 1996 to 2015: a systematic review].

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Guo, L W; Shi, C L; Huang, H Y; Wang, L; Yue, X P; Liu, S Z; Li, J; Su, K; Dai, M; Sun, X B; Shi, J F

2017-01-10

Objective: To explore existing evidence of economic burden of esophageal cancer in China over the past 20 years. Methods: Based on PubMed, CNKI and Wanfang, literatures published from 1996 to 2015 were retrieved with the key words such as " economic burden" , "cost of illness" and so on. Then the information excerpted from those literatures were analyzed after several exclusionary procedures for non-esophageal cancer related literatures. The information about subjects and data source, methodology, main results were structurally abstracted and then analyzed. Quality assessments were conducted independently by two investigators using an 11-item instrument recommended by the Agency for Healthcare Research and Quality (AHRQ) for cross-sectional studies. All the expenditure data were calculated according to year-specific personal health care consumer price index (CPI) of China, the annual growth rate was calculated according to the average speed of growth. Results: A total of 23 studies (21 individual surveys and 2 population-based surveys) were included in the analysis, in which 12 were published over the past 5 years. Among the 21 individual surveys, 17 were hospital-based and the data were obtained through medical record review, and most of which only considered the direct medical economic burden (including the average overall expenditure per patient, per time and per diem). The median expenditure per patient during 1996-2011 ranged from 7 463 to 37 647 yuan (RMB) and the average growth rate was 7.68 % . The median medical expenditure per clinical visit during 1996-2013 ranged from 6 851 to 57 554 yuan (RMB) and the average growth rate was 11.89 % . The median medical expenditure per diem during 1996-2010 ranged from 225 to 1 319 yuan (RMB) and the average growth rate was 12.53 % . The direct medical expenditure per clinical visit varied greatly with area, which were much higher in Beijing, Shanxi and Hubei. In both individual survey and population-based survey, less

The unrecognized burden of typhoid fever.

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Obaro, Stephen K; Iroh Tam, Pui-Ying; Mintz, Eric Daniel

2017-03-01

Typhoid fever (TF), caused by Salmonella enterica serovar Typhi, is the most common cause of enteric fever, responsible for an estimated 129,000 deaths and more than 11 million cases annually. Although several reviews have provided global and regional TF disease burden estimates, major gaps in our understanding of TF epidemiology remain. Areas covered: We provide an overview of the gaps in current estimates of TF disease burden and offer suggestions for addressing them, so that affected communities can receive the full potential of disease prevention offered by vaccination and water, sanitation, and hygiene interventions. Expert commentary: Current disease burden estimates for TF do not capture cases from certain host populations, nor those with atypical presentations of TF, which may lead to substantial underestimation of TF cases and deaths. These knowledge gaps pose major obstacles to the informed use of current and new generation typhoid vaccines.

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011.

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Alies van Lier

Full Text Available Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands.The average annual disease burden was computed for the period 2007-2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911-9961 and influenza (8670 DALYs/year; 95% UI: 8468-8874, which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011

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Bouwknegt, Martijn; Kretzschmar, Mirjam E.; Mangen, Marie-Josée J.; Wallinga, Jacco; de Melker, Hester E.

2016-01-01

Background Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands. Methods and Findings The average annual disease burden was computed for the period 2007–2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911–9961) and influenza (8670 DALYs/year; 95% UI: 8468–8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011.

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van Lier, Alies; McDonald, Scott A; Bouwknegt, Martijn; Kretzschmar, Mirjam E; Havelaar, Arie H; Mangen, Marie-Josée J; Wallinga, Jacco; de Melker, Hester E

2016-01-01

Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands. The average annual disease burden was computed for the period 2007-2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911-9961) and influenza (8670 DALYs/year; 95% UI: 8468-8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be attributed to the

Population distribution and burden of acute gastrointestinal illness in British Columbia, Canada

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Fyfe Murray

2006-12-01

Full Text Available Abstract Background In developed countries, gastrointestinal illness (GI is typically mild and self-limiting, however, it has considerable economic impact due to high morbidity. Methods The magnitude and distribution of acute GI in British Columbia (BC, Canada was evaluated via a cross-sectional telephone survey of 4,612 randomly selected residents, conducted from June 2002 to June 2003. Respondents were asked if they had experienced vomiting or diarrhoea in the 28 days prior to the interview. Results A response rate of 44.3% was achieved. A monthly prevalence of 9.2% (95%CI 8.4 – 10.0, an incidence rate of 1.3 (95% CI 1.1–1.4 episodes of acute GI per person-year, and an average probability that an individual developed illness in the year of 71.6% (95% CI 68.0–74.8, weighted by population size were observed. The average duration of illness was 3.7 days, translating into 19.2 million days annually of acute GI in BC. Conclusion The results corroborate those from previous Canadian and international studies, highlighting the substantial burden of acute GI.

Projections of the current and future disease burden of hepatitis C virus infection in Malaysia.

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McDonald, Scott A; Dahlui, Maznah; Mohamed, Rosmawati; Naning, Herlianna; Shabaruddin, Fatiha Hana; Kamarulzaman, Adeeba

2015-01-01

The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at 2.5% of the adult population. Our objective, satisfying one of the directives of the WHO Framework for Global Action on Viral Hepatitis, was to forecast the HCV disease burden in Malaysia using modelling methods. An age-structured multi-state Markov model was developed to simulate the natural history of HCV infection. We tested three historical incidence scenarios that would give rise to the estimated prevalence in 2009, and calculated the incidence of cirrhosis, end-stage liver disease, and death, and disability-adjusted life-years (DALYs) under each scenario, to the year 2039. In the baseline scenario, current antiviral treatment levels were extended from 2014 to the end of the simulation period. To estimate the disease burden averted under current sustained virological response rates and treatment levels, the baseline scenario was compared to a counterfactual scenario in which no past or future treatment is assumed. In the baseline scenario, the projected disease burden for the year 2039 is 94,900 DALYs/year (95% credible interval (CrI): 77,100 to 124,500), with 2,002 (95% CrI: 1340 to 3040) and 540 (95% CrI: 251 to 1,030) individuals predicted to develop decompensated cirrhosis and hepatocellular carcinoma, respectively, in that year. Although current treatment practice is estimated to avert a cumulative total of 2,200 deaths from DC or HCC, a cumulative total of 63,900 HCV-related deaths is projected by 2039. The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia.

Burden of injury of serious road injuries in six EU countries.

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Weijermars, Wendy; Bos, Niels; Filtness, Ashleigh; Brown, Laurie; Bauer, Robert; Dupont, Emmanuelle; Martin, Jean Louis; Perez, Katherine; Thomas, Pete

2018-02-01

Information about the burden of (non-fatal) road traffic injury is very useful to further improve road safety policy. Previous studies calculated the burden of injury in individual countries. This paper estimates and compares the burden of non-fatal serious road traffic injuries in six EU countries/regions: Austria, Belgium, England, The Netherlands, the Rhône region in France and Spain. It is a cross-sectional study based on hospital discharge databases. of study are patients hospitalized with MAIS3+ due to road traffic injuries. The burden of injury (expressed in years lived with disability (YLD)) is calculated applying a method that is developed within the INTEGRIS study. The method assigns estimated disability information to the casualties using the EUROCOST injury classification. The average burden per MAIS3+ casualty varies between 2.4 YLD and 3.2 YLD per casualty. About 90% of the total burden of injury of MAIS3+ casualties is due to lifelong consequences that are experienced by 19% to 33% of the MAIS3+ casualties. Head injuries, spinal cord injuries and injuries to the lower extremities are responsible for more than 90% of the total burden of MAIS3+ road traffic injuries. Results per transport mode differ between the countries. Differences between countries are mainly due to differences in age distribution and in the distribution over EUROCOST injury groups of the casualties. The analyses presented in this paper can support further improvement of road safety policy. Countermeasures could for example be focused at reducing skull and brain injuries, spinal cord injuries and injuries to the lower extremities, as these injuries are responsible for more than 90% of the total burden of injury of MAIS3+ casualties. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Economic burden of stomach cancer in China during 1996-2015: a systematic review].

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Yao, F; Shi, C L; Liu, C C; Wang, L; Song, S M; Ren, J S; Guo, C G; Lou, P A; Dai, M; Zhu, L; Shi, J F

2017-08-06

Objective: To clarify the research status of economic burden of stomach cancer in China from 1996 to 2015. Methods: Based on three electronic literature databases (China Knowledge Resource Integrated Database, Wanfang Database and PubMed), a total of 2 873, 1 244 and 84 articles published during 1996 to 2015 were found, respectively, using keywords of"cancer","neoplasms","malignant tumor","tumor","economic burden","health expenditure","cost","cost of illness", and"China". According to the inclusion and exclusion criteria, 30 literatures were included in the final analysis. Then the basic information and study subjects, indicators and main results of economic burden were abstracted and analyzed. All the expenditure data were discounted to the values in 2013 by using China's percapita consumer price index. Results: Totally, 30 articles were included, covering 14 provinces and of which 16 were published during 2011-2015. One article was based on population-level and the remaining studies were all based on individual-level. The number of individual-level articles that reported direct medical, non-medical and indirectly economic burden was 29, 1 and 2, respectively. The main indicators of direct medical expenditure were expenditure per patient (22), per clinical visit (9) and per diem (11), respectively. The median expenditure per patient was 7 387-28 743 RMB (CNY), with average annual growth rate (AAGR) of 1.7% (1996-2013). The median expenditure per clinical visit was 18 504-41 871 RMB (2003-2013), with AAGR of 5.5%. The median expenditure per diem was 313-1 445 RMB (1996-2012), with AAGR of 3.7%. Difference was found among provinces. Conclusions: The evidence for economic burden of stomach cancer was still limited over the past two decades and mainly focused on individual and regional levels. An increase and differences in provinces were observed in direct medical expenditure. Evaluation on direct non-medical and indirect medical expenditure needs to be addressed.

The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study.

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2017-08-03

Mental disorders are among the leading causes of nonfatal burden of disease globally. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

A population-based estimate of the economic burden of influenza in Peru, 2009-2010.

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Tinoco, Yeny O; Azziz-Baumgartner, Eduardo; Rázuri, Hugo; Kasper, Matthew R; Romero, Candice; Ortiz, Ernesto; Gomez, Jorge; Widdowson, Marc-Alain; Uyeki, Timothy M; Gilman, Robert H; Bausch, Daniel G; Montgomery, Joel M

2016-07-01

Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013

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Charara, Raghid; Forouzanfar, Mohammad; Naghavi, Mohsen; Moradi-Lakeh, Maziar; Afshin, Ashkan; Vos, Theo; Daoud, Farah; Wang, Haidong; El Bcheraoui, Charbel; Khalil, Ibrahim; Hamadeh, Randah R.; Khosravi, Ardeshir; Rahimi-Movaghar, Vafa; Khader, Yousef; Al-Hamad, Nawal; Makhlouf Obermeyer, Carla; Rafay, Anwar; Asghar, Rana; Rana, Saleem M.; Shaheen, Amira; Abu-Rmeileh, Niveen M. E.; Husseini, Abdullatif; Abu-Raddad, Laith J.; Khoja, Tawfik; Al Rayess, Zulfa A.; AlBuhairan, Fadia S.; Hsairi, Mohamed; Alomari, Mahmoud A.; Ali, Raghib; Roshandel, Gholamreza; Terkawi, Abdullah Sulieman; Hamidi, Samer; Refaat, Amany H.; Westerman, Ronny; Kiadaliri, Aliasghar Ahmad; Akanda, Ali S.; Ali, Syed Danish; Bacha, Umar; Badawi, Alaa; Bazargan-Hejazi, Shahrzad; Faghmous, Imad A. D.; Fereshtehnejad, Seyed-Mohammad; Fischer, Florian; Jonas, Jost B.; Kuate Defo, Barthelemy; Mehari, Alem; Omer, Saad B.; Pourmalek, Farshad; Uthman, Olalekan A.; Mokdad, Ali A.; Maalouf, Fadi T.; Abd-Allah, Foad; Akseer, Nadia; Arya, Dinesh; Borschmann, Rohan; Brazinova, Alexandra; Brugha, Traolach S.; Catalá-López, Ferrán; Degenhardt, Louisa; Ferrari, Alize; Haro, Josep Maria; Horino, Masako; Hornberger, John C.; Huang, Hsiang; Kieling, Christian; Kim, Daniel; Kim, Yunjin; Knudsen, Ann Kristin; Mitchell, Philip B.; Patton, George; Sagar, Rajesh; Satpathy, Maheswar; Savuon, Kim; Seedat, Soraya; Shiue, Ivy; Skogen, Jens Christoffer; Stein, Dan J.; Tabb, Karen M.; Whiteford, Harvey A.; Yip, Paul; Yonemoto, Naohiro; Murray, Christopher J. L.; Mokdad, Ali H.

2017-01-01

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25–49 age group, with a peak in the 35–39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of

Economic burden of COPD in a Swedish cohort: the ARCTIC study

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Lisspers K

2018-01-01

Full Text Available Karin Lisspers,1 Kjell Larsson,2 Gunnar Johansson,1 Christer Janson,3 Madlaina Costa-Scharplatz,4 Jean-Bernard Gruenberger,5 Milica Uhde,6 Leif Jorgensen,7 Florian S Gutzwiller,5 Björn Ställberg1 1Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, 2Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna, 3Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, 4Novartis AB, Täby, Sweden; 5Novartis, Basel, Switzerland; 6IQVIA, Solna, Sweden; 7IQVIA, Copenhagen, Denmark Background: We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC setting.Patients and methods: Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related and indirect health care costs (loss of income, absenteeism, loss of productivity were assessed.Results: A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179 versus the reference population (€2,716, largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient were the largest economic burden in COPD patients of working age during 2013.Conclusion: As non-COPD-related hospital nights represent the largest direct cost, management of

Heatwave and elderly mortality: An evaluation of death burden and health costs considering short-term mortality displacement.

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Cheng, Jian; Xu, Zhiwei; Bambrick, Hilary; Su, Hong; Tong, Shilu; Hu, Wenbiao

2018-06-01

A heatwave can be a devastating natural disaster to human health, and elderly people are particularly vulnerable. With the continuing rise in earth's surface temperature alongside the world's aging population, research on the mortality burden of heatwave for the older population remains relatively sparse. The potential magnitude of benefits of averting such deaths may be considerable. This paper examined the short-term mortality displacement (or "harvesting") of heatwave, characterized the heatwave-mortality relationship, and estimated death burden and health costs attributable to heatwave among the elderly in Australia. We collected daily data on the temperature and deaths of people aged ≥75 years in the five largest cities of Australia (Sydney, Melbourne, Brisbane, Perth and Adelaide), totaling 368,767 deaths in different periods between 1988 and 2011. A total of 15-tiered heatwave definitions, based on intensity (95th to 99th percentiles of temperature distribution) and duration (two or more consecutive days), were used to quantify heatwave effects, using time-series regression and random-effects meta-analysis. We calculated attributable deaths for each city and by different types of heatwave. Potential economic benefits in monetary terms were also estimated, considering that heat-related deaths are avoidable. Among the Australian elderly population, we found significant associations between heatwave and deaths, with raised mortality immediately in the first few days followed by lower-than-expected mortality. In general, heatwave was associated with an average death increase of 28% (95% confidence interval: 15% to 42%), and greater increases were mostly observed for more intense heatwaves across multiple megacities. During the study period, there were dozens to hundreds of deaths attributable to heatwave for each city, equating to an economic loss of several million Australian dollars every year. Although the estimated attributable deaths varied by heatwave

The Economic Burden of Intimate Partner Violence in Ecuador: Setting the Agenda for Future Research and Violence Prevention Policies

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Phaedra Corso

2013-08-01

Full Text Available Introduction: Intimate partner violence (IPV is a widespread social structural problem that affects a great proportion of Ecuadorian women. IPV is a sexually, psychologically, or physically coercive act against an adult or adolescent woman by a current or former intimate partner. Not-for-profit groups in Ecuador report that 70% of women experience 1 of the forms of IPV sometime during their lifetime, but population-based surveys suggest that 41% of Ecuadorian women are exposed to emotional violence, 31% physical violence, and 12% sexual violence by their spouse or partner over their lifetime. Despite the high prevalence, the response of the Ecuadorian government has been insufficient to reduce the number of victims and to provide adequate legal and health services for the prevention and treatment of IPV. Given the power of economic data to influence policy making, the goal of this study is to produce the first estimate of the economic impact of IPV in Ecuador and to identify the policy paths in which these estimates would have the greatest impact for Ecuador.Methods: Using a bottom-up method for estimating the economic burden of IPV and a national prevalence of IPV based on a population-based survey in the 2003–2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 United States (U.S. currency rate. Results: Based on a prevalence of 255,267 women who were victims of IPV in the 2003–2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 the U.S. currency rate. The largest cost category contributing to the economic burden was the costs of healthcare services to treat injuries associated with IPV events.Conclusion: The asymmetry between the economic burden of IPV and the amount of government resources devoted to IPV prevention efforts suggests the need for a greater role to be played by the government and other factors in society in the area of IPV

Health disparities from economic burden of diabetes in middle-income countries: evidence from México.

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Armando Arredondo

Full Text Available The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010-2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05, there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA, serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security-IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-; $1.8 to users; and $.1 to Private Health Insurance (PHI. If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users' pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries.

Disease burden of chronic lymphocytic leukaemia within the European Union.

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Watson, Louise; Wyld, Peter; Catovsky, Daniel

2008-10-01

Whilst Chronic lymphocytic leukaemia (CLL) is considered a rare disease, to our knowledge, the current prevalence of CLL within the European Union (EU) member states is not published. Understanding the number of individuals with CLL is vital to assess disease burden within the wider population. Using 2002 data from the International Agency for Research on Cancer, we estimated the number of individuals with CLL (ICD-10 C91.1) from those reported for all leukaemias (C91-95) and extrapolated the figures by the population increase within the EU between 2002 and 2006, the last year with fully updated community population estimates. One- and 5-yr partial prevalence estimates are reported (i.e. the number of individuals still living 1-5 yr post-diagnosis). We then applied proportional estimates from the literature to assess those requiring immediate treatment, those under observation and their likely progression rates. We found that within the 27 EU states plus Iceland, Norway and Lichtenstein, 1- and 5-yr CLL partial prevalence estimates totalled approximately 13,952 and 46,633 individuals respectively in 2006. By applying Binet staging to the 1-yr estimate, 40% of patients will be stage B/C and require immediate treatment. Thus, 5581 individuals may be treated within the first year of diagnosis. Of the 60% (8371) under observation, by 5 yr up to 33% (2763) may have more advanced disease with increased risk of mortality. Whilst CLL is a rare disease, the number of individuals burdened by the disease within the EU is considerable and thousands of patients require treatment and physician care, which has cost implications for member states.

Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia.

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Wong, C Y; Zalilah, M S; Chua, E Y; Norhasmah, S; Chin, Y S; Siti Nur'Asyura, A

2015-07-21

Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors. This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households. About 26 % of overweight and obese adults coexisting with high proportions of underweight (49%) and stunted (64%) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20%) and OWOBM/STC (19.4%) than households with OWOBM/UWC (12.5%). Boys (P diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.

Prevalence and burden of headache disorders in Lithuania and their public-health and policy implications: a population-based study within the Eurolight Project.

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Rastenytė, Daiva; Mickevičienė, Dalia; Stovner, Lars Jacob; Thomas, Hallie; Andrée, Colette; Steiner, Timothy J

2017-12-01

The Eurolight project assessed the impact of headache disorders in ten EU countries, using the same structured questionnaire but varying sampling methods. In Lithuania, sample selection employed methods in line with consensus recommendations for population-based burden-of-headache studies. The survey was cross-sectional. We identified, from the Residents' Register Service, a sample of inhabitants of Kaunas city and surrounding Kaunas region reflecting age (in the range 18-65 years), gender and rural/urban distributions of Lithuania. Medical students called unannounced at their homes and conducted face-to-face interviews employing a structured questionnaire. Of 1137 people in the pre-identified sample, 573 (male 237 [41.4%], female 336 [58.6%]; mean age 40.9 ± 13.8 years) completed interviews (participation proportion: 50.4%). Gender-adjusted 1-year prevalences were: any headache 74.7%; migraine 18.8%; tension-type headache (TTH) 42.2%; all headache on ≥15 days/month 8.6%; probable medication-overuse headache (pMOH) 3.2%. Migraine (OR: 3.6) and pMOH (OR: 2.9) were associated with female gender. All headache types except TTH were associated with significantly diminished quality of life. Migraine caused a mean 4.5% loss in paid worktime per affected male and 3.5% per affected female. Lost per-person times due to TTH were much less, but to pMOH and other headache on ≥15 days/month much higher. Among the entire workforce, lost productivity to migraine was estimated at 0.7%, to TTH 0.3% and to pMOH or other headache on ≥15 days/month 0.5%. The total of 1.5% may translate directly into lost GDP. Alternative calculations based on headache yesterday (with little recall error) produced, for all headache, a corroborating 1.7%. Similar losses from household work would also drain the nation's economy. Our findings were comparable to those from earlier studies using similar methods in Russia and Georgia. The multiple burdens from headache in Lithuania indicate

Socioeconomic burden of influenza in the Republic of Korea, 2007-2010.

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Mina Suh

Full Text Available BACKGROUND: Although the socioeconomic burden of 2009 pandemic influenza A (H1N1 was considerable, no reliable estimates have been reported. Our aim was to compared medical costs and socioeconomic burden resulting from pandemic influenza A (H1N1 2009 with that of previous seasonal influenza. METHODS: We estimated the medical costs and socioeconomic burden of influenza from May 2007 to April 2010. We used representative national data sources(data from the Health Insurance Review Agency, the National Health Insurance Corporation, the Korea Centers for Disease Control and Prevention, and the Korean National Statistics Office including medical utilization, prescription of antivirals, and vaccination. Uncertainty of data was explored through sensitivity analysis using Monte Carlo simulation. RESULTS: Compared with the seasonal influenza, total medical costs (US$291.7 million associated with pandemic (H1N1 2009 increased more than 37-fold. Compared with the 2007-2008 season, outpatient diagnostic costs (US$135.3 million were 773 times higher in the 2009-2010 season, and the mean diagnostic cost per outpatient visit was 58.8 times higher. Total socioeconomic burden of pandemic (H1N1 2009 was estimated at US$1581.3 million (10%-90%: US$1436.0-1808.3 million and those of seasonal influenza was estimated at US$44.7 million (10%-90%: US$32.4-57.9 million in 2007-2008 season and US$42.3 million (10%-90%: US$31.5-53.8 million in 2008-2009 season. Indirect costs accounted for 56.0% of total costs in pandemic (H1N1 2009, and 66.48-68.09% in seasonal influenza. The largest contributors to total burden were productivity losses of caregiver in pandemic (H1N1 2009, and productivity losses due to morbidity of outpatient in seasonal influenza. CONCLUSIONS: In the Republic of Korea, socioeconomic burden of pandemic (H1N1 2009 were considerably higher than burden of the previous two influenza seasons, primarily because of high diagnostic costs and longer sick leave.

Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure.

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Al-Rawashdeh, Sami Y; Lennie, Terry A; Chung, Misook L

Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF). The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF. A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach's α and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms). Cronbach's α for the ZBI was .921. The ZBI had good item-total (r = 0.395-0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient's dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient's future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 ± 6.8 vs 3.1 ± 4.3; P < .01). The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.

Burden of tuberculosis in indigenous peoples globally: a systematic review.

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Tollefson, D; Bloss, E; Fanning, A; Redd, J T; Barker, K; McCray, E

2013-09-01

The burden of tuberculosis (TB) in the estimated 370 million indigenous peoples worldwide is unknown. To conduct a literature review to summarize the TB burden in indigenous peoples, identify gaps in current knowledge, and provide the foundation for a research agenda prioritizing indigenous health within TB control. A systematic literature review identified articles published between January 1990 and November 2011 quantifying TB disease burden in indigenous populations worldwide. Among the 91 articles from 19 countries included in the review, only 56 were from outside Australia, Canada, New Zealand and the United States. The majority of the studies showed higher TB rates among indigenous groups than non-indigenous groups. Studies from the Amazon generally reported the highest TB prevalence and incidence, but select populations from South-East Asia and Africa were found to have similarly high rates of TB. In North America, the Inuit had the highest reported TB incidence (156/100000), whereas the Metis of Canada and American Indians/Alaska Natives experienced rates of indigenous groups. Where data exist, indigenous peoples were generally found to have higher rates of TB disease than non-indigenous peoples; however, this burden varied greatly. The paucity of published information on TB burden among indigenous peoples highlights the need to implement and improve TB surveillance to better measure and understand global disparities in TB rates.

ANALYSIS OF TAX BURDEN PARAMETERS OF UKRAINE'S ECONOMY

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I. Moyseyenko

2017-11-01

Full Text Available The need to solve the problems of macro-economic stabilization of the country's economy on the basis of determining the tax system efficiency led to the actuality and importance of developing methodological issues of macro-economic tax regulation. In terms of macro-financial stability for the purpose of strategic analysis, the macroeconomic category of tax burden and its fiscal efficiency in terms of direct and indirect taxation is considered. Tax burden indicators at a macro-level quantitatively measure the total level of tax payment and pumping up the budget. Based on the analysis of tax burden it is found that in Ukraine the major fiscal function is performed by consumption taxes (indirect taxes. The methodological principles of the diagnostics of tax burden influence on macro-indices of economic stabilization are as follows: selecting parameters of monitoring tax burden state and fiscal burden efficiency; the assessment of an impact on fiscal efficiency on macro-indices. To prognosticate the efficiency of fiscal burden performance in terms of indirect taxes linear and exponential trend equations are calculated. In terms of the analysis of macro-financial stability the usage of tax rates of indirect taxes as indicators of fiscal efficiency provides sufficient reasons for the conclusions regarding long-term trends of pumping the budget.

Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi

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Amelia Catharine Crampin

2016-02-01

Full Text Available Abstract Background The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed. Results Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors. Conclusions It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.

40 CFR 305.33 - Burden of presentation; burden of persuasion.

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2010-07-01

... persuasion. 305.33 Section 305.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Hearing Procedure § 305.33 Burden of presentation; burden of persuasion. The Requestor has the burden of... justified. Accordingly, the Requestor bears the burdens of presentation and persuasion. Following the...

Increased missense mutation burden of Fatty Acid metabolism related genes in nunavik inuit population.

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Zhou, Sirui; Xiong, Lan; Xie, Pingxing; Ambalavanan, Amirthagowri; Bourassa, Cynthia V; Dionne-Laporte, Alexandre; Spiegelman, Dan; Turcotte Gauthier, Maude; Henrion, Edouard; Diallo, Ousmane; Dion, Patrick A; Rouleau, Guy A

2015-01-01

Nunavik Inuit (northern Quebec, Canada) reside along the arctic coastline where for generations their daily energy intake has mainly been derived from animal fat. Given this particular diet it has been hypothesized that natural selection would lead to population specific allele frequency differences and unique variants in genes related to fatty acid metabolism. A group of genes, namely CPT1A, CPT1B, CPT1C, CPT2, CRAT and CROT, encode for three carnitine acyltransferases that are important for the oxidation of fatty acids, a critical step in their metabolism. Exome sequencing and SNP array genotyping were used to examine the genetic variations in the six genes encoding for the carnitine acyltransferases in 113 Nunavik Inuit individuals. Altogether ten missense variants were found in genes CPT1A, CPT1B, CPT1C, CPT2 and CRAT, including three novel variants and one Inuit specific variant CPT1A p.P479L (rs80356779). The latter has the highest frequency (0.955) compared to other Inuit populations. We found that by comparison to Asians or Europeans, the Nunavik Inuit have an increased mutation burden in CPT1A, CPT2 and CRAT; there is also a high level of population differentiation based on carnitine acyltransferase gene variations between Nunavik Inuit and Asians. The increased number and frequency of deleterious variants in these fatty acid metabolism genes in Nunavik Inuit may be the result of genetic adaptation to their diet and/or the extremely cold climate. In addition, the identification of these variants may help to understand some of the specific health risks of Nunavik Inuit.

The systemic lupus erythematosus travel burden survey: baseline data among a South Carolina cohort.

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Williams, Edith M; Ortiz, Kasim; Zhang, Jiajia; Zhou, Jie; Kamen, Diane

2016-04-29

Many studies on the impact of systemic lupus erythematosus or lupus have identified patient travel costs as being problematic. We administered a survey that examined the impact of self-rated travel burden on lupus patients. The systemic lupus erythematosus travel burden survey included 41 patients enrolled in the systemic lupus erythematosus database project at the Medical University of South Carolina. Most participants reported that travel caused medications to be discontinued or appointments to be missed. In unadjusted logistic regressions of the relationship between these outcomes and medical travel burden, both distance to rheumatologists and time to lupus medical care were significant. Our findings suggest that more research is needed to examine the influence of travel burden among this population, but data from this report could help to inform physicians, academic researchers, and other health professionals in South Carolina and other areas with significant rural populations on how travel burden may impact patients receiving care for lupus and provide an opportunity for the development of interventions aimed at assisting lupus patients with management of stressors related to travel burden.

[Economic burden of cancer in China during 1996-2014: a systematic review].

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Shi, J F; Shi, C L; Yue, X P; Huang, H Y; Wang, L; Li, J; Lou, P A; Mao, A Y; Dai, M

2016-12-23

Objective: To explore the current status of research on economic burden of cancer in China from 1996 to 2014. Methods: The key words including cancer, economic burden, expenditure, cost were used to retrieve the literatures published in CNKI and Wanfang (the two most commonly used databases for literature in Chinese) and PubMed during 1996-2014. A total of 91 studies were included after several exclusionary procedures. Information on subjects and data source, methodology, main results were structurally abstracted. All the expenditure data were discounted to year of 2013 value using China's health care consumer price indices. Results: More than half of the included studies were published over the past 5 years, 32 of the studies were about lung cancer. Among the 83 individual-based surveys, 77 were hospital-based and obtained data via individually medical record abstraction, and most of which only considered the direct medical expenditure. Expenditure per cancer patient and expenditure per diem were the most commonly used outcome indicators. Majority of the findings on expenditure per cancer patient ranged from 10 thousands to 30 thousands Chinese Yuan (CNY), with larger disparity in lung and breast cancer (ranged from 10 thousands to 90 thousands CNY), narrower difference in esophageal and stomach cancer (ranged from 10 thousands to 50 thousands CNY), and most stable trend in cervical cancer (almost all the values less than 20 thousands CNY). Without exception, the expenditures per diem for all the common cancers were increasing over the period from 1996 to 2014 (3-7 fold increase). Only 8 population-level economic burden studies were included and the reported expenditure of cancer at national level ranged from 32.6 billions to 100.7 billions CNY. Conclusions: Evidence on economic burden of cancer in China from 1996 to 2014 are limited and weakly comparable, particularly at a population level, and the reported expenditure per patient may be underestimated.

Burden of rheumatoid arthritis in the Nordic region, 1990-2015: a comparative analysis using the Global Burden of Disease Study 2015.

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Kiadaliri, A A; Kristensen, L-E; Englund, M

2018-03-01

To report mortality and disability due to rheumatoid arthritis (RA) in the Nordic region (Denmark, Finland, Greenland, Iceland, Norway, and Sweden) using data from the Global Burden of Disease Study (GBD) 2015. Using the results of GBD 2015, we present rates and trends in prevalence, mortality, years of life lost, years lived with disability (YLD), and disability-adjusted life-years (DALYs) of RA in the Nordic region during 1990-2015. In 2015, the age-standardized prevalence of RA was higher in the Nordic region than the global level (0.44%, 95% uncertainty interval 0.40-0.48%, vs 0.35%, 0.32-0.38%). For women (men), DALYs increased by 2.4% (12.9%), from 29 263 (10 909) in 1990 to 29 966 (12 311) in 2015. The burden of RA as a proportion of total DALYs in women (men) increased from 0.90% (0.29%) in 1990 to 0.94% (0.36%) in 2015. Age-standardized DALY rates declined in all countries except Denmark and Greenland between 1990 and 2015. Of 315 conditions studied, RA was ranked as the 16th (37th) leading cause of YLD in women (men) in the region. Of 195 countries studied, Greenland, Finland, Denmark, Norway, Sweden, and Iceland had the 7th, 11th, 28th, 38th, 48th, and 78th highest age-standardized YLD rates for RA, respectively. The prevalence of RA in the Nordic region is higher than the global average. Current trends in population growth and ageing suggest a potential increase in RA burden in the coming decades in the region that should be considered in healthcare resources allocation.

45 CFR 672.17 - Burden of presentation; burden of persuasion.

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2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Burden of presentation; burden of persuasion. 672.17 Section 672.17 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT AND HEARING PROCEDURES § 672.17 Burden of presentation; burden of persuasion. The...

Blood pressure and the global burden of cardiovascular disease.

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Rodgers, A; MacMahon, S

1999-01-01

Cardiovascular disease is responsible for a large and increasing proportion of death and disability worldwide. Half of this burden occurs in Asia. This study assessed the possible effects of population-wide (2% lower DBP for all) and targeted (7% lower DBP for those with usual DBP > or = 95 mmHg) BP interventions in Asia, using data from surveys of blood pressure levels, the Global Burden of Disease Project, Eastern Asian cohort studies and randomised trials of blood pressure lowering. Overall each of the two interventions would be expected to avert about one million deaths per year throughout Asia in 2020. These benefits would be approximately additive. About half a million deaths might be averted annually by each intervention in China alone, with about four-fifths of this benefit due to averted stroke. The relative benefits of these two strategies are similar to estimates made for US and UK populations. However, the absolute benefits are many times greater due to the size of the predicted CVD burden in Asia.

Burden of rotavirus gastroenteritis in the Middle Eastern and North African pediatric population.

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Khoury, Hanane; Ogilvie, Isla; El Khoury, Antoine C; Duan, Yinghui; Goetghebeur, Mireille M

2011-01-07

Rotavirus gastroenteritis (RVGE) is the most common cause of severe childhood diarrhea worldwide. Objectives were to estimate the burden of RVGE among children less than five years old in the Middle East (Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Syria, UAE, Yemen), North Africa (Algeria, Egypt, Libya, Morocco, Tunisia) and Turkey. A comprehensive literature search was conducted in major databases on the epidemiology and burden of rotavirus among children less than five years old between 1999 and 2009. Data from each country was extracted and compared. The search identified 43 studies. RVGE was identified in 16-61% of all cases of acute gastroenteritis, with a peak in the winter. RVGE-related hospitalization rates ranged from 14% to 45%, compared to 14%-28% for non-RVGE. Annually, RVGE caused up to 112 fatalities per 100,000 in certain countries in the region. Hospitalization costs ranged from $1.8 to $4.6 million annually, depending on the country. The most recent literature available showed that G1P[8] was the most prevalent genotype combination in 8 countries (range 23%-56%). G2P[4] was most prevalent in 4 countries (26%-48%). G9P[8] and G4P[8] were also frequently detected. RVGE is a common disease associated with significant morbidity, mortality, and economic burden. Given the variety and diverse rotavirus types in the region, use of a vaccine with broad and consistent serotype coverage would be important to help decrease the burden of RVGE in the Middle East and North Africa.

The burden of disease preventable by risk factor reduction in Serbia

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Šipetić Sandra

2013-01-01

Full Text Available Background/Aim. Reliable and comparable analysis of health risks is an important component of evidence-based and preventive programs. The aim of this study was to analyze the impact of the most relevant avoidable risk factors on the burden of the selected conditions in Serbia. Methods. Attributable fractions were calculated from the survey information on the prevalence of a risk factor and the relative risk of dying if exposed to a risk factor. The population-attributable risks were applied to deaths, years of life lost due to premature mortality (YLL, years of life with disability (YLD and disability adjusted life years (DALY. Results. More than 40% of all deaths and of the total YLL are attributable to cigarette smoking, overweight, physical inactivity, inadequate intake of fruit and vegetables, hypertension and high blood cholesterol. Alcohol consumption has in total a beneficial effect. According to the percent of DALY for the selected conditions attributable to the observed risk factors, their most harmful effects are as follows: alcohol consumption on road traffic accidents; cigarette smoking on lung cancer; physical inactivity on cerebrovascular disease (CVD, ischemic heart disease (IHD and colorectal cancer; overweight on type 2 diabetes; hypertension on renal failure and CVD; inadequate intake of fruit and vegetables on IHD and CVD, and high blood cholesterol on IHD. Conclusions. This study shows that a high percentage of disease and injury burden in Serbia is attributable to avoidable risk factors, which emphasizes the need for improvement of relevant preventive strategies and programs at both individual and population levels. Social preferences should be determined for a comprehensive set of conditions and cost effectiveness analyses of potential interventions should be carried out. Furthermore, positive measures, derived from health, disability and quality of life surveys, should be included. [Projekat Ministarstva nauke Republike

Burden, Determinants, and Pharmacological Management of Hypertension in HIV-Positive Patients and Populations: A Systematic Narrative Review.

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Nguyen, Kim Anh; Peer, Nasheeta; Mills, Edward J; Kengne, Andre Pascal

2015-01-01

Hypertension among HIV-positive populations has emerged as a new threat to the health and well being of people living with HIV, particularly among those receiving antiretroviral therapy. We reviewed the global evidence on the burden of disease (including prevalence and incidence), determinants of hypertension among HIV-positive populations, and the pharmacological management of hypertension in HIV-positive patients. We systematically searched PubMed-MEDLINE and EMBASE from January 2000 through February 2015 for relevant studies and traced their citations through the ISI Web of Science. We also searched the websites of the World Health Organisation, the International Society of Hypertension, and the International AIDS Society and constructed a narrative data synthesis. Hypertension is common in HIV-positive populations, with prevalence estimates ranging from 4.7 to 54.4% in high-income countries, and from 8.7 to 45.9% in low- and middle-income countries. The role of HIV-specific factors including disease severity, duration of disease, and treatments on the presence of hypertension in HIV-positive patients is reported, but patterns remain unclear. The clinical management of hypertension in HIV-positive patients is similar to those with hypertension in the general population; however, additional considerations should be given to potential drug interactions between antihypertensive agents and antiretroviral drugs to inform the clinician's selection of these therapies. Hypertension is common in HIV-positive populations and remains an important comorbidity affecting mortality outcomes. Further research examining the development of hypertension and its associated care in HIV-positive patients is required to optimize management of the dual conditions.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990–2013: findings from the Global Burden of Disease Study 2013

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Forouzanfar, Mohammad H; Vollset, Stein Emil; El Bcheraoui, Charbel; Daoud, Farah; Afshin, Ashkan; Charara, Raghid; Khalil, Ibrahim; Higashi, Hideki; Abd El Razek, Mohamed Magdy; Kiadaliri, Aliasghar Ahmad; Alam, Khurshid; Akseer, Nadia; Al-Hamad, Nawal; Ali, Raghib; AlMazroa, Mohammad AbdulAziz; Alomari, Mahmoud A; Al-Rabeeah, Abdullah A; Alsharif, Ubai; Altirkawi, Khalid A; Atique, Suleman; Badawi, Alaa; Barrero, Lope H; Basulaiman, Mohammed; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Bensenor, Isabela M; Buchbinder, Rachelle; Danawi, Hadi; Dharmaratne, Samath D; Zannad, Faiez; Farvid, Maryam S; Fereshtehnejad, Seyed-Mohammad; Farzadfar, Farshad; Fischer, Florian; Gupta, Rahul; Hamadeh, Randah Ribhi; Hamidi, Samer; Horino, Masako; Hoy, Damian G; Hsairi, Mohamed; Husseini, Abdullatif; Javanbakht, Mehdi; Jonas, Jost B; Kasaeian, Amir; Khan, Ejaz Ahmad; Khubchandani, Jagdish; Knudsen, Ann Kristin; Kopec, Jacek A; Lunevicius, Raimundas; Abd El Razek, Hassan Magdy; Majeed, Azeem; Malekzadeh, Reza; Mate, Kedar; Mehari, Alem; Meltzer, Michele; Memish, Ziad A; Mirarefin, Mojde; Mohammed, Shafiu; Naheed, Aliya; Obermeyer, Carla Makhlouf; Oh, In-Hwan; Park, Eun-Kee; Peprah, Emmanuel Kwame; Pourmalek, Farshad; Qorbani, Mostafa; Rafay, Anwar; Rahimi-Movaghar, Vafa; Shiri, Rahman; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Rana, Saleem M; Sepanlou, Sadaf G; Shaikh, Masood Ali; Shiue, Ivy; Sibai, Abla Mehio; Silva, Diego Augusto Santos; Singh, Jasvinder A; Skogen, Jens Christoffer; Terkawi, Abdullah Sulieman; Ukwaja, Kingsley N; Westerman, Ronny; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Lim, Stephen S; Wang, Haidong; Vos, Theo; Naghavi, Mohsen; Lopez, Alan D; Murray, Christopher J L; Mokdad, Ali H

2017-01-01

Objectives We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). Methods The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). Results For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3–1703.4) in 1990 to 1606.0 (95% UI 1141.2–2130.4) in 2013. During 1990–2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7–3.0) in 1990 to 4.7% (95% UI 3.6–5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2–136.0 for low back pain, 27.3–49.7 for neck pain, 9.7–37.3 for osteoarthritis (OA), 0.6–2.2 for rheumatoid arthritis and 0.1–0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. Conclusions This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness. PMID:28209629

Evaluation of the economic burden of leprosy among migrant and resident patients in Guangdong Province, China.

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Xiong, Mingzhou; Li, Ming; Zheng, Daocheng; Wang, Xiaohua; Su, Ting; Chen, Yongfeng; Yang, Bin

2017-12-11

A lot of time and money was needed during the diagnosis and treatment process of leprosy, the delayed leprosy would also impair the labor capability of patients as well, and these put a heavy burden for the leprosy patients. The migrant leprosy patient is a special group and need more concern. Our goal was to assess the economic burden of leprosy on migrant and resident patient populations in Guangdong province, China. We conducted a population-based cross-sectional survey from February to July of 2016. A self-designed questionnaire was administered to leprosy patients who: (1) had registered in Leprosy Management Information System in China (LEPMIS) by the end of February 2016, (2) had received multiple drug treatment (MDT) drugs at a local leprosy control institution for three consecutive months or had had at least one physical check in the past half year, and (3) were willing to take part in the investigation and give informed written consent. Demographic characteristics, Financial and disease information, and costs before and after leprosy diagnosis were collected and compared using t-test and χ2 test. A total of 254 participants completed the questionnaires, including 168 males and 86 females. Migrants and residents accounted for 33.9% and 66.1% of patients, respectively. Among migrant patients, the median cost before diagnosis was $131.6 (39.2-450.9), the median yearly cost of leprosy treatment after diagnosis was $300.6 (158.4-868.5), and the median yearly cost of leprosy complications was $69.5 (11-178.4). In comparison, among residents the median yearly costs were $152.4 (30.7-770.9) pre-diagnosis, $309.7 (103.2-1016.7) after diagnosis, and $91.9 (32.6-303.1) for leprosy complications. Base on this, we determined that the median yearly total expense after diagnosis amounted to 15% of migrant and 38% of resident patients' annual income. Leprosy places a heavy economic burden on both migrant and resident leprosy patients and governmental policies and

The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach.

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de Lagasnerie, Grégoire; Aguadé, Anne-Sophie; Denis, Pierre; Fagot-Campagna, Anne; Gastaldi-Menager, Christelle

2018-03-01

A better understanding of the economic burden of diabetes constitutes a major public health challenge in order to design new ways to curb diabetes health care expenditure. The aim of this study was to develop a new cost-of-illness method in order to assess the specific and nonspecific costs of diabetes from a public payer perspective. Using medical and administrative data from the major French national health insurance system covering about 59 million individuals in 2012, we identified people with diabetes and then estimated the economic burden of diabetes. Various methods were used: (a) global cost of patients with diabetes, (b) cost of treatment directly related to diabetes (i.e., 'medicalized approach'), (c) incremental regression-based approach, (d) incremental matched-control approach, and (e) a novel combination of the 'medicalized approach' and the 'incremental matched-control' approach. We identified 3 million individuals with diabetes (5% of the population). The total expenditure of this population amounted to €19 billion, representing 15% of total expenditure reimbursed to the entire population. Of the total expenditure, €10 billion (52%) was considered to be attributable to diabetes care: €2.3 billion (23% of €10 billion) was directly attributable, and €7.7 billion was attributable to additional reimbursed expenditure indirectly related to diabetes (77%). Inpatient care represented the major part of the expenditure attributable to diabetes care (22%) together with drugs (20%) and medical auxiliaries (15%). Antidiabetic drugs represented an expenditure of about €1.1 billion, accounting for 49% of all diabetes-specific expenditure. This study shows the economic impact of the assumption concerning definition of costs on evaluation of the economic burden of diabetes. The proposed new cost-of-illness method provides specific insight for policy-makers to enhance diabetes management and assess the opportunity costs of diabetes complications

Intercomparison of Finnish and Russian whole-body counters used for the determination of 137Cs body burden in reindeer-herding populations

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Rahola, T.; Tillander, M.

1995-01-01

Intercalibration is a very important quality control in whole-body counting, as the human body is a very difficult ''sample'' to calibrate for. In 1994 the Finnish Centre for Radiation and Nuclear Safety (STUK), the Laboratory of Radiochemistry of the University of Helsinki and the Institute of Radiation Hygiene (IRH) of St. Petersburg agreed to undertake the first Finnish-Russian intercalibration project for whole-body counters. The monitoring of body burdens of indigenous inhabitants in the far north of Russia, from the Kola Peninsula to Chuhodka, has been the responsibility of the ISH since 1960; the above-.mentioned Finnish institutes have monitored reindeer breeders in Finnish Lapland since 1961. The intercalibration was done in the field by measuring the same persons with both systems in Finnish Lapland and in the Kola Peninsula. Mean body burdens in the reindeer-herding population in the areas of current interest are presented in the present paper. 7 refs., 3 figs., 1 tab

Burden of Clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study

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Holly Yu

2016-11-01

Full Text Available Abstract Background Clostridium difficile (C. difficile infection (CDI is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs. Methods This was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS (2008–10. NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI. Results Among 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P < 0.001, 60-day (22.7% vs 7.5%, P < 0.001, 6-month (36.3% vs 18.3%, P < 0.001, and 1-year mortality rates (48.2% vs 31.1%, P < 0.001 were significantly higher among the CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P < 0.001. Conclusions CDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.

The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010

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Ferrari, Alize J.; Norman, Rosana E.; Freedman, Greg; Baxter, Amanda J.; Pirkis, Jane E.; Harris, Meredith G.; Page, Andrew; Carnahan, Emily; Degenhardt, Louisa; Vos, Theo; Whiteford, Harvey A.

2014-01-01

Background The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders. Methods Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty). Results Mental and substance use disorders were responsible for 22.5 million (14.8–29.8 million) of the 36.2 million (26.5–44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%–60.8%)) and anorexia nervosa the lowest (0.2% (0.02%–0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20–30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%–8.6%) to 8.3% (7.1%–9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden. Conclusions Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide

CAREGIVER BURDEN AMONG PEOPLE CARING FOR PATIENTS WITH SCHIZOPHRENIA

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Shivani Bansal

2017-04-01

Full Text Available BACKGROUND Caregivers of patients suffering from mental illness report burden in different areas including effects on family functioning, psychological problems, financial problems and health. The aim of the study is to determine the sociodemographic profile and caregiver burden among caregivers of persons with schizophrenia and to study the effect of patients’ psychopathology on caregiver burden scale. MATERIALS AND METHODS The present study was conducted in the Psychiatry Department, Government Medical College, Amritsar. A sample size of 34 was taken who were primary caregivers (preferably parents or spouse of schizophrenia patients diagnosed using ICD10. Measures included caregiver’s demographic variables and caregiver’s burden using the Zarit burden interview and PANSS scale in patients. Statistical Analysis- Data was analysed using SPSS software version 21. RESULTS The mean age of the caregiver was 42 SD (12.16 years. The majority of the caregivers were parents, married and employed. The mean average score of the responses to Zarit burden interview was (SD=59.52 ± 20.92. Majority of the caregivers experienced severe burden (52.9%, 9 (26.4% caregivers had reported moderate burden and 6 (17.6% had reported mild burden. The mean duration of illness was 6.89 (SD=5.03 years. The level of burden experienced was significantly associated with total PANSS score, negative symptoms, positive symptoms, general psychopathology score and duration of schizophrenia illness (p=0.00. CONCLUSION There is need for psychological assistance and social support for the vulnerable caregivers to help them reduce the burden levels and employ positive coping strategies.

Subjective caregiver burden: validity of the 10-item short version of the Burden Scale for Family Caregivers BSFC-s.

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Graessel, Elmar; Berth, Hendrik; Lichte, Thomas; Grau, Hannes

2014-02-20

Subjective burden is a central variable describing the situation encountered by family caregivers. The 10-item short version of the Burden Scale for Family Caregivers (BSFC-short/BSFC-s) was developed to provide an economical measure of this variable. The present study examined the reliability and validity of the BSFC-s. Comprehensive data from "the IDA project" were the basis of the calculations, which included 351 dyads and examined medical data on people with dementia, interview data from their family caregivers, and health insurance data. A factor analysis was performed to explore the structure of the BSFC-s; Cronbach's alpha was used to evaluate the internal consistency of the scale. The items were analyzed to determine the item difficulty and the discriminatory power. Construct validity was tested with five hypotheses. To establish the predictive validity of the BSFC-s, predictors of institutionalization at a follow-up time of 2.5 years were analyzed (binary logistic regression). The BSFC-s score adhered to a one-factor structure. Cronbach's alpha for the complete scale was .92. A significant increase in the BSFC-s score was observed when dementia progressed, disturbing behavior occurred more frequently, care requirements increased, and when caregivers were diagnosed with depression. Caregiver burden was the second strongest predictor of institutionalization out of a total of four significant predictors. All hypotheses that referred to the construct validity were supported. The BSFC-short with its ten items is a very economical instrument for assessing the caregiver's total subjective burden in a short time frame. The BSFC-s score has predictive validity for the institutionalization of people with dementia. Therefore it is an appropriate outcome measure to evaluate caregiver interventions. The scale is available for free in 20 languages (http://www.caregiver-burden.eu). This availability facilitates the comparison of international research findings.

Towards estimating the burden of disease attributable to second-hand smoke exposure in Polish children

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Dorota Jarosińska

2014-02-01

Full Text Available Objectives: To estimate the burden of disease attributable to second-hand smoke (SHS exposure in Polish children in terms of the number of deaths and disability adjusted life years (DALYs due to lower respiratory infections (LRI, otitis media (OM, asthma, low birth weight (LBW and sudden infant death syndrome (SIDS. Materials and Methods: Estimates of SHS exposure in children and in pregnant women as well as information concerning maternal smoking were derived from a national survey, the Global Youth Tobacco Survey, and the Global Adult Tobacco Survey in Poland. Mortality data (LRI, OM, asthma, and SIDS, the number of cases (LBW, and population data were obtained from national statistics (year 2010, and DALYs came from the WHO (year 2004. The burden of disease due to SHS was calculated by multiplying the total burden of a specific health outcome (deaths or DALYs by a population attributable fraction. Results: Using two estimates of SHS exposure in children: 48% and 60%, at least 12 and 14 deaths from LRI in children aged up to 2 years were attributed to SHS, for the two exposure scenarios, respectively. The highest burden of DALYs was for asthma in children aged up to 15 years: 2412, and 2970 DALYs, for the two exposure scenarios, respectively. For LRI, 419 and 500 DALYs, and for OM, 61 and 77 DALYs were attributed to SHS, for the two exposure scenarios, respectively. Between 13% and 27% of SIDS cases and between 3% and 16% of the cases of LBW at term were attributed to SHS exposure. Conclusions: This study provides a conservative estimate of the public health impact of SHS exposure on Polish children. Lack of comprehensive, up to date health data concerning children, as well as lack of measures that would best reflect actual SHS exposure are major limitations of the study, likely to underestimate the burden of disease.

Burden of rotavirus gastroenteritis in the Middle Eastern and North African pediatric population

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Duan Yinghui

2011-01-01

Full Text Available Abstract Background Rotavirus gastroenteritis (RVGE is the most common cause of severe childhood diarrhea worldwide. Objectives were to estimate the burden of RVGE among children less than five years old in the Middle East (Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Syria, UAE, Yemen, North Africa (Algeria, Egypt, Libya, Morocco, Tunisia and Turkey. Methods A comprehensive literature search was conducted in major databases on the epidemiology and burden of rotavirus among children less than five years old between 1999 and 2009. Data from each country was extracted and compared. Results The search identified 43 studies. RVGE was identified in 16-61% of all cases of acute gastroenteritis, with a peak in the winter. RVGE-related hospitalization rates ranged from 14% to 45%, compared to 14%-28% for non-RVGE. Annually, RVGE caused up to 112 fatalities per 100,000 in certain countries in the region. Hospitalization costs ranged from $1.8 to $4.6 million annually, depending on the country. The most recent literature available showed that G1P[8] was the most prevalent genotype combination in 8 countries (range 23%-56%. G2P[4] was most prevalent in 4 countries (26%-48%. G9P[8] and G4P[8] were also frequently detected. Conclusions RVGE is a common disease associated with significant morbidity, mortality, and economic burden. Given the variety and diverse rotavirus types in the region, use of a vaccine with broad and consistent serotype coverage would be important to help decrease the burden of RVGE in the Middle East and North Africa.

Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China.

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Stevens, Warren; Peneva, Desi; Li, Jim Z; Liu, Larry Z; Liu, Gordon; Gao, Runlin; Lakdawalla, Darius N

2016-05-10

Lifestyle and dietary changes reflect an ongoing epidemiological transition in China, with cardiovascular disease (CVD) playing an ever-increasing role in China's disease burden. This study assessed the burden of CVD and the potential value of lipid and blood pressure control strategies in China. We estimated the likely burden of CVD between 2016 and 2030 and how expanded use of lipid lowering and blood pressure control medication would impact that burden in the next 15 years. Accounting for the costs of drug use, we assessed the net social value of a policy that expands the utilization of lipid and blood pressure lowering therapies in China. Rises in prevalence of CVD risk and population aging would likely increase the incidence of acute myocardial infarctions (AMIs) by 75 million and strokes by 118 million, while the number of CVD deaths would rise by 39 million in total between 2016 and 2030. Universal treatment of hypertension and dyslipidemia patients with lipid and blood pressure lowering therapies could avert between 10 and 20 million AMIs, between 8 and 30 million strokes, and between 3 and 10 million CVD deaths during the 2016-2030 period, producing a positive social value net of health care costs as high as $932 billion. In light of its aging population and epidemiological transition, China faces near-certain increases in CVD morbidity and mortality. Preventative measures such as effective lipid and blood pressure management may reduce CVD burden substantially and provide large social value. While the Chinese government is implementing more systematic approaches to health care delivery, prevention of CVD should be high on the agenda.

Validity and reliability of Turkish Caregiver Burden Scale among family caregivers of haemodialysis patients.

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Cil Akinci, Ayse; Pinar, Rukiye

2014-02-01

To investigate the validity and reliability of the Caregiver Burden Scale in family members who provide primary care for haemodialysis patients. In Turkey, there is a need for a multi-dimensional instrument to evaluate the caregiver burden in people who provide care for patients with chronic diseases. A methodological study. The study sample consisted of 161 family members who provide primary care for haemodialysis patients. The forward-backward translation method was used to develop the Turkish Caregiver Burden Scale. The reliability was based on internal consistency investigated by Cronbach's alpha and item-total correlation. The factorial construct validity of the scale was tested with confirmatory factor analysis. By means of convergent and divergent validity, correlation between Caregiver Burden Scale and 36-Item Short Form Health Survey (SF-36) and correlation between Caregiver Burden Scale and the Maslach Burnout Scale were investigated. Cronbach's alpha and item-total correlations results suggested that there was good internal reliability. We found five underlying factors similar to original Scale's five-factor solution. The confirmatory factor analysis five-factor model represented an acceptable fit. Factor loadings were significant, with standardised loadings ranging from 0·43-0·81. By means of divergent validity, all sub-dimension scores and the total score of the Caregiver Burden Scale were negatively correlated with the SF-36, whereas there was a positive correlation with the emotional exhaustion and depersonalisation subscales of the Maslach Burnout Scale as expected. These results suggest that the Caregiver Burden Scale is a reliable and valid instrument which can be used with confidence in Turkish caregivers for haemodialysis patients to screen caregiver burden. The burden experienced by people who provide care for patients with chronic diseases can be evaluated with the Caregiver Burden Scale. Additionally, the Caregiver Burden Scale can be used

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

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Martí Sebastián

2010-10-01

Full Text Available Abstract Background Cardiovascular disease (CVD is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL. The aim of the study was to estimate the burden of acute coronary heart disease (CHD and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$. Incremental cost-effectiveness ratios (ICER were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved, mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved, and lowering cholesterol with

Burden of childhood diseases and malnutrition in a semi-urban slum in southern India

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Sarkar Rajiv

2013-01-01

Full Text Available Abstract Background India has seen rapid unorganized urbanization in the past few decades. However, the burden of childhood diseases and malnutrition in such populations is difficult to quantify. The morbidity experience of children living in semi-urban slums of a southern Indian city is described. Methods A total of 176 children were recruited pre-weaning from four geographically adjacent, semi-urban slums located in the western outskirts of Vellore, Tamil Nadu for a study on water safety and enteric infections and received either bottled or municipal drinking water based on their area of residence. Children were visited weekly at home and had anthropometry measured monthly until their second birthday. Results A total of 3932 episodes of illness were recorded during the follow-up period, resulting in an incidence of 12.5 illnesses/child-year, with more illness during infancy than in the second year of life. Respiratory, mostly upper respiratory infections, and gastrointestinal illnesses were most common. Approximately one-third of children were stunted at two years of age, and two-thirds had at least one episode of growth failure during the two years of follow up. No differences in morbidity were seen between children who received bottled and municipal water. Conclusions Our study found a high burden of childhood diseases and malnutrition among urban slum dwellers in southern India. Frequent illnesses may adversely impact children’s health and development, besides placing an additional burden on families who need to seek healthcare and find resources to manage illness.

Burden of Serious Fungal Infections in Jordan

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Jamal Wadi

2018-01-01

Full Text Available Objective: To estimate the burden of fungal infections in Jordan for the first time. Material and Methods: Population data was from UN 2011 statistics and TB cases from WHO in 2012. Fewer than 100 patients with HIV were recorded in Jordan in 2013. Approximately 100 renal transplants and eight liver transplants are performed annually. There were 12,233 major surgical procedures in Jordan in 2013, of which 5.3% were major abdominal surgeries; candidemia was estimated in 5% of the population based on other countries, with 33% occurring in the ICU. Candida peritonitis/intra-abdominal candidiasis was estimated to affect 50% of the number of ICU candidemia cases. No adult asthma rates have been recorded for Jordan, so the rate from the Holy Land (8.54% clinical asthma from To et al. has been used. There are an estimated 49,607 chronic obstructive pulmonary disease (COPD patients in Jordan, with 64% symptomatic, 25% Gold stage 3% or 4%, and 7% (3472 are assumed to be admitted to hospital each year. No cystic fibrosis cases have been recorded. Literature searches on fungal infections revealed few data and no prevalence data on fungal keratitis or tinea capitis, even though tinea capitis comprised 34% of patients with dermatophytoses in Jordan. Results: Jordan has 6.3 million inhabitants (65% adults, 6% are >60 years old. The current burden of serious fungal infections in Jordan was estimated to affect ~119,000 patients (1.9%, not including any cutaneous fungal infections. Candidemia was estimated at 316 cases and invasive aspergillosis in leukemia, transplant, and COPD patients at 84 cases. Chronic pulmonary aspergillosis prevalence was estimated to affect 36 post-TB patients, and 175 in total. Allergic bronchopulmonary aspergillosis (ABPA and severe asthma with fungal sensitization (SAFS prevalence in adults with asthma were estimated at 8900 and 11,748 patients. Recurrent vulvovaginal candidiasis was estimated to affect 97,804 patients, using a 6

Human resources for health and burden of disease: an econometric approach.

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Castillo-Laborde, Carla

2011-01-26

The effect of health workers on health has been proven to be important for various health outcomes (e.g. mortality, coverage of immunisation or skilled birth attendants). The study aim of this paper is to assess the relationship between health workers and disability-adjusted life years (DALYs), which represents a much broader concept of health outcome, including not only mortality but also morbidity. Cross-country multiple regression analyses were undertaken, with DALYs and DALYs disaggregated according to the three different groups of diseases as the dependent variable. Aggregate health workers and disaggregate physicians, nurses, and midwives were included as independent variables, as well as a variable accounting for the skill mix of professionals. The analysis also considers controlling for the effects of income, income distribution, percentage of rural population with access to improved water source, and health expenditure. This study presents evidence of a statistically negative relationship between the density of health workers (especially physicians) and the DALYs. An increase of one unit in the density of health workers per 1000 will decrease, on average, the total burden of disease between 1% and 3%. However, in line with previous findings in the literature, the density of nurses and midwives could not be said to be statistically associated to DALYs. If countries increase their health worker density, they will be able to reduce significantly their burden of disease, especially the burden associated to communicable diseases. This study represents supporting evidence of the importance of health workers for health.

Relationships between family resilience and posttraumatic growth in breast cancer survivors and caregiver burden.

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Liu, Ye; Li, Yuli; Chen, Lijun; Li, Yurong; Qi, Weiye; Yu, Li

2018-04-01

To examine the relationships between family resilience and posttraumatic growth (PTG) of breast cancer survivors and caregiver burden among principal caregivers in China. Participants in this cross-sectional study comprised 108 women aged 26 to 74 years (M = 49, SD = 9) with early-stage breast cancer and 108 principal caregivers. Participants were recruited from a comprehensive cancer center of a public hospital in Shandong Province, China. The principal caregivers completed the Shortened Chinese Version of the Family Resilience Assessment Scale and the Chinese Version of the Zarit Caregiver Burden Interview; patients completed the Short Form of the Posttraumatic Growth Inventory and questions designed to obtain sociodemographic information. Hierarchical regression analysis was conducted to assess the adjusted association between family resilience and PTG and caregiver burden, while controlling for sociodemographics. Families showed a slightly elevated level of family resilience since the cancer experience, and patients showed a moderate degree of PTG. Principal caregivers reported moderate burden. The Shortened Chinese Version of the Family Resilience Assessment Scale total score was positively related to the Short Form of the Posttraumatic Growth Inventory total score (β = .28, P Caregiver Burden Interview total score (β = -.28, P resilience impacts PTG of breast cancer survivors and caregiver burden. Our findings indicated the necessity of interventions to facilitate family resilience, promote PTG among breast cancer survivors, and decrease family members' caregiver burden. Copyright © 2018 John Wiley & Sons, Ltd.

The increasing burden of depression

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Lépine J-P

2011-05-01

Full Text Available Jean-Pierre Lépine1, Mike Briley21Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris Unité INSERM 705 CNRS UMR 8206, Université Paris Diderot, Paris, France; 2NeuroBiz Consulting and Communication, Castres, FranceAbstract: Recent epidemiological surveys conducted in general populations have found that the lifetime prevalence of depression is in the range of 10% to 15%. Mood disorders, as defined by the World Mental Health and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, have a 12-month prevalence which varies from 3% in Japan to over 9% in the US. A recent American survey found the prevalence of current depression to be 9% and the rate of current major depression to be 3.4%. All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population. Recent studies have also shown the importance of depression as a risk factor for cardiovascular death. The risk of cardiac mortality after an initial myocardial infarction is greater in patients with depression and related to the severity of the depressive episode. Greater severity of depressive symptoms has been found to be associated with significantly higher risk of all-cause mortality including cardiovascular death and stroke. In addition to mortality, functional impairment and disability associated with depression have been consistently reported. Depression increases the risk of decreased workplace productivity and absenteeism resulting in lowered income or unemployment. Absenteeism and presenteeism (being physically present at work but functioning suboptimally have been estimated to result in a loss of $36.6 billion per year in the US. Worldwide projections by the World Health Organization for the year 2030 identify unipolar major depression as the leading cause of disease burden

Non-fatal burden of disease due to mental disorders in the Netherlands.

NARCIS (Netherlands)

Lokkerbol, J.; de Graaf, R.; ten Have, M.; Cuijpers, P.; Beekman, A.; Weehuizen, R.; Smit, H.F.E.

2013-01-01

Purpose: To estimate the disease burden due to 15 mental disorders at both individual and population level. Methods: Using a population-based survey (Nemesis, N = 7,056) the number of years lived with disability per one million population were assessed. This was done with and without adjustment for

The burden of suicide and homicide of Wisconsin's children and youth.

Science.gov (United States)

Shiffler, Thomas; Hargarten, Stephen W; Withers, Richard L

2005-01-01

To describe the epidemiology of violent deaths (suicides and homicides) of children and youth in Wisconsin. Linked data from death certificates, coroners or medical examiners, Uniform Crime Reports, police case reports and crime laboratories were analyzed using SPSS 11.5. Analyses from 2000 to 2002 describe suicides and homicides of children and youth under age 25. Rates are per 100,000 population per year. A total of 585 persons under age 25 in Wisconsin died from suicide or homicide during 2000--2002. Suicides outnumbered homicides 323 (55%) to 262 (45%). Firearms were involved in 59% (n=344) of cases. Fatality rates increased with advancing age, ranging from 2.0 in 0-13 year olds to 26.9 in youth age 21-24. There were over twice as many violent deaths compared to cancer and infectious disease deaths combined (n=253). Suicides and homicides are a significant burden on the children and youth of Wisconsin. An investment in reducing this burden requires comprehensive data and informed programs and policies. We recommend that physicians and public health community leaders collaborate with the criminal justice community and policy makers to develop, implement, and evaluate prevention programs and policies.

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China.

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Xiubin Sun

Full Text Available Feicheng County is a high-risk area for esophageal cancer in Shandong province, China. It is important to determine the long-term spatio-temporal trends in epidemiological characteristics and the burden of esophageal cancer, especially since the implementation of the national esophageal cancer screening program for early detection and treatment in 2005.The data collected in Feicheng County from 2001 to 2012 was extracted from the whole-population cancer registry system. The incidence, mortality, disability-adjusted life years (DALY and changing trends in esophageal cancer according to age and sex were calculated and described.The incidence rate of esophageal cancer in Feicheng was consistently high, and increased significantly for male, but not for female from 2001 to 2012, according to the joinpoint regression analysis. The highest and lowest yearly crude incidence rates were 160.78 and 95.97 per 100000 for males, and 81.36 and 52.17 per 100000 for females. The highest and lowest crude yearly mortality rates were 122.26 and 94.40 per 100000 for males, and 60.75 and 49.35 per 100000for females. Esophageal squamous cell carcinoma was the main pathology type and the tumor location changed significantly from 2001 to 2012. Overall, the DALY remained roughly stable and was estimated as 11.50 for males and 4.90 for females per 1000 people. The burden was mainly caused by premature death. There is an obvious spatial pattern in the distribution of incidence density and burden.Esophageal cancer remains a public health issue in Feicheng County with a high incidence, mortality and disease burden. The incidence and burden have obvious spatial heterogeneity, and further studies should be conducted to identify geographical risk factors for precise local prevention and control measures.

The economic burden of caregiving on families of children and adolescents with cancer: a population-based assessment.

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Pagano, Eva; Baldi, Ileana; Mosso, Maria Luisa; di Montezemolo, Luca Cordero; Fagioli, Franca; Pastore, Guido; Merletti, Franco

2014-06-01

Childhood cancer represents a relevant economic burden on families. The preferred tool to investigate family expenditure is the retrospective questionnaire, which is subject to recall errors and selection bias. Therefore, in the present study the economic burden of caregiving on families of children and adolescents (0-19 years of age) with cancer was analysed using administrative data as an alternative to retrospective questionnaires. Incident cases of cancer diagnosed in children and adolescents in 2000-2005 (N = 917) were identified from the Piedmont Childhood Cancer Registry and linked to available administrative databases to identify episodes of care during the 3 years after diagnosis (N = 13,433). The opportunity cost of informal caregiving was estimated as the value of the time spent by one of the parents, and was assumed to be equal to the number of days during which the child received inpatient care, day-care or outpatient radiotherapy. Factors affecting the level of economic burden of caregiving on families were analysed in a multivariable model. The economic burden of caregiving increased when care was supplied at the Regional Referral Centre, or when treatment complexity was high. Families with younger children had a higher level of economic burden of caregiving. Leukaemia required a higher family commitment than any other cancer considered. Estimates of the economic burden of caregiving on families of children and adolescents with cancer derived from administrative data should be considered a minimum burden. The estimated effect of the covariates is informative for healthcare decision-makers in planning support programmes. © 2013 Wiley Periodicals, Inc.

Global burden of human mycetoma: a systematic review and meta-analysis.

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Wendy W J van de Sande

2013-11-01

Full Text Available Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (international surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained.

Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico.

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Arredondo, Armando; Orozco, Emanuel; Alcalde-Rabanal, Jaqueline; Navarro, Juan; Azar, Alejandra

2018-01-01

OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994-2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013-2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%-17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%-15% of the total budget allocated to the uninsured population and 15%-17% for the population insured depending on the region.

Burden of Diarrhea in the Eastern Mediterranean Region, 1990–2013: Findings from the Global Burden of Disease Study 2013

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Khalil, Ibrahim; Colombara, Danny V.; Forouzanfar, Mohammad Hossein; Troeger, Christopher; Daoud, Farah; Moradi-Lakeh, Maziar; El Bcheraoui, Charbel; Rao, Puja C.; Afshin, Ashkan; Charara, Raghid; Abate, Kalkidan Hassen; El Razek, Mohammed Magdy Abd; Abd-Allah, Foad; Abu-Elyazeed, Remon; Kiadaliri, Aliasghar Ahmad; Akanda, Ali Shafqat; Akseer, Nadia; Alam, Khurshid; Alasfoor, Deena; Ali, Raghib; AlMazroa, Mohammad A.; Alomari, Mahmoud A.; Al-Raddadi, Rajaa Mohammad Salem; Alsharif, Ubai; Alsowaidi, Shirina; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Ammar, Walid; Antonio, Carl Abelardo T.; Asayesh, Hamid; Asghar, Rana Jawad; Atique, Suleman; Awasthi, Ashish; Bacha, Umar; Badawi, Alaa; Barac, Aleksandra; Bedi, Neeraj; Bekele, Tolesa; Bensenor, Isabela M.; Betsu, Balem Demtsu; Bhutta, Zulfiqar; Bin Abdulhak, Aref A.; Butt, Zahid A.; Danawi, Hadi; Dubey, Manisha; Endries, Aman Yesuf; Faghmous, Imad D. A.; Farid, Talha; Farvid, Maryam S.; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fischer, Florian; Fitchett, Joseph Robert Anderson; Gibney, Katherine B.; Ginawi, Ibrahim Abdelmageem Mohamed; Gishu, Melkamu Dedefo; Gugnani, Harish Chander; Gupta, Rahul; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hamidi, Samer; Harb, Hilda L.; Hedayati, Mohammad T.; Hsairi, Mohamed; Husseini, Abdullatif; Jahanmehr, Nader; Javanbakht, Mehdi; Jibat, Tariku; Jonas, Jost B.; Kasaeian, Amir; Khader, Yousef Saleh; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khoja, Tawfik Ahmed Muthafer; Kinfu, Yohannes; Kissoon, Niranjan; Koyanagi, Ai; Lal, Aparna; Latif, Asma Abdul Abdul; Lunevicius, Raimundas; El Razek, Hassan Magdy Abd; Majeed, Azeem; Malekzadeh, Reza; Mehari, Alem; Mekonnen, Alemayehu B.; Melaku, Yohannes Adama; Memish, Ziad A.; Mendoza, Walter; Misganaw, Awoke; Mohamed, Layla Abdalla Ibrahim; Nachega, Jean B.; Le Nguyen, Quyen; Nisar, Muhammad Imran; Peprah, Emmanuel Kwame; Platts-Mills, James A.; Pourmalek, Farshad; Qorbani, Mostafa; Rafay, Anwar; Rahimi-Movaghar, Vafa; Ur Rahman, Sajjad; Rai, Rajesh Kumar; Rana, Saleem M.; Ranabhat, Chhabi L.; Rao, Sowmya R.; Refaat, Amany H.; Riddle, Mark; Roshandel, Gholamreza; Ruhago, George Mugambage; Saleh, Muhammad Muhammad; Sanabria, Juan R.; Sawhney, Monika; Sepanlou, Sadaf G.; Setegn, Tesfaye; Sliwa, Karen; Sreeramareddy, Chandrashekhar T.; Sykes, Bryan L.; Tavakkoli, Mohammad; Tedla, Bemnet Amare; Terkawi, Abdullah S.; Ukwaja, Kingsley; Uthman, Olalekan A.; Westerman, Ronny; Wubshet, Mamo; Yenesew, Muluken A.; Yonemoto, Naohiro; Younis, Mustafa Z.; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Al Rabeeah, Abdullah A.; Wang, Haidong; Naghavi, Mohsen; Vos, Theo; Lopez, Alan D.; Murray, Christopher J. L.; Mokdad, Ali H.

2016-01-01

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0–1) in Bahrain and Oman to 471 (95% UI = 245–763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520–989) in Syria to 40,869 (95% UI = 21,540–65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. PMID:27928080

Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients.

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Degen, Ryan M; Conti, Matthew S; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

2018-02-01

National rates of lateral epicondylitis and surgical treatment are poorly defined. Disease burden of lateral epicondylitis (LE) continues to increase annually. Further study is necessary to optimize treatment algorithms to reduce associated health-care expenditures. The purpose of this study is to review the annual incidence of LE, surgical rates, and associated health-care costs in a population setting. A national database was queried for LE from 2007 to 2014. Surgical cases were identified and annual rates were recorded. Demographic and epidemiologic data were reported with descriptive statistics, while trends over time were analyzed using linear regression. Eighty-five thousand three hundred eighteen cases of LE were identified. The annual incidence per 10,000 patients remained constant ( p  = 0.304). The proportion of diagnoses in patients 65 years diagnosed with, and receiving surgical treatment for, LE has significantly increased in recent years. Total reimbursement and average per-patient reimbursement have steadily risen, demonstrating the increasing burden of cost on the health-care system.

Remarks and suggestions concerned with formulation of the definition of quantity ''committed dose'' and quantity ''radiation burden'' useful in estimates of population exposure

International Nuclear Information System (INIS)

Cwik, T.

1990-01-01

The paper contains remarks to the definitions of the quantity ''commited dose'' given in the publications of the ICRP. The suggestions are presented on the mode of formulating the definition of the quantity ''commited dose'' and the definition of the quantity denoted hitherto by the symbol H 50 . The other suggestions deal with introduction of the quantity ''radiation burden'', assigned for use in assessments of irradiation expressed ''per caput'' of population. 9 refs. (author)

The burden of injuries in Iranian children in 2005

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Jafari Nahid

2010-03-01

Full Text Available Abstract Background Child injury is recognized as a global health problem. Injuries caused the highest burden of disease among the total population of Iran in 2003. We aimed to estimate the morbidity, mortality, and disease burden caused by child injuries in the 0- to 14-year-old population of Iran in 2005. Methods We estimated average age- and sex-specific mortality rates for different types of child injuries from 2001 to 2006 using Iran's death registration data. Incidence rates for nonfatal outcomes of child injuries in 2005 were estimated through a time- and place-limited sample hospital registry study for injuries. We used the World Health Organization's methods for estimation of years of life lost due to premature mortality and years lived with disability in 2005. Results Injuries were the most important cause of death in children ages 1 to 14, with 35, 33.4, 24.9, and 22.9 deaths per 100,000 in the 0-14, 1-4, 5-9, and 10-14 age groups respectively. Road transport injuries were responsible for the highest death rate per 100,000 population among all types of injuries in children, with 15.5 for ages 0-14, 16.1 for ages 1-4, 16.3 for ages 5-9, and 13.1 for ages 10-14. Incidence rates of injuries leading to hospitalization were 459, 530, and 439 per 100,000 in the 0-14, 1-4, and 5-14 age groups respectively. Incidence rates of injuries leading to outpatient care were 1,812, 2,390, and 1,650 per 100,000 in the same age groups respectively. Among injury types, falls and burns had the highest hospitalization and outpatient care incidence rates. Conclusions Injuries, particularly road transport injuries, were the most important health problem of children in Iran in 2003 and 2005. Strong social policy is needed to ensure child survival.

Dietetic characteristics of a sample of Mayan dual burden households in Merida, Yucatan, Mexico

OpenAIRE

Azcorra, Hugo; Wilson, Hannah; Bogin, Barry; Varela-Silva, Maria Inês; Vázquez-Vázquez, Adriana; Dickinson, Federico

2013-01-01

The Maya are the most populous and shortest in stature Native American ethnic group. The Maya provide us a good opportunity to study the dietetic characteristics of a group who experience nutritional dual burden (the combination of under and overnutrition) at the individual, mother-child dyad and population level. The aim of this study is to describe general dietetic patterns of a sample of Maya mothers and children who experienced nutritional dual burden and were living in the city of Merida...

Knowns and unknowns on burden of disease due to chemicals: a systematic review

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Bertollini Roberto

2011-01-01

Full Text Available Abstract Background Continuous exposure to many chemicals, including through air, water, food, or other media and products results in health impacts which have been well assessed, however little is known about the total disease burden related to chemicals. This is important to know for overall policy actions and priorities. In this article the known burden related to selected chemicals or their mixtures, main data gaps, and the link to public health policy are reviewed. Methods A systematic review of the literature for global burden of disease estimates from chemicals was conducted. Global disease due to chemicals was estimated using standard methodology of the Global Burden of Disease. Results In total, 4.9 million deaths (8.3% of total and 86 million Disability-Adjusted Life Years (DALYs (5.7% of total were attributable to environmental exposure and management of selected chemicals in 2004. The largest contributors include indoor smoke from solid fuel use, outdoor air pollution and second-hand smoke, with 2.0, 1.2 and 0.6 million deaths annually. These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively. Conclusions The known burden due to chemicals is considerable. This information supports decision-making in programmes having a role to play in reducing human exposure to toxic chemicals. These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden. Chemicals with known health effects, such as dioxins, cadmium, mercury or chronic exposure to pesticides could not be included in this article due to incomplete data and information. Effective public health interventions are known to manage chemicals and limit their public health impacts and should be implemented at national and international levels.

Knowns and unknowns on burden of disease due to chemicals: a systematic review

Science.gov (United States)

2011-01-01

Background Continuous exposure to many chemicals, including through air, water, food, or other media and products results in health impacts which have been well assessed, however little is known about the total disease burden related to chemicals. This is important to know for overall policy actions and priorities. In this article the known burden related to selected chemicals or their mixtures, main data gaps, and the link to public health policy are reviewed. Methods A systematic review of the literature for global burden of disease estimates from chemicals was conducted. Global disease due to chemicals was estimated using standard methodology of the Global Burden of Disease. Results In total, 4.9 million deaths (8.3% of total) and 86 million Disability-Adjusted Life Years (DALYs) (5.7% of total) were attributable to environmental exposure and management of selected chemicals in 2004. The largest contributors include indoor smoke from solid fuel use, outdoor air pollution and second-hand smoke, with 2.0, 1.2 and 0.6 million deaths annually. These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively. Conclusions The known burden due to chemicals is considerable. This information supports decision-making in programmes having a role to play in reducing human exposure to toxic chemicals. These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden. Chemicals with known health effects, such as dioxins, cadmium, mercury or chronic exposure to pesticides could not be included in this article due to incomplete data and information. Effective public health interventions are known to manage chemicals and limit their public health impacts and should be implemented at national and international levels. PMID:21255392

Identifying Sociodemographic Characteristics Associated With Burden Among Caregivers of the Urban Homebound

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Ania Wajnberg MD

2016-09-01

Full Text Available Limited research has explored whether the burden associated with caring for homebound patients varies across racial groups or by relationship status. We examined these variations for this vulnerable population. Patients self-identified informal caregivers and caregiver burden/depression were assessed using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies–Depression scale (CES-D. Forty-nine informal caregivers completed the interview. Mean age was 58 ( SD = 14, 78% were female, 37% Black, 35% Hispanic, and 46% had completed high school. Over 60% of caregivers had moderate or severe caregiver burden and 30% had significant depression. White caregivers had greater burden than Black and Hispanic caregivers ( p = .02. Mean caregiver burden was higher among spouse/partner caregivers, versus those who identified as children or other family or friends ( p = .004. Additional research is needed to better understand the experience of racial and ethnic minorities and spouses in providing informal care to homebound adults.

Caregiver burden among relatives of patients with schizophrenia in Katsina, Nigeria

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Abdulkareem Jika Yusuf

2009-06-01

Full Text Available Objective: Caring for patients’ with schizophrenia leads to an enormous burden on the caregivers. However, the magnitude of this problem remains largely unknown in Sub-Saharan Africa. The objective of this study was to determine the burden of care giving among relatives of patients with schizophrenia. Materials and method: A total of 129 primary care-givers of patients with schizophrenia attending out-patient clinic of Katsina state Psychiatric Hospital were interviewed using a socio-demographic data collection sheet and Zarith Burden Interview (ZBI. Data obtained was analysed using Statistical Package for Social Sciences version 13. Results: The mean age of the respondents was 45.07±8.91. Majority of the caregivers are females. High level of burden was found in 47.3% of the respondents. The level of burden experienced was significantly associated with place of residence and family size. Conclusion: Schizophrenia is associated with high level of caregiver burden and effort should be made at alleviating this burden for better out come in both the patients and caregivers.

Response Burden in Official Business Surveys: Measurement and Reduction Practices of National Statistical Institutes

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Bavdaž Mojca

2015-12-01

Full Text Available Response burden in business surveys has long been a concern for National Statistical Institutes (NSIs for three types of reasons: political reasons, because response burden is part of the total administrative burden governments impose on businesses; methodological reasons, because an excessive response burden may reduce data quality and increase data-collection costs; and strategic reasons, because it affects relations between the NSIs and the business community. This article investigates NSI practices concerning business response burden measurement and reduction actions based on a survey of 41 NSIs from 39 countries. Most NSIs monitor at least some burden aspects and have implemented some actions to reduce burden, but large differences exist between NSIs’ methodologies for burden measurement and actions taken to reduce burden. Future research should find ways to deal with methodological differences in burden conceptualization, operationalization, and measurement, and provide insights into the effectiveness and efficiency of burden-reduction actions.

Forecasting and Analyzing the Disease Burden of Aged Population in China, Based on the 2010 Global Burden of Disease Study

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Chengzhen Bao

2015-06-01

Full Text Available Background: Forecasting the disease burden of the elderly will contribute to make a comprehensive assessment about physical and mental status of the elderly in China and provide a basis for reducing the negative consequences of aging society to a minimum. Methods: This study collected data from a public database online provided by Global Burden of Disease Study 2010. Grey model GM (1, 1 was used to forecast all-cause and disease-specific rates of disability adjusted life years (DALYs in 2015 and 2020. Results: After cross-sectional and longitudinal analysis, we found that non-communicable diseases (NCDs were still the greatest threats in the elderly, followed by injuries. As for 136 predicted causes, more than half of NCDs increased obviously with age, less than a quarter of communicable, material, neonatal, and nutritional disorders or injuries had uptrend. Conclusions: The findings display the health condition of the Chinese elderly in the future, which will provide critical information for scientific and sociological researches on preventing and reducing the risks of aging society.

Validating the InterVA model to estimate the burden of mortality from verbal autopsy data: a population-based cross-sectional study.

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Sebsibe Tadesse

Full Text Available BACKGROUND: In countries with incomplete or no vital registration systems, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to validate the InterVA model for estimating the burden of mortality from verbal autopsy data by using physician review as a reference standard. METHODS AND FINDINGS: A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥ 14 years and died between 01 January, 2010 and 15 February, 2012 were included in the study. The verbal autopsy interviews were reviewed by the InterVA model and physicians to estimate cause-specific mortality fractions. Cohen's kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value were applied to compare the agreement between the InterVA model and the physician review. A total of 408 adult deaths were studied. There was a general similarity and just slight differences between the InterVA model and the physicians in assigning cause-specific mortality. Both approaches showed an overall agreement in 298 (73% cases [kappa = 0.49, 95% CI: 0.37-0.60]. The observed sensitivities and specificities across causes of death categories varied from 13.3% to 81.9% and 77.7% to 99.5%, respectively. CONCLUSIONS: In understanding the burden of disease and setting health intervention priorities in areas that lack reliable vital registration systems, an accurate analysis of verbal autopsies is essential. Therefore, users should be aware of the suboptimal performance of the InterVA model. Similar validation studies need to be undertaken considering the limitation of the physician review as gold standard since physicians may misinterpret some of the verbal autopsy data and finally reach a wrong conclusion of the cause of death.

Upper gastrointestinal cancer burden in Hebei Province, China: A population-based study.

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Li, Dao-Juan; Liang, Di; Song, Guo-Hui; Li, Yong-Wei; Wen, Deng-Gui; Jin, Jing; He, Yu-Tong

2017-04-14

To investigate the incidence and mortality rates of upper gastrointestinal cancer (UGIC) in Hebei Province, China, and to identify high-risk populations to improve UGIC prevention and control. Data for UGIC patients were collected from 21 population-based cancer registries covering 15.25% of the population in Hebei Province. Mortality data were extracted from three national retrospective death surveys (1973-1975, 1990-1992 and 2004-2005). The data were stratified by 5-year age groups, gender and area (high-risk/non-high-risk areas) for analysis. The age-period-cohort and grey system model were used. The crude incidence rate of UGIC was 55.47/100000, and the adjusted rate (Segi's population) was 44.90/100000. Males in rural areas had the highest incidence rate (world age-standardized rate = 87.89/100000). The crude mortality rate of UGIC displayed a decreasing trend in Hebei Province from the 1970s to 2013, and the adjusted rate decreased by 43.81% from the 1970s (58.07/100000) to 2013 (32.63/100000). The mortality rate declined more significantly in the high-risk areas (57.26%) than in the non-high-risk areas (55.02%) from the 1970s to 2013. The median age at diagnosis of UGIC was 65.06 years in 2013. There was a notable delay in the median age at death from the 1970s (66.15 years) to 2013 (70.39 years), especially in the high-risk areas. In Cixian, the total trend of the cohort effect declined, and people aged 65-69 years were a population at relatively high risk for UGIC. We predicted that the crude mortality rates of UGIC in Cixian and Shexian would decrease to 98.80 and 133.99 per 100000 in 2018, respectively. UGIC was the major cause of cancer death in Hebei Province, and males in rural areas were a high-risk population. We should strengthen early detection and treatment of UGIC in this population.

Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study.

Science.gov (United States)

Franceschini, N; Fry, R C; Balakrishnan, P; Navas-Acien, A; Oliver-Williams, C; Howard, A G; Cole, S A; Haack, K; Lange, E M; Howard, B V; Best, L G; Francesconi, K A; Goessler, W; Umans, J G; Tellez-Plaza, M

2017-03-01

Cadmium (Cd) is an environmental pollutant that has been associated with cardiovascular disease in populations, but the relationship of Cd with hypertension has been inconsistent. We studied the association between urinary Cd concentrations, a measure of total body burden, and blood pressure in American Indians, a US population with above national average Cd burden. Urinary Cd was measured using inductively coupled plasma mass spectrometry, and adjusted for urinary creatinine concentration. Among 3714 middle-aged American Indian participants of the Strong Heart Study (mean age 56 years, 41% male, 67% ever-smokers, 23% taking antihypertensive medications), urinary Cd ranged from 0.01 to 78.48 μg g -1 creatinine (geometric mean=0.94 μg g -1 ) and it was correlated with smoking pack-year among ever-smokers (r 2 =0.16, Pyears), and urinary Cd was similarly elevated in light- and never-smokers (geometric means of 0.88 μg g -1 creatinine for both categories). Log-transformed urinary Cd was significantly associated with higher systolic blood pressure in models adjusted for age, sex, geographic area, body mass index, smoking (ever vs never, and cumulative pack-years) and kidney function (mean blood pressure difference by lnCd concentration (β)=1.64, P=0.002). These associations were present among light- and never-smokers (β=2.03, P=0.002, n=2627), although not significant among never-smokers (β=1.22, P=0.18, n=1260). Cd was also associated with diastolic blood pressure among light- and never-smokers (β=0.94, P=0.004). These findings suggest that there is a relationship between Cd body burden and increased blood pressure in American Indians, a population with increased cardiovascular disease risk.

The burden of illness of osteoporosis in Canada.

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Tarride, J-E; Hopkins, R B; Leslie, W D; Morin, S; Adachi, J D; Papaioannou, A; Bessette, L; Brown, J P; Goeree, R

2012-11-01

To update the 1993 burden of illness of osteoporosis in Canada, administrative and community data were used to calculate the 2010 costs of osteoporosis at $2.3 billion in Canada or 1.3% of Canada's healthcare expenditures. Prevention of fractures in high-risk individuals is key to decrease the financial burden of osteoporosis. Since the 1996 publication of the burden of osteoporosis in 1993 in Canada, the population has aged and the management of osteoporosis has changed. The study purpose was to estimate the current burden of illness due to osteoporosis in Canadians aged 50 and over. Analyses were conducted using five national administrative databases from the Canadian Institute for Health Information for the fiscal-year ending March 31 2008 (FY 2007/2008). Gaps in national data were supplemented by provincial and community data extrapolated to national levels. Osteoporosis-related fractures were identified using a combination of most responsible diagnosis at discharge and intervention codes. Fractures associated with severe trauma codes were excluded. Costs, expressed in 2010 dollars, were calculated for osteoporosis-related hospitalizations, emergency care, same day surgeries, rehabilitation, continuing care, homecare, long-term care, prescription drugs, physician visits, and productivity losses. Sensitivity analyses were conducted to measure the impact on the results of key assumptions. Osteoporosis-related fractures were responsible for 57,413 acute care admissions and 832,594 hospitalized days in FY 2007/2008. Acute care costs were estimated at $1.2 billion. When outpatient care, prescription drugs, and indirect costs were added, the overall yearly cost of osteoporosis was over $2.3 billion for the base case analysis and as much as $3.9 billion if a proportion of Canadians were assumed to be living in long-term care facilities due to osteoporosis. Osteoporosis is a chronic disease that affects a large segment of the adult population and results in a

A preliminary study into the economic burden of cerebral palsy in China.

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Wang, Bin; Chen, Yingyao; Zhang, Jie; Li, Jun; Guo, Yan; Hailey, David

2008-08-01

To measure the economic burden of cerebral palsy (CP) in China is to provide information on CP's societal impacts to policy-makers. The economic burden of CP includes direct healthcare costs, direct non-healthcare costs, developmental costs and indirect costs such as productivity loss. The incidence approach is employed to estimate the lifetime economic burden of a new CP birth and that of all new cases in China in 2003. Caregivers of 319 CP patients were interviewed in specialty hospitals in five cities in 2004. Average expenditure and utilization rates for different services by age groups from this sample were obtained to estimate the economic burden of CP. Chinese CP patients' life expectancy and survival rate were simulated with reference to Australian data with Human Development Index adjustment. From the societal perspective, the average lifetime economic burden of a new CP case in China was US$ 67,044 in 2003, and the life-span total economic loss due to all new CP cases in 2003 amounted to US$ 2-4 billion. Indirect (productivity) costs are responsible for 93% of total economic loss, and direct healthcare and developmental costs make up 3% each. There are several factors which contribute to the extraordinarily high economic burden of CP, including productivity loss, reduced life expectancy, dependency, progressive deterioration of motor physical function, and recurrent use of rehabilitation services. The economic burden of CP in China is substantial for the family of a CP patient, as well as to society. Public provision and financing of necessary preventive and rehabilitative services is urgently needed to mitigate this heavy burden for patients and their families.

Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

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Patel JG

2014-03-01

Full Text Available Jeetvan G Patel,1,2 Saurabh P Nagar,2 Anand A Dalal2 1Pharmacy Administration and Public Health, University of Houston, Houston, TX, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USA Objective: To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD in the US. Methods: Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results: Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars with COPD ($1,521–$3,348 in 2010 [US dollars] and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions: COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability

Burden of pediatric hepatitis C

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El-Shabrawi, Mortada Hassan; Kamal, Naglaa Mohamed

2013-01-01

Hepatitis C virus (HCV) is a major health burden infecting 170-210 million people worldwide. Additional 3-4 millions are newly-infected annually. Prevalence of pediatric infection varies from 0.05%-0.36% in the United States and Europe; up to 1.8%-5.8% in some developing countries. The highest prevalence occurs in Egypt, sub-Saharan Africa, Amazon basin and Mongolia. HCV has been present in some populations for several centuries, notably genotypes 1 and 2 in West Africa. Parenteral anti-schis...

The global burden of cholera

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Lopez, Anna Lena; You, Young Ae; Kim, Young Eun; Sah, Binod; Maskery, Brian; Clemens, John

2012-01-01

Abstract Objective To estimate the global burden of cholera using population-based incidence data and reports. Methods Countries with a recent history of cholera were classified as endemic or non-endemic, depending on whether they had reported cholera cases in at least three of the five most recent years. The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera, and incidence rates from published studies were applied to groups of countries to estimate the annual number of cholera cases in endemic countries. The estimates of cholera cases in non-endemic countries were based on the average numbers of cases reported from 2000 to 2008. Literature-based estimates of cholera case-fatality rates (CFRs) were used to compute the variance-weighted average cholera CFRs for estimating the number of cholera deaths. Findings About 1.4 billion people are at risk for cholera in endemic countries. An estimated 2.8 million cholera cases occur annually in such countries (uncertainty range: 1.4–4.3) and an estimated 87 000 cholera cases occur in non-endemic countries. The incidence is estimated to be greatest in children less than 5 years of age. Every year about 91 000 people (uncertainty range: 28 000 to 142 000) die of cholera in endemic countries and 2500 people die of the disease in non-endemic countries. Conclusion The global burden of cholera, as determined through a systematic review with clearly stated assumptions, is high. The findings of this study provide a contemporary basis for planning public health interventions to control cholera. PMID:22461716

Burden of ischemic heart diseases in Iran, 1990-2010: Findings from the Global Burden of Disease study 2010

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Mohammad Reza Maracy

2015-01-01

Full Text Available Background: Cardiovascular diseases are viewed worldwide as one of the main causes of death.This study aims to report the burden of ischemic heart diseases (IHDs in Iran by using data of the global burden of disease (GBD study, 1990-2010. Materials and Methods: The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjusted life years (DALYs for diseases and injuries in the world. Years of life lost (YLLs due to premature mortality were computed on the basis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm. Years lived with disability (YLDs were assessed by the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculated with a Bayesian meta-regression method (DisMod-MR. Data from population-based surveys were used for producing disability weights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques. Results: The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95% uncertainty interval (UI: 4,341-5,099 to 3,245 (95% UI: 2,810-3,529 person-years per 100,000]. The decrease were 38.14% among women and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222 95% UI: 207-243 (to 175 (95% UI:152-190 person-years per 100,000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05% and 4.28%, respectively, in the above period. Conclusion: Despite decreasing age-standardized IHD of mortality, YLL, YLD, and DALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHD deaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.

Human resources for health and burden of disease: an econometric approach

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Castillo-Laborde Carla

2011-01-01

Full Text Available Abstract Background The effect of health workers on health has been proven to be important for various health outcomes (e.g. mortality, coverage of immunisation or skilled birth attendants. The study aim of this paper is to assess the relationship between health workers and disability-adjusted life years (DALYs, which represents a much broader concept of health outcome, including not only mortality but also morbidity. Methods Cross-country multiple regression analyses were undertaken, with DALYs and DALYs disaggregated according to the three different groups of diseases as the dependent variable. Aggregate health workers and disaggregate physicians, nurses, and midwives were included as independent variables, as well as a variable accounting for the skill mix of professionals. The analysis also considers controlling for the effects of income, income distribution, percentage of rural population with access to improved water source, and health expenditure. Results This study presents evidence of a statistically negative relationship between the density of health workers (especially physicians and the DALYs. An increase of one unit in the density of health workers per 1000 will decrease, on average, the total burden of disease between 1% and 3%. However, in line with previous findings in the literature, the density of nurses and midwives could not be said to be statistically associated to DALYs. Conclusions If countries increase their health worker density, they will be able to reduce significantly their burden of disease, especially the burden associated to communicable diseases. This study represents supporting evidence of the importance of health workers for health.

The burden on informal caregivers of people with bipolar disorder.

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Ogilvie, Alan D; Morant, Nicola; Goodwin, Guy M

2005-01-01

Caregivers of people with bipolar disorder may experience a different quality of burden than is seen with other illnesses. A better understanding of their concerns is necessary to improve the training of professionals working with this population. Conceptualizing caregiver burden in a conventional medical framework may not focus enough on issues important to caregivers, or on cultural and social issues. Perceptions of caregivers about bipolar disorder have important effects on levels of burden experienced. It is important to distinguish between caregivers' experience of this subjective burden and objective burden as externally appraised. Caregivers' previous experiences of health services may influence their beliefs about the illness. Caregiver burden is associated with depression, which affects patient recovery by adding stress to the living environment. The objective burden on caregivers of patients with bipolar disorder is significantly higher than for those with unipolar depression. Caregivers of bipolar patients have high levels of expressed emotion, including critical, hostile, or over-involved attitudes. Several measures have been developed to assess the care burden of patients with depressive disorders, but may be inappropriate for patients with bipolar disorder because of its cyclical nature and the stresses arising from manic and hypomanic episodes. Inter-episode symptoms pose another potential of burden in patients with bipolar disorder. Subsyndromal depressive symptoms are common in this phase of the illness, resulting in severe and widespread impairment of function. Despite the importance of assessing caregiver burden in bipolar disorder, relevant literature is scarce. The specific effects of mania and inter-episode symptoms have not been adequately addressed, and there is a lack of existing measures to assess burden adequately, causing uncertainty regarding how best to structure family interventions to optimally alleviate burden. The relatively few

The economic burden of kidney disorders in Korea.

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Kim, Ju Hee; Ho, Seung Hee; Kim, Hyun-Jin; Lee, Sol

2018-03-01

To estimate the economic burden of kidney disorders in Korea. The economic burden of kidney disorders was estimated using a prevalence-based approach. Related kidney diseases in patients with kidney disorders (RPWKD) were defined using codes from the tenth International Classification of Disease (E70-E90, F30-F48, F60-F69, F90-F99, K65-K67, N00-N08, N17-N19, and N30-N39). All diseases in patients with kidney disorders (APWKD) were defined as kidney disorders that involved all disease codes. Economic costs were divided into direct costs (medical costs and non-medical costs) and indirect costs (productivity loss because of morbidity and premature mortality). The prevalence of kidney disorders increased from 0.08% (2008) to 0.11% (2011). The total economic burden of RPWKD also substantially increased from $898.9 million (2008) to $1.43 billion (2011). This ∼59.4% increase in the economic burden was equal to 0.12% of the Korean gross domestic product. The economic burden of APWKD also increased during the study period: $1.06 billion (2008), $1.23 billion (2009), $1.44 billion (2010), and $1.46 billion (2011). The present study provides the first data regarding the economic burden of kidney disorders in Korea. The findings support the need for early intervention services and prevention programs to prevent, identify, and manage kidney disorders.

Estimating the Global Burden of Endemic Canine Rabies

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Hampson, Katie; Coudeville, Laurent; Lembo, Tiziana; Sambo, Maganga; Kieffer, Alexia; Attlan, Michaël; Barrat, Jacques; Blanton, Jesse D.; Briggs, Deborah J.; Cleaveland, Sarah; Costa, Peter; Freuling, Conrad M.; Hiby, Elly; Knopf, Lea; Leanes, Fernando; Meslin, François-Xavier; Metlin, Artem; Miranda, Mary Elizabeth; Müller, Thomas; Nel, Louis H.; Recuenco, Sergio; Rupprecht, Charles E.; Schumacher, Carolin; Taylor, Louise; Vigilato, Marco Antonio Natal; Zinsstag, Jakob; Dushoff, Jonathan

2015-01-01

Background Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries. Methodology/Principal Findings We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%). Conclusions/Significance This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to

Estimating the global burden of endemic canine rabies.

Directory of Open Access Journals (Sweden)

Katie Hampson

2015-04-01

Full Text Available Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000 human deaths, over 3.7 million (95% CIs: 1.6-10.4 million disability-adjusted life years (DALYs and 8.6 billion USD (95% CIs: 2.9-21.5 billion economic losses annually. The largest component of the economic burden is due to premature death (55%, followed by direct costs of post-exposure prophylaxis (PEP, 20% and lost income whilst seeking PEP (15.5%, with only limited costs to the veterinary sector due to dog vaccination (1.5%, and additional costs to communities from livestock losses (6%.This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

Updated Global Burden of Cholera in Endemic Countries

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Ali, Mohammad; Nelson, Allyson R.; Lopez, Anna Lena; Sack, David A.

2015-01-01

Background The global burden of cholera is largely unknown because the majority of cases are not reported. The low reporting can be attributed to limited capacity of epidemiological surveillance and laboratories, as well as social, political, and economic disincentives for reporting. We previously estimated 2.8 million cases and 91,000 deaths annually due to cholera in 51 endemic countries. A major limitation in our previous estimate was that the endemic and non-endemic countries were defined based on the countries’ reported cholera cases. We overcame the limitation with the use of a spatial modelling technique in defining endemic countries, and accordingly updated the estimates of the global burden of cholera. Methods/Principal Findings Countries were classified as cholera endemic, cholera non-endemic, or cholera-free based on whether a spatial regression model predicted an incidence rate over a certain threshold in at least three of five years (2008-2012). The at-risk populations were calculated for each country based on the percent of the country without sustainable access to improved sanitation facilities. Incidence rates from population-based published studies were used to calculate the estimated annual number of cases in endemic countries. The number of annual cholera deaths was calculated using inverse variance-weighted average case-fatality rate (CFRs) from literature-based CFR estimates. We found that approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries. Among these cases, there are an estimated 95,000 deaths (uncertainty range: 21,000-143,000). Conclusion/Significance The global burden of cholera remains high. Sub-Saharan Africa accounts for the majority of this burden. Our findings can inform programmatic decision-making for cholera control. PMID:26043000

Cardiovascular burden and percutaneous interventions in Russian Federation: systematic epidemiological update.

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Kharlamov, Alexander N

2017-02-01

The situation with cardiovascular (CV) burden in Russian population is alerting, and becomes of interest due to high CV mortality, and shorter lifespan if compare with the Western society amid the absence of the established monitoring or screening system for major CV risk factors. The purpose of this systematic epidemiological update was to explore CV burden in Russia. The study represents pooled results with a systematic epidemiological review of the national mass screening, selected randomized clinical trials and statistical datasets of the national public health CV institutions exploring the trends of the CV burden in all 83 regions of Russia. We overviewed data from a number of the available Russian-speaking national data sources of 2001-2014, and NANOM-FIM trial (NCT01270139) as the only available real-world population study. The CV diseases in Russia accounted for 54.9% of all deaths in 2011-2014. The death rate was 13.3 per 1,000 citizens with CV mortality of 653.9 per 100,000. The life expectancy achieves 64.3 years for male and 76.1 years for female. The mean age of pts in trial was 51.6 years (77.2% males). A total of 175 Russian PCI centers implemented 205,902 angio a year, and 75,378 PCI achieving 531 PCI per 1,000,000 with placement of 101,451 stents (1.37 stents per PCI; 48,057 DES). The smoking (17.3% of screened with a 2,786 cigarettes a year; 70.6% in trial), excessive alcohol consumption (1.8% of screened with a 11.6 L per year; 50.6% in trial), unhealthy Russian diet (abundance of carbohydrates/sugar, saturated and trans fats in 24.3% of screened), psychosocial factors (20%) and physical inactivity (19.6% of screened) remain the major modifiable risk factors. They, in turn, affect such risk factors as dyslipidemia (86.7% in trial), obesity (16.7% of screened; BMI in trial was 28.4), and hypertension (40.8% suffered; 86.1% in trial). CV mortality was not directly associated with a level of poverty (r=0.26, P=0.02) or socio-economic development (P

40 CFR 179.91 - Burden of going forward; burden of persuasion.

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2010-07-01

... persuasion. 179.91 Section 179.91 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...; burden of persuasion. (a) The party whose request for an evidentiary hearing was granted has the burden... FFDCA has the burden of persuasion in the hearing on that issue, whether the proceeding concerns the...

Economic and disease burden of dengue in Mexico.

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Eduardo A Undurraga

2015-03-01

Full Text Available Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies.We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000 symptomatic and 119 (95%CL: 75-171 fatal dengue episodes annually on average (2010-2011, compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292 million, or $1.56 (95%CL: 1.38-2.68 per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209 million or $0.80 per capita (95%CL: 0.62-1.12 corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99 disability-adjusted life years (DALYs per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden.With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of

Economic and disease burden of dengue in Mexico.

Science.gov (United States)

Undurraga, Eduardo A; Betancourt-Cravioto, Miguel; Ramos-Castañeda, José; Martínez-Vega, Ruth; Méndez-Galván, Jorge; Gubler, Duane J; Guzmán, María G; Halstead, Scott B; Harris, Eva; Kuri-Morales, Pablo; Tapia-Conyer, Roberto; Shepard, Donald S

2015-03-01

Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies. We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000) symptomatic and 119 (95%CL: 75-171) fatal dengue episodes annually on average (2010-2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292) million, or $1.56 (95%CL: 1.38-2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209) million or $0.80 per capita (95%CL: 0.62-1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden. With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre

The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden.

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Gierk, Benjamin; Kohlmann, Sebastian; Kroenke, Kurt; Spangenberg, Lena; Zenger, Markus; Brähler, Elmar; Löwe, Bernd

2014-03-01

Somatic symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of somatic symptom burden, but its reliability, validity, and usefulness have not yet been tested. To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire-2 depression scale, Generalized Anxiety Disorder-2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general somatic symptom burden. Somatic symptom burden as measured by the SSS-8 was significantly associated with depression (r = 0.57 [95% CI, 0.54 to 0.60]), anxiety (r = 0.55 [95% CI, 0.52 to 0.58]), general health status (r = -0.24 [95% CI, -0.28 to -0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) somatic symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. The SSS-8 is a reliable and valid self-report measure of somatic symptom burden. Cutoff scores identify individuals with low, medium, high, and very high somatic

Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study.

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Nissensohn, Mariela; Sánchez-Villegas, Almudena; Ortega, Rosa M; Aranceta-Bartrina, Javier; Gil, Ángel; González-Gross, Marcela; Varela-Moreiras, Gregorio; Serra-Majem, Lluis

2016-04-20

Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI) are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9-75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. On average, TWI was 1.7 L (SE 21.2) for men and 1.6 L (SE 18.9) for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA) recommendations. Mean total energy intake (EI) was 1810 kcal/day (SE 11.1), of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39) and EI (r = 0.23), suggesting that beverage variety is an indicator of higher consumption of food and drinks. The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern.

To Treat or to Prevent?: Reducing the Population Burden of Violence-related Post-traumatic Stress Disorder.

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Cerdá, Magdalena; Tracy, Melissa; Keyes, Katherine M; Galea, Sandro

2015-09-01

Violence-related post-traumatic stress disorder (PTSD) remains a prevalent and disabling psychiatric disorder in urban areas. However, the most effective allocation of resources into prevention and treatment to reduce this problem is unknown. We contrasted the impact of two interventions on violence-related PTSD: (1) a population-level intervention intended to prevent violence (i.e., hot-spot policing), and (2) an individual-level intervention intended to shorten PTSD duration (i.e., cognitive-behavioral therapy-CBT). We used agent-based modeling to simulate violence and PTSD in New York City under four scenarios: (1) no intervention, (2) targeted policing to hot spots of violence, (3) increased access to CBT for people who suffered from violence-related PTSD, and (4) a combination of the two interventions. Combined prevention and treatment produced the largest decrease in violence-related PTSD prevalence: hot-spot policing plus a 50% increase in CBT for 5 years reduced the annual prevalence of violence-related PTSD from 3.6% (95% confidence interval = 3.5%, 3.6%) to 3.4% (3.3%, 3.5%). It would have been necessary to implement hot-spot policing or to increase CBT by 200% for 10 years for either intervention to achieve the same reduction in isolation. This study provides an empirically informed demonstration that investment in combined strategies that target social determinants of mental illness and provide evidence-based treatment to those affected by psychiatric disorders can produce larger reductions in the population burden from violence-related PTSD than either preventive or treatment interventions alone. However, neither hot-spot policing nor CBT, alone or combined, will produce large shifts in the population prevalence of violence-related PTSD.

Economic burden made celiac disease an expensive and challenging condition for Iranian patients.

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Pourhoseingholi, Mohamad Amin; Rostami-Nejad, Mohammad; Barzegar, Farnoush; Rostami, Kamran; Volta, Umberto; Sadeghi, Amir; Honarkar, Zahra; Salehi, Niloofar; Asadzadeh-Aghdaei, Hamid; Baghestani, Ahmad Reza; Zali, Mohammad Reza

2017-01-01

The aim of this study was to estimate the economic burden of celiac disease (CD) in Iran. The assessment of burden of CD has become an important primary or secondary outcome measure in clinical and epidemiologic studies. Information regarding medical costs and gluten free diet (GFD) costs were gathered using questionnaire and checklists offered to the selected patients with CD. The data included the direct medical cost (including Doctor Visit, hospitalization, clinical test examinations, endoscopies, etc.), GFD cost and loss productivity cost (as the indirect cost) for CD patient were estimated. The factors used for cost estimation included frequency of health resource utilization and gluten free diet basket. Purchasing Power Parity Dollar (PPP$) was used in order to make inter-country comparisons. Total of 213 celiac patients entered to this study. The mean (standard deviation) of total cost per patient per year was 3377 (1853) PPP$. This total cost including direct medical cost, GFD costs and loss productivity cost per patients per year. Also the mean and standard deviation of medical cost and GFD cost were 195 (128) PPP$ and 932 (734) PPP$ respectively. The total costs of CD were significantly higher for male. Also GFD cost and total cost were higher for unmarried patients. In conclusion, our estimation of CD economic burden is indicating that CD patients face substantial expense that might not be affordable for a good number of these patients. The estimated economic burden may put these patients at high risk for dietary neglect resulting in increasing the risk of long term complications.

Economic Burden of HIV/AIDS Upon Households in Nepal: A Critical Review

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Newlands, David; Simkhada, Padam

2015-01-01

Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them. PMID:26913211

Prevalence and burden of Sickle Cell Disease among ...

African Journals Online (AJOL)

Background: Sickle cell disease (SCD) is the most common form of haemoglobin opathy in Nigeria but there is paucity of data for its effects on undergraduate students in universities despite the fact that this population of people suffer more burdens of the disease due to relative lack of parental care and their recently ...

Estimated Human and Economic Burden of Four Major Adult Vaccine-Preventable Diseases in the United States, 2013.

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McLaughlin, John M; McGinnis, Justin J; Tan, Litjen; Mercatante, Annette; Fortuna, Joseph

2015-08-01

Low uptake of routinely recommended adult immunizations is a public health concern. Using data from the peer-reviewed literature, government disease-surveillance programs, and the US Census, we developed a customizable model to estimate human and economic burden caused by four major adult vaccine-preventable diseases (VPD) in 2013 in the United States, and for each US state individually. To estimate the number of cases for each adult VPD for a given population, we multiplied age-specific incidence rates obtained from the literature by age-specific 2013 Census population data. We then multiplied the estimated number of cases for a given population by age-specific, estimated medical and indirect (non-medical) costs per case. Adult VPDs examined were: (1) influenza, (2) pneumococcal disease (both invasive disease and pneumonia), (3) herpes zoster (shingles), and (4) pertussis (whooping cough). Sensitivity analyses simulated the impact of various epidemiological scenarios on the total estimated economic burden. Estimated US annual cost for the four adult VPDs was $26.5 billion (B) among adults aged 50 years and older, $15.3B (58 %) of which was attributable to those 65 and older. Among adults 50 and older, influenza, pneumococcal disease, herpes zoster, and pertussis made up $16.0B (60 %), $5.1B (19 %), $5.0B (19 %), and $0.4B (2 %) of the cost, respectively. Among those 65 and older, they made up $8.3B (54 %), $3.8B (25 %), $3.0B (20 %), and 0.2B (1 %) of the cost, respectively. Most (80-85 %) pneumococcal costs stemmed from nonbacteremic pneumococcal pneumonia (NPP). Cost attributable to adult VPD in the United States is substantial. Broadening adult immunization efforts beyond influenza only may help reduce the economic burden of adult VPD, and a pneumococcal vaccination effort, primarily focused on reducing NPP, may constitute a logical starting place. Sensitivity analyses revealed that a pandemic influenza season or change in size of the US elderly population

Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey.

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Li, Xiang; Cai, Hong; Wang, Chaoyi; Guo, Chuanhai; He, Zhonghu; Ke, Yang

2016-07-01

To evaluate the financial burden of oesophageal cancer under the protection of the new Rural Cooperative Medical Scheme (NCMS) and to provide evidence and suggestions to policymakers in a high-incidence region in China. We analysed inpatient claim data for oesophageal cancer, gastric cancer and colorectal cancer from 1 January to 31 December 2013. The data were extracted from the NCMS management system of Hua County, Henan Province, a typical high-risk region for oesophageal cancer in China. Cancer-specific health economic indicators were calculated to evaluate the financial burden under the protection of the local NCMS. The total cost of oesophageal cancer was 2.7-3.6 times higher than that of gastric cancer and colorectal cancer, respectively, due to high incidence of oesophageal cancer. For each hospitalisation to treat oesophageal cancer, the average total cost and out-of-pocket expenses after reimbursement equalled an entire year's gross domestic product per capita and per capita disposable income, respectively, for the local area. The average total cost per hospitalisation for oesophageal cancer increased monotonically with hospital level for surgical hospitalisations, and it increased more rapidly for non-surgical hospitalisations (from $301 to $2589, 860%) than for gastric cancer (from $289 to $1453, 503%) and colorectal cancer (from $359 to $1610, 448%). Vulnerable groups with less access to high-level hospitals were found in different gender and age groups. Oesophageal cancer imposes serious financial burdens on communities and patients' households in this high-incidence region, and no preferential policy from the local NCMS has been designed to address this issue. A special supportive policy should be developed on the basis of local disease profiles and population characteristics to alleviate the financial burden of populations at high risk for certain high-cost diseases. © 2016 John Wiley & Sons Ltd.

[The perceived burden of care and its correlates in schizophrenia].

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Gülseren, Leyla; Cam, Birmay; Karakoç, Berna; Yiğit, Tamer; Danacı, Ayşen Esen; Cubukçuoğlu, Zeynep; Taş, Cumhur; Gülseren, Seref; Mete, Levent

2010-01-01

The present study aimed to investigate the perceived level of burden of care and its correlates in family members of schizophrenia patients. The study included 239 schizophrenic patients that were followed-up at the psychiatric outpatient clinics of Izmir Ataturk Education and Research Hospital, and Celal Bayar University Medical School, and 239 of their primary caregivers. Patients were assessed using the Positive and Negative Syndrome Scale (PANNS), Global Assessment of Functioning Scale (GAF), Social Functioning Scale (SFS), Brief Cognitive State Examination (BCE), and UKU Side Effect Rating Scale. Their primary caregivers were assessed using the Perceived Family Burden Scale (PFBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Caregiver PFBS scores ere correlated with male patients, female caregivers, inadequate social support, economic difficulty, the presence of chronic physical disorder in the caregivers, patient violence toward the caregivers, total duration of illness, the number of patient hospitalizations, PANNS total and subscale scores, and SFS, BDI, and BAI scores. Perceived burden of care was predicted by the severity of the patients' positive symptoms, SFS independence/competence and interpersonal functioning subscale scores, and caregivers' anxiety and depression levels. In order to decrease the burden of care in schizophrenia we recommend effective management of patient symptoms, enhancement of patient social functioning, interventions that target caregivers with high levels anxiety and depression, and social support provided by healthcare professionals.

Systematic review of general burden of disease studies using disability-adjusted life years

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Polinder Suzanne

2012-11-01

Full Text Available Abstract Objective To systematically review the methodology of general burden of disease studies. Three key questions were addressed: 1 what was the quality of the data, 2 which methodological choices were made to calculate disability adjusted life years (DALYs, and 3 were uncertainty and risk factor analyses performed? Furthermore, DALY outcomes of the included studies were compared. Methods Burden of disease studies (1990 to 2011 in international peer-reviewed journals and in grey literature were identified with main inclusion criteria being multiple-cause studies that quantified the burden of disease as the sum of the burden of all distinct diseases expressed in DALYs. Electronic database searches included Medline (PubMed, EMBASE, and Web of Science. Studies were collated by study population, design, methods used to measure mortality and morbidity, risk factor analyses, and evaluation of results. Results Thirty-one studies met the inclusion criteria of our review. Overall, studies followed the Global Burden of Disease (GBD approach. However, considerable variation existed in disability weights, discounting, age-weighting, and adjustments for uncertainty. Few studies reported whether mortality data were corrected for missing data or underreporting. Comparison with the GBD DALY outcomes by country revealed that for some studies DALY estimates were of similar magnitude; others reported DALY estimates that were two times higher or lower. Conclusions Overcoming “error” variation due to the use of different methodologies and low-quality data is a critical priority for advancing burden of disease studies. This can enlarge the detection of true variation in DALY outcomes between populations or over time.

Strategies to determine and control the contributions of indoor air pollution to total inhalation exposure (STRATEX)

DEFF Research Database (Denmark)

Cochet, C.; Fernandes, E.O.; Jantunen, M.

ECA-IAQ (European Collaborative Action, Urban Air, Indoor Environment and Human Exposure), 2006. Strategies to determine and control the contributions of indoor air pollution to total inhalation exposure (STRATEX), Report No 25. EUR 22503 EN. Luxembourg: Office for Official Publications...... of the European Communities It is now well established that indoor air pollution contributes significantly to the global burden of disease of the population. Therefore, the knowledge of this contribution is essential in view of risk assessment and management. The ECA STRATEX report collates the respective...... information and describes the strategies to determine population exposure to indoor air pollutants. Its major goal is to emphasise the importance of the contribution of indoor air to total air exposure. Taking this contribution into account is a prerequisite for sound risk assessment of air pollution...

Global numbers of infection and disease burden of soil transmitted helminth infections in 2010.

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Pullan, Rachel L; Smith, Jennifer L; Jasrasaria, Rashmi; Brooker, Simon J

2014-01-21

Quantifying the burden of parasitic diseases in relation to other diseases and injuries requires reliable estimates of prevalence for each disease and an analytic framework within which to estimate attributable morbidity and mortality. Here we use data included in the Global Atlas of Helminth Infection to derive new global estimates of numbers infected with intestinal nematodes (soil-transmitted helminths, STH: Ascaris lumbricoides, Trichuris trichiura and the hookworms) and use disability-adjusted life years (DALYs) to estimate disease burden. Prevalence data for 6,091 locations in 118 countries were sourced and used to estimate age-stratified mean prevalence for sub-national administrative units via a combination of model-based geostatistics (for sub-Saharan Africa) and empirical approaches (for all other regions). Geographical variation in infection prevalence within these units was approximated using modelled logit-normal distributions, and numbers of individuals with infection intensities above given thresholds estimated for each species using negative binomial distributions and age-specific worm/egg burden thresholds. Finally, age-stratified prevalence estimates for each level of infection intensity were incorporated into the Global Burden of Disease Study 2010 analytic framework to estimate the global burden of morbidity and mortality associated with each STH infection. Globally, an estimated 438.9 million people (95% Credible Interval (CI), 406.3 - 480.2 million) were infected with hookworm in 2010, 819.0 million (95% CI, 771.7 - 891.6 million) with A. lumbricoides and 464.6 million (95% CI, 429.6 - 508.0 million) with T. trichiura. Of the 4.98 million years lived with disability (YLDs) attributable to STH, 65% were attributable to hookworm, 22% to A. lumbricoides and the remaining 13% to T. trichiura. The vast majority of STH infections (67%) and YLDs (68%) occurred in Asia. When considering YLDs relative to total populations at risk however, the burden

Economic burden of fire-related deaths in Finland, 2000-2010: Indirect costs using a human capital approach.

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Haikonen, Kari; Lillsunde, Pirjo M; Lunetta, Philippe; Kokki, Esa

2016-02-01

The aim of this study was to examine the indirect economic burden of fire-related deaths in Finland in the period 2000-2010. The Human Capital (HC) approach was the main method used to estimate productivity losses due to fire-related deaths. Additionally, Potential Years of Life Lost (PYLL) due to deaths were reported. A total of 1090 fire-related deaths occurred in the period 2000-2010 within a population of some 5.4 million. The majority were male (76% vs 24%), with a mean age of 52 (CI: 51.0-53.2) years for males and 57 (CI: 54.6-59.6) for females; 24% (CI: 21.1-26.2%) of victims were over the retirement age. Most of the victims died of combustion gas poisoning (65%, CI: 61.8-67.6%), followed by burns (33%, CI: 30.6-36.3%). Alcohol was often involved and victims were often socially disadvantaged, with socioeconomic features significantly deviating from those of the general population. Annual PYLL ranged from 2094 (CI: 1861-2326) to 3299 (CI: 3008-3594), with an annual average PYLL of 2763 (CI: 2675-2851). PYLL per death fell in the study period from 34.3 (2000, CI: 31.0-37.7) to 24.6 (2010, CI: 21.8-27.6). The reduction is attributable to a decreasing fraction of young victims and an increase in average ages. Total productivity loss in the period 2000-2010 was c.a. EUR 342 million (CI: 330-354 million), giving an annual average of EUR 31.1 million (CI: 30.0-32.2 million), with the mean for a victim being EUR 0.315 million (CI: 0.30-0.33 million). The economic burden of deaths is considerable and this study remedies the lack of academic knowledge about the burden of fire-related deaths. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Economic Burden for Lung Cancer Survivors in Urban China.

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Zhang, Xin; Liu, Shuai; Liu, Yang; Du, Jian; Fu, Wenqi; Zhao, Xiaowen; Huang, Weidong; Zhao, Xianming; Liu, Guoxiang; Mao, Zhengzhong; Hu, Teh-Wei

2017-03-15

With the rapid increase in the incidence and mortality of lung cancer, a growing number of lung cancer patients and their families are faced with a tremendous economic burden because of the high cost of treatment in China. This study was conducted to estimate the economic burden and patient responsibility of lung cancer patients and the impact of this burden on family income. This study uses data from a retrospective questionnaire survey conducted in 10 communities in urban China and includes 195 surviving lung cancer patients diagnosed over the previous five years. The calculation of direct economic burden included both direct medical and direct nonmedical costs. Indirect costs were calculated using the human capital approach, which measures the productivity lost for both patients and family caregivers. The price index was applied for the cost calculation. The average economic burden from lung cancer was $43,336 per patient, of which the direct cost per capita was $42,540 (98.16%) and the indirect cost per capita was $795 (1.84%). Of the total direct medical costs, 35.66% was paid by the insurer and 9.84% was not covered by insurance. The economic burden for diagnosed lung cancer patients in the first year following diagnosis was $30,277 per capita, which accounted for 171% of the household annual income, a percentage that fell to 107% after subtracting the compensation from medical insurance. The economic burden for lung cancer patients is substantial in the urban areas of China, and an effective control strategy to lower the cost is urgently needed.

The burden of road traffic crashes, injuries and deaths in Africa: a systematic review and meta-analysis

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Thompson, Jacqueline Y; Akanbi, Moses A; Azuh, Dominic; Samuel, Victoria; Omoregbe, Nicholas; Ayo, Charles K

2016-01-01

Abstract Objective To estimate the burden of road traffic injuries and deaths for all road users and among different road user groups in Africa. Methods We searched MEDLINE, EMBASE, Global Health, Google Scholar, websites of African road safety agencies and organizations for registry- and population-based studies and reports on road traffic injury and death estimates in Africa, published between 1980 and 2015. Available data for all road users and by road user group were extracted and analysed. We conducted a random-effects meta-analysis and estimated pooled rates of road traffic injuries and deaths. Findings We identified 39 studies from 15 African countries. The estimated pooled rate for road traffic injury was 65.2 per 100 000 population (95% confidence interval, CI: 60.8–69.5) and the death rate was 16.6 per 100 000 population (95% CI: 15.2–18.0). Road traffic injury rates increased from 40.7 per 100 000 population in the 1990s to 92.9 per 100 000 population between 2010 and 2015, while death rates decreased from 19.9 per 100 000 population in the 1990s to 9.3 per 100 000 population between 2010 and 2015. The highest road traffic death rate was among motorized four-wheeler occupants at 5.9 per 100 000 population (95% CI: 4.4–7.4), closely followed by pedestrians at 3.4 per 100 000 population (95% CI: 2.5–4.2). Conclusion The burden of road traffic injury and death is high in Africa. Since registry-based reports underestimate the burden, a systematic collation of road traffic injury and death data is needed to determine the true burden. PMID:27429490

Predictors of caregiver burden in Iranian family caregivers of cancer patients.

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Mirsoleymani, Seyed Reza; Rohani, Camelia; Matbouei, Mahsa; Nasiri, Malihe; Vasli, Parvaneh

2017-01-01

Caregiver burden threatens the psychological, emotional, functional and even physical health of caregivers. The aims of this study were to determine caregiver burden and family distress and the relationship between them, also to explore predictors of caregiver burden in a sample of Iranian family caregivers of cancer patients. This is a cross-sectional study with correlational design. A total of 104 family caregivers of cancer patients were asked to respond to the Caregiver Burden Inventory (CBI) and the Family Distress Index (FDI) together with a sociodemographic questionnaire. For evaluating the relationship between CBI and FDI scores, the Pearson's product-moment correlation was used. In addition, multiple linear regression analysis was applied to explore the predictive factors of caregiver burden. A high burden was experienced by almost half of the caregivers (48.1%). The FDI mean score was 9.76 ± 5.40 ranged from 0 to 24. A strong positive correlation was found between the caregiver burden and family distress ( r = 0.76). Multiple linear regression results showed the predictive role of FDI score (β = 0.71, P = 0.001), patient's gender (β = -0.25, P = 0.001), and early cancer diagnosis (β =0.13, P = 0.027) in caregiver burden. They could explain 65% of variance in the level of burden in family caregivers. Family nurses should consider the caregivers burden and vulnerability of families with cancer patient, especially if the patient is a male or has a new diagnosis. They should also design special programs for the whole family as a system that family can adapt to the new situation.

Correlates of caregiver burden among family caregivers of older Korean Americans.

Science.gov (United States)

Casado, Banghwa; Sacco, Paul

2012-05-01

Despite the rapid growth of older ethnic minority populations, knowledge is limited about informal caregiving among these groups. Our aim was to identify correlates of caregiver burden among family caregivers of older Korean Americans (KAs). A cross-sectional survey collected data from 146 KA caregivers. Using a modified stress-appraisal model, we examined background and context characteristics (caregiver sex, relationship to care recipient, college education, English proficiency, time in caregiving role, family support network, friend support network), a primary stressor (care recipient functional dependency), a primary appraisal (caregiving hours), and resources (family agreement, care management self-efficacy, service use self-efficacy) as potential correlates of caregiver burden. Interactions between the primary stressor, primary appraisal, and resources were also tested. Being female and the care recipient's spouse were associated with higher burden. Conversely, a larger family support network, greater family agreement, and greater care management self-efficacy were associated with lower burden. A significant interaction was detected between functional dependency and family agreement; higher levels of family agreement moderated the association between care recipient functional dependency and caregiver burden. Interventions to reduce caregiver burden in KA caregivers may be more effective if they include approaches specifically designed to build family support, improve family agreement, and increase caregivers' self-efficacy.

Meta-analysis of relationships between human offtake, total mortality and population dynamics of gray wolves (Canis lupus).

Science.gov (United States)

Creel, Scott; Rotella, Jay J

2010-09-29

Following the growth and geographic expansion of wolf (Canis lupus) populations reintroduced to Yellowstone National Park and central Idaho in 1995-1996, Rocky Mountain wolves were removed from the endangered species list in May 2009. Idaho and Montana immediately established hunting seasons with quotas equaling 20% of the regional wolf population. Combining hunting with predator control, 37.1% of Montana and Idaho wolves were killed in the year of delisting. Hunting and predator control are well-established methods to broaden societal acceptance of large carnivores, but it is unprecedented for a species to move so rapidly from protection under the Endangered Species Act to heavy direct harvest, and it is important to use all available data to assess the likely consequences of these changes in policy. For wolves, it is widely argued that human offtake has little effect on total mortality rates, so that a harvest of 28-50% per year can be sustained. Using previously published data from 21 North American wolf populations, we related total annual mortality and population growth to annual human offtake. Contrary to current conventional wisdom, there was a strong association between human offtake and total mortality rates across North American wolf populations. Human offtake was associated with a strongly additive or super-additive increase in total mortality. Population growth declined as human offtake increased, even at low rates of offtake. Finally, wolf populations declined with harvests substantially lower than the thresholds identified in current state and federal policies. These results should help to inform management of Rocky Mountain wolves.

Meta-analysis of relationships between human offtake, total mortality and population dynamics of gray wolves (Canis lupus.

Directory of Open Access Journals (Sweden)

Scott Creel

Full Text Available Following the growth and geographic expansion of wolf (Canis lupus populations reintroduced to Yellowstone National Park and central Idaho in 1995-1996, Rocky Mountain wolves were removed from the endangered species list in May 2009. Idaho and Montana immediately established hunting seasons with quotas equaling 20% of the regional wolf population. Combining hunting with predator control, 37.1% of Montana and Idaho wolves were killed in the year of delisting. Hunting and predator control are well-established methods to broaden societal acceptance of large carnivores, but it is unprecedented for a species to move so rapidly from protection under the Endangered Species Act to heavy direct harvest, and it is important to use all available data to assess the likely consequences of these changes in policy. For wolves, it is widely argued that human offtake has little effect on total mortality rates, so that a harvest of 28-50% per year can be sustained. Using previously published data from 21 North American wolf populations, we related total annual mortality and population growth to annual human offtake. Contrary to current conventional wisdom, there was a strong association between human offtake and total mortality rates across North American wolf populations. Human offtake was associated with a strongly additive or super-additive increase in total mortality. Population growth declined as human offtake increased, even at low rates of offtake. Finally, wolf populations declined with harvests substantially lower than the thresholds identified in current state and federal policies. These results should help to inform management of Rocky Mountain wolves.

Economic burden of irritable bowel syndrome in China.

Science.gov (United States)

Zhang, Fang; Xiang, Wei; Li, Chun-Yan; Li, Shu-Chuen

2016-12-21

To estimate annual direct and indirect costs for patients diagnosed with irritable bowel syndrome (IBS) and subtypes. Patients completed a standardized questionnaire concerning usage of healthcare resources, travel costs, meals, and productivity loss of patients when seeking treatment for IBS. Total annual costs per patient were calculated as the sum of direct (including medical and nonmedical) and indirect costs. Total annual costs per patient among various IBS subtypes were compared. Analysis of variance and bootstrapped independent sample t -tests were performed to determine differences between groups after controlling for IBS subtypes. A total of 105 IBS patients (64.80% female), mean age of 57.12 years ± 10.31 years), mean disease duration of 4.31 years ± 5.40 years, were included. Total annual costs per patient were estimated as CNY18262.84 (USD2933.08). Inpatient and outpatient healthcare use were major cost drivers, accounting for 46.41%and 23.36% of total annual costs, respectively. Productivity loss accounted for 25.32% of total annual costs. The proportions of direct and indirect costs were similar to published studies in other countries. Nationally, the total costs of managing IBS would amount to CNY123.83 billion (USD1.99 billion). Among the IBS subtypes, total annual costs per patient of IBS-M was highest at CNY18891.18 (USD3034). Furthermore, there was significant difference in productivity loss among IBS subtypes ( P = 0.031). IBS imposes a huge economic burden on patients and healthcare systems, which could account for 3.3% of the total healthcare budget for the entire Chinese nation. More than two-thirds of total annual costs of IBS consist of inpatient and outpatient healthcare use. Among the subtypes, IBS-M patients appear to have the greatest economic burden but require further confirmation.

Regional variations in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia

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H. Krueger

2016-04-01

Full Text Available Introduction: Prevalence rates of excess weight, tobacco smoking and physical inactivity vary substantially by geographical region within British Columbia (B.C.. The purpose of this study is to determine the potential reduction in economic burden in B.C. if all regions in the province achieved prevalence rates of these three risk factors equivalent to those of the region with the lowest rates. Methods: We used a previously developed approach based on population-attributable fractions to estimate the economic burden associated with the various risk factors. Sexspecific relative risk and age/sex-specific prevalence data was used in the modelling. Results: The annual economic burden attributable to the three risk factors in B.C. was about $5.6 billion in 2013, with a higher proportion of this total attributable to excess weight ($2.6 billion than to tobacco smoking ($2.0 billion. While B.C. has lower prevalence rates of the risk factors than any other Canadian province, there is significant variation within the province. If each region in the province were to achieve the best prevalence rates for the three risk factors, then $1.4 billion (24% of the $5.6 billion in economic burden could be avoided annually. Conclusion: There are notable disparities in the prevalence of each risk factor across health regions within B.C., which were mirrored in each region’s attributable economic burden. A variety of social, environmental and economic factors likely drive some of this geographical variation and these underlying factors should be considered when developing prevention programs.

Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study.

Science.gov (United States)

Yakoob, Mohammad Y; Micha, Renata; Khatibzadeh, Shahab; Singh, Gitanjali M; Shi, Peilin; Ahsan, Habibul; Balakrishna, Nagalla; Brahmam, Ginnela N V; Chen, Yu; Afshin, Ashkan; Fahimi, Saman; Danaei, Goodarz; Powles, John W; Ezzati, Majid; Mozaffarian, Dariush

2016-12-01

To quantify cardiovascular disease and diabetes deaths attributable to dietary and metabolic risks by country, age, sex, and time in South Asian countries. We used the 2010 Global Burden of Disease national surveys to characterize risk factor levels by age and sex. We derived etiological effects of risk factors-disease endpoints, by age, from meta-analyses. We defined optimal levels. We combined these inputs with cause-specific mortality rates to compute population-attributable fractions as a percentage of total cardiometabolic deaths. Suboptimal diet was the leading cause of cardiometabolic mortality in 4 of 5 countries, with population-attributable fractions from 40.7% (95% uncertainty interval = 37.4, 44.1) in Bangladesh to 56.9% (95% uncertainty interval = 52.4, 61.5) in Pakistan. High systolic blood pressure was the second leading cause, except in Bangladesh, where it superseded suboptimal diet. This was followed in all nations by high fasting plasma glucose, low fruit intake, and low whole grain intake. Other prominent burdens were more variable, such as low intake of vegetables, low omega-3 fats, and high sodium intake in India, Nepal, and Pakistan. Important similarities and differences are evident in cardiometabolic mortality burdens of modifiable dietary and metabolic risks across these countries, informing health policy and program priorities.

Prognostic factors in Hodgkin's disease stage III with special reference to tumour burden

DEFF Research Database (Denmark)

Specht, L.; Nissen, N.I.

1988-01-01

of lymphographically involved regions), histologic subtype, B-symptoms, number of involved regions, mediastinal involvement, pretreatment ESR, sex, age, laparotomy, and substage were examined in multivariate analysis. With regard to disease-free survival, total tumour burden (intraabdominal and peripheral...... regarding early stage disease to the effect that tumour burden is the single most important prognostic factor in Hodgkin's disease....

Economic Burden in Chinese Patients with Diabetes Mellitus Using Electronic Insurance Claims Data.

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Yunyu Huang

Full Text Available There is a paucity of studies that focus on the economic burden in daily care in China using electronic health data. The aim of this study is to describe the development of the economic burden of diabetic patients in a sample city in China from 2009 to 2011 using electronic data of patients' claims records.This study is a retrospective, longitudinal study in an open cohort of Chinese patients with diabetes. The patient population consisted of people living in a provincial capital city in east China, covered by the provincial urban employee basic medical insurance (UEBMI. We included any patient who had at least one explicit diabetes diagnosis or received blood glucose lowering medication in at least one registered outpatient visit or hospitalization during a calendar year in the years 2009-2011. Cross-sectional descriptions of different types of costs, prevalence of diabetic complications and related diseases, medication use were performed for each year separately and differences between three years were compared using a chi-square test or the non-parametric Kruskal-Wallis H test.Our results showed an increasing trend in total medical cost (from 2,383 to 2,780 USD, p = 0.032 and diabetes related cost (from 1,655 to 1,857 USD for those diabetic patients during the study period. The diabetes related economic burden was significantly related to the prevalence of complications and related diseases (p<0.001. The overall medication cost during diabetes related visits also increased (from 1,335 to 1,383 USD, p = 0.021. But the use pattern and cost of diabetes-related medication did not show significant changes during the study period.The economic burden of diabetes increased significantly in urban China. It is important to improve the prevention and treatment of diabetes to contribute to the sustainability of the Chinese health-care system.

Plasma Total Cysteine and Cardiovascular Risk Burden: Action and Interaction

OpenAIRE

De Chiara, Benedetta; Sedda, Valentina; Parolini, Marina; Campolo, Jonica; De Maria, Renata; Caruso, Raffaele; Pizzi, Gianluigi; Disoteo, Olga; Dellanoce, Cinzia; Corno, Anna Rosa; Cighetti, Giuliana; Parodi, Oberdan

2012-01-01

We hypothesized that redox analysis could provide sensitive markers of the oxidative pathway associated to the presence of an increasing number of cardiovascular risk factors (RFs), independently of type. We classified 304 subjects without cardiovascular disease into 4 groups according to the total number of RFs (smoking, hypertension, hypercholesterolaemia, hyperhomocysteinaemia, diabetes, obesity, and their combination). Oxidative stress was evaluated by measuring plasma total and reduced h...

Pleural mesothelioma and lung cancer risks in relation to occupational history and asbestos lung burden

Science.gov (United States)

Gilham, Clare; Rake, Christine; Burdett, Garry; Nicholson, Andrew G; Davison, Leslie; Franchini, Angelo; Carpenter, James; Hodgson, John; Darnton, Andrew; Peto, Julian

2016-01-01

Background We have conducted a population-based study of pleural mesothelioma patients with occupational histories and measured asbestos lung burdens in occupationally exposed workers and in the general population. The relationship between lung burden and risk, particularly at environmental exposure levels, will enable future mesothelioma rates in people born after 1965 who never installed asbestos to be predicted from their asbestos lung burdens. Methods Following personal interview asbestos fibres longer than 5 µm were counted by transmission electron microscopy in lung samples obtained from 133 patients with mesothelioma and 262 patients with lung cancer. ORs for mesothelioma were converted to lifetime risks. Results Lifetime mesothelioma risk is approximately 0.02% per 1000 amphibole fibres per gram of dry lung tissue over a more than 100-fold range, from 1 to 4 in the most heavily exposed building workers to less than 1 in 500 in most of the population. The asbestos fibres counted were amosite (75%), crocidolite (18%), other amphiboles (5%) and chrysotile (2%). Conclusions The approximate linearity of the dose–response together with lung burden measurements in younger people will provide reasonably reliable predictions of future mesothelioma rates in those born since 1965 whose risks cannot yet be seen in national rates. Burdens in those born more recently will indicate the continuing occupational and environmental hazards under current asbestos control regulations. Our results confirm the major contribution of amosite to UK mesothelioma incidence and the substantial contribution of non-occupational exposure, particularly in women. PMID:26715106

The factors affecting the burden of care of informal caregivers of the elderly in Tehran

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Hosein Rohani

2015-03-01

Full Text Available Background: Rapid growth of the elderly population followed by an increase in long term care will lead to a rise in the health costs of the elderly and the healthcare burden of their caregivers. This study was carried out to examine the factors affecting the burden of care for informal caregivers in order to design better interventional programs and to reduce this burden and unwanted consequences. Methods: This cross-sectional study was conducted in retirement associations of Tehran in 2012. The study population included 200 elderly and 200 caregivers. The instruments for data collection included two questionnaires about the elderly and their caregivers that were completed in a face-to-face interview. The data were analyzed by SPSS-16 software using multiple linear regression. Results: About 60% of the elderly and 34% of caregivers were female. Burden of care was low in 70%, moderate in 11.5%, and high in 18.5% of caregivers. Female caregivers were suffering 1.42 unit more burden of care than male caregivers (P= 0.027. Also, there was a significant association between the burden of care of untrained caregivers and instrumental activities of the daily living of the elderly (P< 0.001, daily activity of the elderly (P<0.001 and adequacy of wage (= 0.001. Conclusion: According to the results, being a female caregiver, daily physical activity of the elderly, instrumental activities of the daily living of the elderly, and adequacy of the wage were the most important factors in increasing the burden of care for caregivers of the elderly.

“Burden of osteoporotic fractures in primary health care in Catalonia (Spain: a population-based study”

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Pagès-Castellà Aina

2012-05-01

Full Text Available Abstract Background Knowledge on the epidemiology of non-hip fractures in Spain is limited and somewhat outdated. Using computerized primary care records from the SIDIAP database, we derived age and sex-specific fracture incidence rates for the region of Catalonia during the year 2009. Methods The SIDIAP database contains quality-checked clinical information from computerized medical records of a representative sample of >5,800,000 patients (80% of the population of Catalonia. We conducted a retrospective cohort study including all patients aged ≥50 years, and followed them from January 1 to December 31, 2009. Major osteoporotic fractures registered in SIDIAP were ascertained using ICD-10 codes and validated by comparing data to hospital admission and patient-reported fractures records. Incidence rates and 95% confidence intervals were calculated. Results In total, 2,011,430 subjects were studied (54.6% women. Overall fracture rates were 10.91/1,000 person-years (py [95%CI 10.89–10.92]: 15.18/1,000 py [15.15–15.21] in women and 5.78/1,000 py [5.76–5.79] in men. The most common fracture among women was wrist/forearm (3.86/1,000 py [3.74–3.98], while among men it was clinical spine (1.25/1,000 py [1.18–1.33]. All fracture rates increased with age, but varying patterns were observed: while most of the fractures (hip, proximal humerus, clinical spine and pelvis increased continuously with age, wrist and multiple rib fractures peaked at age 75–80 and then reached a plateau. Conclusions Our study provides local estimates of age, sex and site-specific fracture burden in primary health care, which will be helpful for health-care planning and delivery. A proportion of fractures are not reported in primary care records, leading to underestimation of fracture incidence rates in these data.

Economic and Disease Burden of Dengue in Mexico

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Undurraga, Eduardo A.; Betancourt-Cravioto, Miguel; Ramos-Castañeda, José; Martínez-Vega, Ruth; Méndez-Galván, Jorge; Gubler, Duane J.; Guzmán, María G.; Halstead, Scott B.; Harris, Eva; Kuri-Morales, Pablo; Tapia-Conyer, Roberto; Shepard, Donald S.

2015-01-01

Background Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies. Methods and Findings We estimated the annual economic and disease burden of dengue in Mexico for the years 2010–2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000–253,000) symptomatic and 119 (95%CL: 75–171) fatal dengue episodes annually on average (2010–2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151–292) million, or $1.56 (95%CL: 1.38–2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87–209) million or $0.80 per capita (95%CL: 0.62–1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36–99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden. Conclusion With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak

Prospective study of the burden of rotavirus gastroenteritis in Danish children and their families

DEFF Research Database (Denmark)

Hoffmann, Thomas; Iturriza, Miren; Faaborg-Andersen, Jens

2011-01-01

This was the first study to characterize the total burden of rotavirus gastroenteritis (RVGE) at both hospital and general physician (GP) clinics in Denmark, and also the first to confirm rotavirus (RV) as the leading cause of acute gastroenteritis (GE) among children......This was the first study to characterize the total burden of rotavirus gastroenteritis (RVGE) at both hospital and general physician (GP) clinics in Denmark, and also the first to confirm rotavirus (RV) as the leading cause of acute gastroenteritis (GE) among children...

Burden of emergency conditions and emergency care utilization: New estimates from 40 countries

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Chang, Cindy Y.; Abujaber, Samer; Reynolds, Teri A.; Camargo, Carlos A.; Obermeyer, Ziad

2016-01-01

Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care. PMID:27334758

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

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2018-01-01

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California. PMID:29659481

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

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Raoul S. Liévanos

2018-04-01

Full Text Available The California Community Environmental Health Screening Tool (CalEnviroScreen advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California.

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California.

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Liévanos, Raoul S

2018-04-16

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California.

Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study

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Mariela Nissensohn

2016-04-01

Full Text Available Background: Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. Methods: The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9–75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. Results: On average, TWI was 1.7 L (SE 21.2 for men and 1.6 L (SE 18.9 for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA recommendations. Mean total energy intake (EI was 1810 kcal/day (SE 11.1, of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39 and EI (r = 0.23, suggesting that beverage variety is an indicator of higher consumption of food and drinks. Conclusions: The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern.

Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study

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Nissensohn, Mariela; Sánchez-Villegas, Almudena; Ortega, Rosa M.; Aranceta-Bartrina, Javier; Gil, Ángel; González-Gross, Marcela; Varela-Moreiras, Gregorio; Serra-Majem, Lluis

2016-01-01

Background: Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI) are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. Methods: The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9–75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. Results: On average, TWI was 1.7 L (SE 21.2) for men and 1.6 L (SE 18.9) for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA) recommendations. Mean total energy intake (EI) was 1810 kcal/day (SE 11.1), of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39) and EI (r = 0.23), suggesting that beverage variety is an indicator of higher consumption of food and drinks. Conclusions: The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern. PMID:27104564

Burden control by artificial intelligence

Energy Technology Data Exchange (ETDEWEB)

Saxen, H.; Nikus, M. [Aabo Akademi, Turku (Finland). Heat Engineering Lab.

1998-07-01

The burden distribution plays an important role for the fuel economy of the blast furnace. By an appropriate burden distribution, the operation of the furnace is smooth and the gas is utilized well, the burden descends steadily and the wear of the lining is minimal. Since it is very difficult to obtain reliable information about the burden distribution in operating blast furnaces, this research project developed methods for interpretation of burden and gas distribution in the shaft mainly based on temperature measurements from above-burden probes.

Caregiver burden in atypical dementias: comparing frontotemporal dementia, Creutzfeldt-Jakob disease, and Alzheimer's disease.

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Uflacker, Alice; Edmondson, Mary C; Onyike, Chiadi U; Appleby, Brian S

2016-02-01

Caregiver burden is a significant issue in the treatment of dementia and a known contributor to institutionalization of patients with dementia. Published data have documented increased caregiver burden in behavioral variant frontotemporal dementia (bvFTD) compared to Alzheimer's disease (AD). Another atypical dementia with high-perceived caregiver burden is sporadic Creutzfeldt-Jakob disease (sCJD), but no formal studies have assessed this perception. The aim of this study was to compare caregiver burden across atypical dementia etiologies. 76 adults with atypical dementia (young-onset AD [YOAD], bvFTD, language variant FTD [lvFTD], and sCJD) were administered an abbreviated version of the Zarit Burden Interview (ZBI), Neuropsychiatric Inventory (NPI-Q), and other assessment instruments during a five-year time period at Johns Hopkins Hospital (JHH). A Cox regression model examined differences between disease categories that impact mean ZBI scores. Mean ZBI scores were significantly different between dementia etiologies, with bvFTD and sCJD having the highest caregiver burden (p = 0.026). Mean NPI-Q caregiver distress scores were highest in bvFTD and sCJD (p = 0.002), with sCJD and bvFTD also having the highest number of endorsed symptom domains (p = 0.012). On regression analyses, an interactive variable combining final diagnosis category and NPI-Q total severity score demonstrated statistically significant differences in mean ZBI scores for sCJD and bvFTD. This study demonstrates that bvFTD and sCJD have increased levels of caregiver burden, NPI-Q caregiver distress, total severity scores, and number of endorsed symptom domains. These results suggest that higher caregiver burden in bvFTD and sCJD are disease specific and possibly related to neuropsychiatric symptoms.

Burden of care in the caregivers of patients with anxiety disorders

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Manu Agarwal

2017-01-01

Full Text Available Introduction: Anxiety disorders are one of the frequently encountered psychiatric disorders in psychiatric clinics which have significant impact on the psychosocial well-being of the patient as well as their caregivers. Study Design and Aims: This study is a non- invasive, cross sectional study of 91 patients with anxiety disorder (except obsessive compulsive disorder aimed to assess the burden of care on their key-relatives and to study various socio demographic and clinical variables of the patient in relation to burden of care on key-relatives. Methodology: Patients diagnosed with anxiety disorders other than obsessive compulsive disorder and their key relatives satisfying the selection criteria were enrolled in the study. Assessment was done on semi-structured proforma, ICD 10 DCR, SCAN (Schedules for Clinical Assessment in Neuropsychiatry, International Personality Disorder Examination (IPDE, Burden assessment schedule, Hamilton Anxiety Rating Scale (HAM-A. Result: Total adjusted burden score in our study was 40.41 which is suggestive of mild burden. It was found that the burden of care was higher in male gender, married individuals, in joint families, among spouses, urban background, in the age group 41 to 50 years, low income group particularly on farmers and laborers. Generalized anxiety disorder was associated with more burden of care in comparison to other anxiety disorders. Conclusion: Key relatives of patients with anxiety disorder have significant burden of care in different domains along the socio-demographic strata.

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

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Abd ElHafeez, Samar; Bolignano, Davide; D’Arrigo, Graziella; Dounousi, Evangelia; Tripepi, Giovanni; Zoccali, Carmine

2018-01-01

Objectives While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. Design, setting and participants We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. Outcome measurement The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. Results In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%–90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%–51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). Conclusion In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies. PMID:29326180

Prevalence and Burden of Gait Disorders in Elderly Men and Women Aged 60–97 Years: A Population-Based Study

Science.gov (United States)

Mahlknecht, Philipp; Kiechl, Stefan; Bloem, Bastiaan R.; Willeit, Johann; Scherfler, Christoph; Gasperi, Arno; Rungger, Gregorio; Poewe, Werner; Seppi, Klaus

2013-01-01

Background Although gait disorders are common in the elderly, the prevalence and overall burden of these disorders in the general community is not well defined. Methods In a cross-sectional investigation of the population-based Bruneck Study cohort, 488 community-residing elderly aged 60–97 years underwent a thorough neurological assessment including a standardized gait evaluation. Gait disorders were classified according to an accepted scheme and their associations to falls, neuropsychological measures, and quality of life were explored. Results Overall, 32.2% (95% confidence interval [CI] 28.2%–36.4%) of participants presented with impaired gait. Prevalence increased with age (pgait. A total of 24.0% (95%CI 20.4%–28.0%) manifested neurological gait disorders, 17.4% (14.3%–21.0%) non-neurological gait problems, and 9.2% (6.9%–12.1%) a combination of both. While there was no association of neurological gait disorders with gender, non-neurological gait disorders were more frequent in women (p = 0.012). Within the group of neurological gait disorders 69.2% (95%CI 60.3%–76.9%) had a single distinct entity and 30.8% (23.1%–39.7%) had multiple neurological causes for gait impairment. Gait disorders had a significant negative impact on quantitative gait measures, but only neurological gait disorders were associated with recurrent falls (odds ratio 3.3; 95%CI 1.4–7.5; p = 0.005 for single and 7.1; 2.7–18.7; pgait disorders). Finally, we detected a significant association of gait disorders, in particular neurological gait disorders, with depressed mood, cognitive dysfunction, and compromised quality of life. Conclusions Gait disorders are common in the general elderly population and are associated with reduced mobility. Neurological gait disorders in particular are associated with recurrent falls, lower cognitive function, depressed mood, and diminished quality of life. PMID:23894511

Respiratory syncytial virus--the unrecognised cause of health and economic burden among young children in Australia.

Science.gov (United States)

Ranmuthugala, Geetha; Brown, Laurie; Lidbury, Brett A

2011-06-01

Respiratory syncytial virus (RSV) presents very similar to influenza and is the principle cause of bronchiolitis in infants and young children worldwide. Yet, there is no systematic monitoring of RSV activity in Australia. This study uses existing published data sources to estimate incidence, hospitalisation rates, and associated costs of RSV among young children in Australia. Published reports from the Laboratory Virology and Serology Reporting Scheme, a passive voluntary surveillance system, and the National Hospital Morbidity Dataset were used to estimate RSV-related age-specific hospitalisation rates in New South Wales and Australia. These estimates and national USA estimates of RSV-related hospitalisation rates were applied to Australian population data to estimate RSV incidence in Australia. Direct economic burden was estimated by applying cost estimates used to derive economic cost associated with the influenza virus. The estimated RSV-related hospitalisation rates ranged from 2.2-4.5 per 1,000 among children less than 5 years of age to 8.7-17.4 per 1,000 among infants. Incidence ranged from 110.0-226.5 per 1,000 among the under five age group to 435.0-869.0 per 1,000 among infants. The total annual direct healthcare cost was estimated to be between $24 million and $50 million. Comparison with the health burdens attributed to the influenza virus and rotavirus suggests that the disease burden caused by RSV is potentially much higher. The limitations associated with using a passive surveillance system to estimate disease burden, and the need to explore further assessments and to monitor RSV activity are discussed.

Beyond Attributable Burden: Estimating the Avoidable Burden of Disease Associated with Household Air Pollution.

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Randall Kuhn

, though for different reasons. ALRI impacts diminish due to the declining burden of ALRI in the base case forecast, particularly apparent in South Asia and Southeast Asia. Although NCD burdens are rising in regions affected by HAP, the avoidable risk of NCD nonetheless diminishes due to lagged effects. Because the stove transition and the decline of ALRI are proceeding more slowly in Sub-Saharan Africa, avoidable impacts would also be more persistent (3.9% of total DALY due to HAP compared to South Asia (3.6% or Southeast Asia (2.5%.Our results illustrate how a temporal dynamic calculation of avoidable risk may yield different estimates, compared to a static attributable risk estimate, of the global and regional burden of disease. Our results suggest a window of rising and falling opportunity for HAP interventions that may have already closed in Southeast Asia and may be closing quickly in South Asia, but may remain open longer in Sub-Saharan Africa. A proper accounting of global health priorities should apply an avoidable risk framework that considers the role of ongoing social, economic and health transitions in constantly altering the disease and risk factor landscape.

Body Burden of Hg in Different Bio-Samples of Mothers in Shenyang City, China

Science.gov (United States)

Xu, Jian; Du, Juan; Yan, Chong-huai

2014-01-01

Hg is an accumulative and neuro-toxic heavy metal which has a wide range of adverse effects in human health. However, few studies are available on body burden of Hg level in different bio-samples of pregnant women in Chinese population. Therefore, this study evaluated Hg levels in different maternal bio-samples in Shenyang city, China and investigated the correlation of Hg levels in different bio-samples. From October to December 2008, 200 pregnant women about to deliver their babies at ShengJing Hospital (Shenyang city, northeast of China) participated in this study. The geometric mean (GM) of Hg levels in cord blood, maternal venous blood, breast milk, and maternal urine were 2.18 µg/L, 1.17 µg/L, 1.14 µg/L, and 0.73 µg/L, respectively, and the GM of maternal hair Hg level was 404.45 µg/kg. There was a strong correlation between cord blood and maternal blood total Hg level (r = 0.713, PHg exposure (unadjusted OR 3.5, adjusted OR 2.94, PHg burden of mothers and the risk factors of prenatal Hg exposure in Shenyang city, China. PMID:24858815

Estimating the burden of disease attributable to high cholesterol in ...

African Journals Online (AJOL)

Objectives. To estimate the burden of disease attributable to high cholesterol in adults aged 30 years and older in South Africa in 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies were used to derive the prevalence by population group.

Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

Science.gov (United States)

Donnay, S; Balsa, J A; Álvarez, Julia; Crespo, C; Pérez-Alcántara, F; Polanco, C

2013-11-01

Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

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Perez, Enrique; Majowicz, Shannon E.; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

2010-01-01

This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI. PMID:20411678

Social anxiety in the general population: introducing abbreviated versions of SIAS and SPS.

Science.gov (United States)

Kupper, Nina; Denollet, Johan

2012-01-01

Social anxiety is characterized by the experience of stress, discomfort and fear in social situations, and is associated with substantial personal and societal burden. Two questionnaires exist that assess the aspects of social anxiety, i.e. social interaction anxiety (SIAS) and social phobia (SPS). There is no agreement in literature on the dimensionality of social anxiety. Further, the length of a questionnaire may negatively affect response rates and participation at follow-up occasions. To explore the structure of social anxiety in the general population, and to examine psychosocial and sociodemographic correlates. Our second aim was to construct abbreviated versions of SIAS and SPS that can be easily used and with minimal burden. A total of 1598 adults from the general Dutch population completed a survey asking information on social anxiety, mood and demographics. Exploratory and confirmatory factor analyses as well as reliability analysis with item-total statistics were performed. Confirmatory factor analysis revealed a 3-factor structure for social phobia, and a 2-factor structure for the SIAS, with the second factor containing both reversely scored items. The abbreviated versions of SPS (11 items) and SIAS (10 items) show excellent discriminant and construct validity (Cronbach's α=.90 and .92), while specificity analysis showed that gender, marital status and educational level (SIAS(10): pSIAS, reducing the questionnaire burden for participants in epidemiological and biobehavioral research. Copyright © 2011 Elsevier B.V. All rights reserved.

Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India.

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Victoria Walsh

2016-08-01

Full Text Available Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF, and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor.A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036 of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1-99. Early lymphedema (Dreyer stages 1 & 2 was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4-7. Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15-29 (aPR: 3.21, 95% CI 2.45, 4.21. The number of adenolymphangitis (ADL episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97-7.30. This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India.These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.

Clinical and Economic Burden of Revision Knee Arthroplasty

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Mohit Bhandari

2012-01-01

Full Text Available Surgery is indicated for symptomatic knee osteoarthritis (OA when conservative measures are unsuccessful. High tibial osteotomy (HTO, unicompartmental knee arthroplasty (UKA, and total knee arthroplasty (TKA are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.

Nosocomial infections among acute leukemia patients in China: An economic burden analysis.

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Wu, Xiaohui; Yan, Tianyuan; Liu, Yunhong; Wang, Jingna; Li, Yingxia; Wang, Shuhui

2016-10-01

The economic burden associated nosocomial infections (NIs) in patients with acute leukemia (AL) in China was unclear. A prospective study was conducted to quantify the medical cost burden of NIs among AL patients. Nine hundred ninety-four patients diagnosed with AL between January 2011 and December 2013 were included. Relevant necessary information was extracted from the hospital information system and hospital infection surveillance system. The primary outcome was incidence of NIs and the secondary was economic burden results, including extra medical costs and prolonged length of stay (LOS). We estimated the total incremental cost of NIs by comparing all-cause health care costs in patients with versus without infections. Prolonged duration of stay was compared in patients with different infections. Of 994 patients with AL, 277 (27.9%) experienced NIs. NI was associated with a total incremental cost of $3,092 per patient ($5,227 vs $2,135; P economic burden on patients with AL. The study highlights the influence of NIs on LOS and health care costs and appeal to the establishment of prophylactic measures for NIs to reduce the unnecessary waste of medical resources in the long run. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review

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Ashwini M. Namasivayam-MacDonald

2018-06-01

Full Text Available With the rapid increase in the elderly population, there is a simultaneous increased need for care provided by family caregivers. Research in the field of head and neck cancer has indicated that caring for patients with dysphagia can impact a caregiver’s quality of life. Given that many older adults present with dysphagia, one can assume that their caregivers are equally, if not more greatly, affected. The purpose of this systematic review was to examine all relevant literature regarding the caregiver burden in caregivers of community-dwelling older adults with dysphagia. A review of relevant studies published through April 2018 was conducted using search terms related to dysphagia, caregiver burden, and older adults. The search yielded 2331 unique abstracts. Of the 176 abstracts that underwent full review, four were accepted. All reported an increase in caregiver burden due to presence of dysphagia in care recipients. Worsening feeding-related behaviors were associated with burden, and the use of feeding tubes was more frequently associated with “heavy burden”. The presence of dysphagia in community-dwelling older adults is a factor leading to an increased burden among caregivers. Although aspects of dysphagia play a role in the caregiver burden, the specific reasons for the increased burden are unknown. Clinicians should be aware of dysphagia as a source of the burden, and future studies should further define the relationship between dysphagia and the caregiver burden in order to develop comprehensive approaches to care.

Burden of disease from road traffic and railway noise - a quantification of healthy life years lost in Sweden.

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Eriksson, Charlotta; Bodin, Theo; Selander, Jenny

2017-11-01

Objectives National quantifications of the health burden related to traffic noise are still rare. In this study, we use disability-adjusted life-years (DALY) measure to assess the burden of disease from road traffic and railway noise in Sweden. Methods The number of DALY was assessed for annoyance, sleep disturbance, hypertension, myocardial infarction (MI) and stroke using a method previously implemented by the World Health Organization (WHO). Population exposure to noise was obtained from the Swedish Environmental Protection Agency and the Swedish Transport Administration. Data on disease occurrence were gathered from registers held by the National Board of Health and Welfare and Statistics Sweden. Disability weights (DW) and duration were based on WHO definitions. Finally, we used research-based exposure-response functions or relative risks to estimate disease attributable to noise in each exposure category. Results The number of DALY attributed to traffic noise in Sweden was estimated to be 41 033 years; 36 711 (90%) related to road traffic and 4322 (10%) related to railway traffic. The most important contributor to the disease burden was sleep disturbances, accounting for 22 218 DALY (54%), followed by annoyance, 12 090 DALY (30%), and cardiovascular diseases, 6725 DALY (16%). Conclusions Road traffic and railway noise contribute significantly to the burden of disease in Sweden each year. The total number of DALY should, however, be interpreted with caution due to limitations in data quality.

Air Pollution, Disease Burden, and Health Economic Loss in China.

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Niu, Yue; Chen, Renjie; Kan, Haidong

2017-01-01

As the largest developing country in the world, China is now facing one of the severest air pollution problems. The objective of this section is to evaluate the disease burden and corresponding economic loss attributable to ambient air pollution in China. We reviewed a series of studies by Chinese or foreign investigators focusing on the disease burden and economic loss in China. These studies showed both the general air pollution and haze episodes have resulted in substantial disease burden in terms of excess number of premature deaths, disability-adjusted life-year loss, and years of life lost. The corresponding economic loss has accounted for an appreciable proportion of China's national economy. Overall, the disease burden and health economic loss due to ambient air pollution in China is greater than in the remaining parts of the world, for one of the highest levels of air pollution and the largest size of exposed population. Consideration of both health and economic impacts of air pollution can facilitate the Chinese government to develop environmental policies to reduce the emissions of various air pollutants and protect the public health.

Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review.

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Hoque, Mohammad Enamul; Mannan, Munim; Long, Kurt Z; Al Mamun, Abdullah

2016-04-01

To assess the economic burden of underweight and overweight among adults in the Asia-Pacific region. Systematic review of articles published until March 2015. Seventeen suitable articles were found, of which 13 assess the economic burden of overweight/obesity and estimate that it accounts for 1.5-9.9% of a country's total healthcare expenditure. Four articles on the economic burden of underweight estimate it at 2.5-3.8% of the country's total GDP. Using hospital data, and compared to normal weight individuals, four articles estimated extra healthcare costs for overweight individuals of 7-9.8% and more, and extra healthcare costs for obese individuals of 17-22.3% and higher. Despite methodological diversity across the studies, there is a consensus that both underweight and overweight impose a substantial financial burden on healthcare systems in the Asia-Pacific region. © 2016 John Wiley & Sons Ltd.

The Burden and Impact of Vertigo: Findings from the REVERT Patient Registry

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Benecke, Heike; Agus, Sam; Kuessner, Daniel; Goodall, Gordon; Strupp, Michael

2013-01-01

Objective: Despite the high prevalence of vertigo globally and an acknowledged, but under-reported, effect on an individual’s wellbeing, few studies have evaluated the burden on healthcare systems and society. This study was aimed to quantitatively determine the impact of vertigo on healthcare resource use and work productivity. Methods: The economic burden of vertigo was assessed through a multi-country, non-interventional, observational registry of vertigo patients: the Registry to Evaluate the Burden of Disease in Vertigo. Patients included were those with a new diagnosis of Meniere’s disease, benign paroxysmal positional vertigo, other vertigo of peripheral vestibular origin, or peripheral vestibular vertigo of unknown origin. Results: A total of 4,294 patients at 618 centers in 13 countries were included during the registry. Of the 4,105 patients analyzed, only half were in employment. Among this working patient population, 69.8% had reduced their workload, 63.3% had lost working days, and 4.6% had changed and 5.7% had quit their jobs, due to vertigo symptoms. Use of healthcare services among patients was high. In the 3 months preceding Visit 1, patients used emergency services 0.4 ± 0.9 times, primary care consultations 1.6 ± 1.8 times, and specialist consultations 1.4 ± 2.0 times (all mean ± SD). A mean of 2.0 ± 5.4 days/patient was also spent in hospital due to vertigo. Conclusion: In addition to the negative impact on the patient from a humanistic perspective, vertigo has considerable impact on work productivity and healthcare resource use. PMID:24106487

The burden and impact of vertigo: findings from the REVERT patient registry

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Heike eBenecke

2013-10-01

Full Text Available Objective: Despite the high prevalence of vertigo globally and an acknowledged, but underreported, effect on an individual’s wellbeing, few studies have evaluated the burden on healthcare systems and society. This study was aimed to quantitatively determine the impact of vertigo on healthcare resource use and work productivity. Methods: The economic burden of vertigo was assessed through a multi-country, non-interventional, observational registry of vertigo patients: the Registry to Evaluate the Burden of Disease in Vertigo (REVERT. Patients included were those with a new diagnosis of Meniere’s disease (MD, benign paroxysmal positional vertigo (BPPV, other vertigo of peripheral vestibular origin or peripheral vestibular vertigo of unknown origin. Results: A total of 4,294 patients at 618 centers in 13 countries were included during the registry. Of the 4,105 patients analyzed, only half were in employment. Among this working patient population, 69.8% had reduced their workload, 63.3% had lost working days and 4.6% had changed and 5.7% had quit their jobs, due to vertigo symptoms. Use of healthcare services among patients was high. In the 3 months preceding Visit 1, patients used emergency services 0.4 ± 0.9 times, primary care consultations 1.6 ± 1.8 times and specialist consultations 1.4 ± 2.0 times (all mean ± SD. A mean of 2.0 ± 5.4 days/patient was also spent in hospital due to vertigo.Conclusions: In addition to the negative impact on the patient from a humanistic perspective, vertigo has considerable impact on work productivity and healthcare resource use.

The economic burden of type 2 diabetes mellitus in rural southwest China.

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Le, Cai; Lin, Li; Jun, Dong; Jianhui, He; Keying, Zhao; Wenlong, Cui; Ying, Song; Tao, Wei

2013-05-10

This study was conducted in order to estimate the economic burden of diabetes in a given year in rural Yunnan province of China, including direct, indirect and intangible costs. A cross-sectional survey was conducted in rural southwest China in early 2011 among 9396 consenting individuals aged ≥ 18 years. Information on participants' demographic characteristics, and economic consequences and related aspects of diabetes were obtained using a standard questionnaire. Fasting blood sugar level was also measured for each individual. Years of life lost (YLL) due to diabetes was estimated using medical death certificates. A prevalence-based cost-of-illness method was used to estimate the economic burden of diabetes. The overall prevalence and YLL of diabetes was 6.5% and 1168.1 years in the study population, respectively. Total cost of illness related to diabetes was estimated to be $46.8 million. Mean unit direct medical costs, direct non-medical costs, morbidity costs, mortality costs, intangible costs, and cost of illness were $863.2, $44.6, $59.7, $7797.7, $936.2, and $9686.6, respectively. Direct costs accounted for the largest proportion of the economic costs of diabetes. Age was positively associated with direct costs whereas negatively associated with indirect costs. Patients aged 45-59 years incurred the highest intangible costs. Both indirect and intangible costs increased with level of education. Diabetes is a major public health problem in terms of morbidity and economic burden in rural southwest China. The region should increase investment in the further control of diabetes, and improvement of patient quality of life. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Estimation of 137Cs body burden in Japanese, 2

International Nuclear Information System (INIS)

Uchiyama, Masashi

1978-01-01

The biological half-life of 137 Cs in the total body of human subjects was determined in 23 individuals of Japanese male adult in their normal works by measuring amount of 137 Cs in both their total body and daily urine in the same period. For the group, the value was determined by averaging the half-lives for individuals, by comparing the mean body burden and the mean daily urinary excretion, or by applying a curve fitting method to the body burden estimate. The biological half-life averaged 86 days, ranging from 50 to 161 days. The averages of the biological half-lives for the group were 83, 87 and 82 days in the different periods of observation. By the curve fitting method, 85 days was found for the group. The biological half-life for the individuals depended on both body weight and age, to a lesser extent, of the subjects. (author)

What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women.

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Agarwal, Arnav; Eryuzlu, Leyla N; Cartwright, Rufus; Thorlund, Kristian; Tammela, Teuvo L J; Guyatt, Gordon H; Auvinen, Anssi; Tikkinen, Kari A O

2014-06-01

No study has compared the bothersomeness of all lower urinary tract symptoms (LUTS) using a population-based sample of adults. Despite this lack of evidence, investigators have often cited their LUTS of interest as the "most bothersome" or "one of the most bothersome." To compare the population- and individual-level burden of LUTS in men and women. In this population-based cross-sectional study, questionnaires were mailed to 6000 individuals (18-79 yr of age) randomly identified from the Finnish Population Register. The validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS. The age-standardized prevalence of at least moderate bother was calculated for each symptom (population-level burden). Among symptomatic individuals, the proportion of affected individuals with at least moderate bother was calculated for each symptom (individual-level bother). A total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%), postmicturition dribble (5.8%), and urgency urinary incontinence (UUI) (5.0%). Burden from incontinence symptoms was higher in women than men, and the opposite was true for voiding and postmicturition symptoms. At the individual level, UUI was the most bothersome for both genders. Although the response proportion was high, approximately a third did not participate. Both men and women with UUI report moderate or major bother more frequently than individuals with other LUTS. At the population level, the most prevalent bothersome symptoms are urgency, SUI, and nocturia. Urinary urgency was the most common troubling symptom in a large population-based study; however, for individuals, urgency incontinence was the most likely to be rated as bothersome. Copyright © 2014 European Association of Urology. All rights reserved.

Multiparameter analysis of fall-out plutonium burdens in human liver

International Nuclear Information System (INIS)

Griffith, W.C.; Guilmette, R.A.

1991-01-01

The effect of multiple factors on Pu liver burdens is estimated for a group of 310 people who were selected to have relative uniform exposure to fall-out plutonium ( 239 Pu plus 240 Pu), based on age in 1952, the start of atmospheric testing of thermonuclear weapons, and based on residence history in eastern Colorado, where they died between 1975 and 1979. The data were analysed using multiple linear regression of the logarithm of the total liver plutonium burden on other available covariates. The results of the regression indicated that the liver burden was increased by 34% in very heavy smokers (100 pack year history) compared to non-smokers, decreased by 27% in females compared to males, decreased by 24% in people with a neoplasm in the liver compared to those without a neoplasm, and decreased by 64% in people with cirrhosis compared to those without cirrhosis. However, all of those parameters accounted for only 26% of the variability in liver burdens observed among these people, indicating that there remains a large unexplained variation. (author)

Psychometric Properties of the Turkish Version of Caregiver Burden Index (CBI) for Parents of Children with Allergies.

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Ekim, Ayfer; Hecan, Melis; Oren, Serkan

Childhood chronic diseases have a great impact, including physiological, social and financial burdens, on parents. The concept of "caregiver burden" is gaining importance to understand the effects of allergic diseases and plan family-centered strategies. The purpose of this study was to examine the psychometric properties of the Caregiver Burden Index (CBI) in Turkish mothers of children with allergies. The participants of this methodological study were 213 mothers of children with allergies between 6 and 12years. Construct validity was evaluated through factor analysis and reliability was evaluated through internal consistency and item-total correlation. In reliability analysis, the overall Cronbach's alpha value (0.85) demonstrated a high level of reliability. The corrected item-total correlation varied between 0.63 and 0.84. In exploratory factor analysis, it was detected that 3 factors structure explained 73.6% of the total variance. This study indicated that the CBI is a valid and reliable tool to assess the caregiver burden of mothers of Turkish children with allergies. The results of this study contribute to the development and implementation of evidence based models of care that address the caregiver burden needs of parents whose children have allergies. Copyright © 2017 Elsevier Inc. All rights reserved.

High perceived caregiver burden for relatives of patients following hip fracture surgery

DEFF Research Database (Denmark)

Ariza-Vega, Patrocinio; Ortiz-Piña, Mariana; Kristensen, Morten Tange

2018-01-01

treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing...... her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture......PURPOSE: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery. METHODS: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed...

Estimating the burden of rabies in Ethiopia by tracing dog bite victims.

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Tariku Jibat Beyene

Full Text Available In developing countries where financial resources are limited and numerous interests compete, there is a need for quantitative data on the public health burden and costs of diseases to support intervention prioritization. This study aimed at estimating the health burden and post-exposure treatment (PET costs of canine rabies in Ethiopia by an investigation of exposed human cases. Data on registered animal bite victims during the period of one year were collected from health centers in three districts, i.e. Bishoftu, Lemuna-bilbilo and Yabelo, to account for variation in urban highland and lowland areas. This data collection was followed by an extensive case search for unregistered victims in the same districts as the registered cases. Victims were visited and questioned on their use of PET, incurred treatment costs and the behavioral manifestations of the animal that had bitten them. Based on the collected data PET costs were evaluated by financial accounting and the health burden was estimated in Disability-Adjusted Life Years (DALYs. In total 655 animal bite cases were traced of which 96.5% was caused by dog bites. 73.6% of the biting dogs were suspected to be potentially rabid dog. Annual suspected rabid dog exposures were estimated per evaluated urban, rural highland and rural lowland district at, respectively, 135, 101 and 86 bites, which led, respectively, to about 1, 4 and 3 deaths per 100,000 population. In the same district order average costs per completed PET equaled to 23, 31 and 40 USD, which was significantly higher in rural districts. Extrapolation of the district results to the national level indicated an annual estimate of approximately 3,000 human deaths resulting in about 194,000 DALYs per year and 97,000 exposed persons requiring on average 2 million USD treatment costs per year countrywide. These estimations of the burden of rabies to the Ethiopian society provide decision makers insights into the potential benefits of

Estimating the burden of rabies in Ethiopia by tracing dog bite victims.

Science.gov (United States)

Beyene, Tariku Jibat; Mourits, Monique C M; Kidane, Abraham Haile; Hogeveen, Henk

2018-01-01

In developing countries where financial resources are limited and numerous interests compete, there is a need for quantitative data on the public health burden and costs of diseases to support intervention prioritization. This study aimed at estimating the health burden and post-exposure treatment (PET) costs of canine rabies in Ethiopia by an investigation of exposed human cases. Data on registered animal bite victims during the period of one year were collected from health centers in three districts, i.e. Bishoftu, Lemuna-bilbilo and Yabelo, to account for variation in urban highland and lowland areas. This data collection was followed by an extensive case search for unregistered victims in the same districts as the registered cases. Victims were visited and questioned on their use of PET, incurred treatment costs and the behavioral manifestations of the animal that had bitten them. Based on the collected data PET costs were evaluated by financial accounting and the health burden was estimated in Disability-Adjusted Life Years (DALYs). In total 655 animal bite cases were traced of which 96.5% was caused by dog bites. 73.6% of the biting dogs were suspected to be potentially rabid dog. Annual suspected rabid dog exposures were estimated per evaluated urban, rural highland and rural lowland district at, respectively, 135, 101 and 86 bites, which led, respectively, to about 1, 4 and 3 deaths per 100,000 population. In the same district order average costs per completed PET equaled to 23, 31 and 40 USD, which was significantly higher in rural districts. Extrapolation of the district results to the national level indicated an annual estimate of approximately 3,000 human deaths resulting in about 194,000 DALYs per year and 97,000 exposed persons requiring on average 2 million USD treatment costs per year countrywide. These estimations of the burden of rabies to the Ethiopian society provide decision makers insights into the potential benefits of implementing effective

Estimation of lung cancer burden in Australia, the Philippines, and Singapore: an evaluation of disability adjusted life years.

Science.gov (United States)

Morampudi, Suman; Das, Neha; Gowda, Arun; Patil, Anand

2017-02-01

Lung cancer is one of the leading cancers and major causes of cancer mortality worldwide. The economic burden associated with the high mortality of lung cancer is high, which accounts for nearly $180 billion on a global scale in 2008. This paper aims to understand the economic burden of lung cancer in terms of disability adjusted life years (DALY) in Australia, the Philippines, and Singapore. The years of life lost (YLL) and years lost due to disability (YLD) were calculated using the formula developed by Murray and Lopez in 1996 as part of a comprehensive assessment of mortality and disability for diseases, injuries and risk factors in 1990 and projected to 2020. The same formula is represented in the Global Burden of Disease template provided by the World Health Organization. Appropriate assumptions were made when data were unavailable and projections were performed using regression analysis to obtain data for 2015. The total DALYs due to lung cancer in Australia, the Philippines, and Singapore were 91,695, 38,584, and 12,435, respectively, and the corresponding DALY rates per a population of 1,000 were 4.0, 0.4, and 2.2, respectively, with a discount rate of 3%. When researchers calculated DALYs without the discount rate, the burden of disease increased substantially; the DALYs were 117,438 in Australia, 50,977 in the Philippines, and 16,379 in Singapore. Overall, YLL or premature death accounted for more than 95% of DALYs in these countries. Strategies for prevention, early diagnosis, and prompt treatment must be devised for diseases where the major burden is due to mortality.

The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families.

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Burke, Rachel M; Rebolledo, Paulina A; Embrey, Sally R; Wagner, Laura Danielle; Cowden, Carter L; Kelly, Fiona M; Smith, Emily R; Iñiguez, Volga; Leon, Juan S

2013-08-02

Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (pcosts to families were significantly higher for inpatients as compared to outpatients of urban (pcosts made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

Economic cost and burden of dengue during epidemics and non-epidemic years in Taiwan

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Dih-Ling Luh

2018-03-01

Full Text Available Background: Determining the disease and economic burden of dengue is critical for the allocation of public health resources. Several studies have used disability-adjusted life-years (DALYs to estimate the disease burden of dengue in different regions. However, there are no published studies discussing the estimates of dengue-related economic and disease burden specifically in Taiwan. Objectives: We assessed the economic cost and disease burden of dengue infections in Taiwan for the period 1998–2014, and compared these during epidemic and non-epidemic years. Methods: We estimated the annual DALYs per million population using the disability weights for dengue fever (DF, dengue hemorrhagic fever (DHF, dengue shock syndrome (DSS, and death cases. Economic costs were estimated and divided into direct (medical costs and indirect costs (lost work days and caregiver fees. Results: For the period 1998–2014, a mean of 115.3 (range: 6.3–934.3 DALYs per million population annually were lost to dengue. In epidemic years, direct costs associated with dengue resulted mostly from hospitalization (86.09%, emergency (7.77%, outpatient (6.10%, and drug costs (0.03%. For indirect costs, lost productivity due to death (70.76% was the dominant contributor. Overall, the costs were 12.3 times higher in epidemic years than in non-epidemic years (Wilcoxon rank sum test, p < 0.05. Conclusions: This study is the first to evaluate the economic costs and disease burden of dengue infections for this period in Taiwan, and reveals significant differences in economic impact between epidemic and non-epidemic years. Keywords: Economic cost of disease, Disease burden, Disability-adjusted life years (DALYs, Dengue, Epidemic

Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

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Bordonaba-Bosque Daniel

2011-06-01

Full Text Available Abstract Background There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain. Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®. Results The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p Conclusions Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.

Dealing with uncertainties in environmental burden of disease assessment

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van der Sluijs Jeroen P

2009-04-01

Full Text Available Abstract Disability Adjusted Life Years (DALYs combine the number of people affected by disease or mortality in a population and the duration and severity of their condition into one number. The environmental burden of disease is the number of DALYs that can be attributed to environmental factors. Environmental burden of disease estimates enable policy makers to evaluate, compare and prioritize dissimilar environmental health problems or interventions. These estimates often have various uncertainties and assumptions which are not always made explicit. Besides statistical uncertainty in input data and parameters – which is commonly addressed – a variety of other types of uncertainties may substantially influence the results of the assessment. We have reviewed how different types of uncertainties affect environmental burden of disease assessments, and we give suggestions as to how researchers could address these uncertainties. We propose the use of an uncertainty typology to identify and characterize uncertainties. Finally, we argue that uncertainties need to be identified, assessed, reported and interpreted in order for assessment results to adequately support decision making.

Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy

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Poli A

2015-11-01

Full Text Available Anna Poli,1 Sergio Di Matteo,2 Giacomo M Bruno,2 Enrica Fornai,1 Maria Chiara Valentino,2 Giorgio L Colombo2,31Vigilanza e Controllo Infezioni Correlate all'Assistenza, Ospedale Piero Palagi, Azienda Sanitaria di Firenze, Firenze, Italy; 2SAVE Studi – Health Economics and Outcomes Research, Milan, Italy; 3Department of Drug Sciences, University of Pavia, Pavia, ItalyIntroduction: Despite the awareness about the increasing rates of Clostridium difficile infection (CDI and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation, few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication.Methods: We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI.Results: We enrolled 69 patients (19 males and 50 females, with a mean age of 82.16 years (minimum 46 to maximum 98. The total number of hospitalization days observed was 886 (12.8 per patient on average. The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature.Conclusion: The economic impact of CDI is most

Burden of total and cause-specific mortality related to tobacco smoking among adults aged ≥ 45 years in Asia: a pooled analysis of 21 cohorts.

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Wei Zheng

2014-04-01

Full Text Available Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest.We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan-accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37-1.51 and 1.48-fold (1.38-1.58 elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%-17.2% and 3.3% (2.6%-4.0% of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000-1,744,700. Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y.Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented. Please see later in the article for

The heterogeneity in financial and time burden of caregiving to children with chronic conditions.

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Zan, Hua; Scharff, Robert L

2015-03-01

We examine the financial and time burdens associated with caring for children with chronic conditions, focusing on disparities across types of conditions. Using linked data from the 2003 to 2006 National Health Interview Survey and 2004-2008 Medical Expenditure Panel Survey, we created measures of financial burden (out-of-pocket healthcare costs, the ratio of out-of-pocket healthcare costs to family income, healthcare costs paid by insurance, and total healthcare costs) and time burden (missed school time due to illness or injury and the number of doctor visits) associated with 14 groups of children's chronic conditions. We used the two-part model to assess the effect of condition on financial burden and finite mixture/latent class model to analyze the time burden of caregiving. Controlling for the influences of other socio-demographic characteristics on caregiving burden, children with chronic conditions have higher financial and time burdens relative to caregiving burdens for healthy children. Levels of financial burden and burden sharing between families and insurance system also vary by type of condition. For example, children with pervasive developmental disorder or heart disease have a relatively low financial burden for families, while imposing a high cost on the insurance system. In contrast, vision difficulties are associated with a high financial burden for families relative to the costs borne by others. With respect to time burden, conditions such as cerebral palsy and heart disease impose a low time burden, while conditions such as pervasive developmental disorder are associated with a high time burden. This study demonstrates that differences exist in caregiving burden for children by type of chronic condition. Each condition has a unique profile of time and financial cost burden for families and the insurance system. These results have implications for policymakers and for families' savings and employment decisions.

Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context.

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Toth, Peter P; Danese, Mark; Villa, Guillermo; Qian, Yi; Beaubrun, Anne; Lira, Armando; Jansen, Jeroen P

2017-06-01

To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population. Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into four cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (n = 1448), acute coronary syndrome (ACS) (n = 602), ischemic stroke (IS) (n = 151), and heart failure (HF) (n = 291) incident cohorts. The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considered CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), i.e. CTTC relationship. Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk prevalent ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high-risk ASCVD patients with a new CV event during follow-up had a subsequent CV event. Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9,341-$14,833) to $16,856 ($12,903-$20,678) in ASCVD patients with baseline LDL-C levels ≥70 mg/dL and ≥100 mg/dL, respectively. Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed

Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015.

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Cohen, Aaron J; Brauer, Michael; Burnett, Richard; Anderson, H Ross; Frostad, Joseph; Estep, Kara; Balakrishnan, Kalpana; Brunekreef, Bert; Dandona, Lalit; Dandona, Rakhi; Feigin, Valery; Freedman, Greg; Hubbell, Bryan; Jobling, Amelia; Kan, Haidong; Knibbs, Luke; Liu, Yang; Martin, Randall; Morawska, Lidia; Pope, C Arden; Shin, Hwashin; Straif, Kurt; Shaddick, Gavin; Thomas, Matthew; van Dingenen, Rita; van Donkelaar, Aaron; Vos, Theo; Murray, Christopher J L; Forouzanfar, Mohammad H

2017-05-13

Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM 2·5 ) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure-response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure-response functions spanning the global range of exposure. Ambient PM 2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM 2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM 2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000-422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will

Daily total physical activity level and total cancer risk in men and women: results from a large-scale population-based cohort study in Japan.

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Inoue, Manami; Yamamoto, Seiichiro; Kurahashi, Norie; Iwasaki, Motoki; Sasazuki, Shizuka; Tsugane, Shoichiro

2008-08-15

The impact of total physical activity level on cancer risk has not been fully clarified, particularly in non-Western, relatively lean populations. The authors prospectively examined the association between daily total physical activity (using a metabolic equivalents/day score) and subsequent cancer risk in the Japan Public Health Center-based Prospective Study. A total of 79,771 general-population Japanese men and women aged 45-74 years who responded to a questionnaire in 1995-1999 were followed for total cancer incidence (4,334 cases) through 2004. Compared with subjects in the lowest quartile, increased daily physical activity was associated with a significantly decreased risk of cancer in both sexes. In men, hazard ratios for the second, third, and highest quartiles were 1.00 (95% confidence interval (CI): 0.90, 1.11), 0.96 (95% CI: 0.86, 1.07), and 0.87 (95% CI: 0.78, 0.96), respectively (p for trend = 0.005); in women, hazard ratios were 0.93 (95% CI: 0.82, 1.05), 0.84 (95% CI: 0.73, 0.96), and 0.84 (95% CI: 0.73, 0.97), respectively (p for trend = 0.007). The decreased risk was more clearly observed in women than in men, especially among the elderly and those who regularly engaged in leisure-time sports or physical exercise. By site, decreased risks were observed for cancers of the colon, liver, and pancreas in men and for cancer of the stomach in women. Increased daily physical activity may be beneficial in preventing cancer in a relatively lean population.

Chromosome breakage in lymphocytes from humans with body burdens of 226Ra

International Nuclear Information System (INIS)

Hoegerman, S.F.; Cummins, H.T.; Bronec, J.F.

1976-01-01

Peripheral lymphocytes from 10 controls and 40 patients with body burdens of 226 Ra ranging from below the limit of detection to 8.6 μCi were scored for unstable chromosome aberrations. The patient population was divided into four groups: a group with body burdens below the limit of detection (less than 0.003 μCi, 12 patients); a low-burden group (0.003 to 0.099 μCi, 13 patients); a moderate-burden group (0.1 to 0.99 μCi, 11 patients); and a high-burden group (greater than 1.0 μCi, 4 patients). In none of these groups was the frequency of cells with unstable aberrations significantly elevated above that in the controls. The rate of occurrence of dicentric and ring chromosomes was above the control frequency in only the two patients with the highest burdens (3.55 and 8.6 μCi). Our results are consistent with the expectation derived from a recent calculation of alpha dose delivered to blood by bone-deposited radium and its decay products. Marshall and Hoegerman have estimated that the blood dose for an individual with a radium burden of 1.0 μCi is 0.09 +- 0.03 rad/year. The value is compared with the dose estimate used by Boyd et al. in their study of British radium-dial painters, and the relevance of the blood dose to the lymphocyte dose is discussed

The use of mussel PAH burdens to assess bioavailability and long-term risk to wildlife following the Exxon Valdez oil spill

International Nuclear Information System (INIS)

Mankiewicz, P.J.; Boehm, P.D.; Neff, J.

1993-01-01

Mussels (Mytilus edulis) were collected as part of shoreline studies following the Exxon Valdez oil spill and analyzed for polycyclic aromatic hydrocarbons (PAH). Data from sites monitored through 1991 in Prince William Sound indicate tissue PAH burdens decreasing over an order of magnitude per year and near levels observed at control sites by the summer of 1991. The distribution of PAH analyses in the tissue shows extensive weathering of the oil and is similar to the pattern observed in adjacent sediments. This similarity in PAH fingerprints suggests mussel accumulation of oil particulates rather than dissolved aromatics. Analyses indicate that the highest PAH concentrations in mussels are at least an order of magnitude below levels known to cause reproductive effects in wildlife. Evaluation of the abundance of mussels in Prince William Sound indicate that the impacted mussels are a small fraction of the total mussel population. Considering the above and that mussels generally comprise a small fraction of total diet, there is little long-term risk to wildlife from the consumption of mussels. These results will be placed in context to a 1993 survey of mussel tissue burdens in Prince William Sound

Mindfulness as a Protective Factor for the Burden of Caregivers of Amyotrophic Lateral Sclerosis Patients.

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Pagnini, Francesco; Phillips, Deborah; Bosma, Colin M; Reece, Andrew; Langer, Ellen

2016-01-01

Caregivers of people with severe chronic conditions, such as amyotrophic lateral sclerosis (ALS), are at risk of developing depression and anxiety and reduced quality of life. Few studies have explored protective factors in this population and none investigated the role of mindfulness. The study aimed to examine the relationship between mindfulness and health-related outcomes in a population of ALS caregivers. We conducted an online survey with ALS caregivers, and again at 4-month follow-up, to assess mindfulness, burden, quality of life, anxiety, and depression. The associations between mindfulness and the other outcomes were evaluated both cross-sectionally and longitudinally. Mindfulness correlated negatively with burden, depression, and anxiety and positively with quality of life, maintaining stability through time. Our results showed that mindfulness is positively related to quality of life and negatively related to level of burden. We suggest that this construct can represent a preventative factor toward the negative effects of caregiving. © 2015 Wiley Periodicals, Inc.

Burden of celiac disease in the Mediterranean area.

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Greco, Luigi; Timpone, Laura; Abkari, Abdelhak; Abu-Zekry, Mona; Attard, Thomas; Bouguerrà, Faouzi; Cullufi, Paskal; Kansu, Aydan; Micetic-Turk, Dusanka; Mišak, Zrinjka; Roma, Eleftheria; Shamir, Raanan; Terzic, Selma

2011-12-07

To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost. For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries. In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550,000 symptomatic adults and about 240,000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600,000 celiac patients will die in

Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years

NARCIS (Netherlands)

Torgerson, Paul R.; Hagan, José E.; Costa, Federico; Calcagno, Juan; Kane, Michael; Martinez-Silveira, Martha S.; Goris, Marga G. A.; Stein, Claudia; Ko, Albert I.; Abela-Ridder, Bernadette

2015-01-01

Background Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in

Estimating the disease burden of methicillin-resistant Staphylococcus aureus in Japan: Retrospective database study of Japanese hospitals.

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Hironori Uematsu

Full Text Available The nationwide impact of antimicrobial-resistant infections on healthcare facilities throughout Japan has yet to be examined. This study aimed to estimate the disease burden of methicillin-resistant Staphylococcus aureus (MRSA infections in Japanese hospitals.Retrospective analysis of inpatients comparing outcomes between subjects with and without MRSA infection.A nationwide administrative claims database.1133 acute care hospitals throughout Japan.All surgical and non-surgical inpatients who were discharged between April 1, 2014 and March 31, 2015.Disease burden was assessed using hospitalization costs, length of stay, and in-hospital mortality. Using a unique method of infection identification, we categorized patients into an anti-MRSA drug group and a control group based on anti-MRSA drug utilization. To estimate the burden of MRSA infections, we calculated the differences in outcome measures between these two groups. The estimates were extrapolated to all 1584 acute care hospitals in Japan that have adopted a prospective payment system.We categorized 93 838 patients into the anti-MRSA drug group and 2 181 827 patients into the control group. The mean hospitalization costs, length of stay, and in-hospital mortality of the anti-MRSA drug group were US$33 548, 75.7 days, and 22.9%, respectively; these values were 3.43, 2.95, and 3.66 times that of the control group, respectively. When extrapolated to the 1584 hospitals, the total incremental burden of MRSA was estimated to be US$2 billion (3.41% of total hospitalization costs, 4.34 million days (3.02% of total length of stay, and 14.3 thousand deaths (3.62% of total mortality.This study quantified the approximate disease burden of MRSA infections in Japan. These findings can inform policymakers on the burden of antimicrobial-resistant infections and support the application of infection prevention programs.

Model calculation of radiocaesium transfer into food products in semi-natural forest ecosystems in the Czech Republic after a nuclear reactor accident and an estimate of the population dose burden

International Nuclear Information System (INIS)

Svadlenkova, M.; Konecny, J.; Smutny, V.

1996-01-01

Radioactivity of food products from semi-natural forest ecosystems can contribute appreciably to the radiological burden of the human population following a nuclear accident, as found after the Chernobyl disaster in 1986. In the Czech Republic, radiocaesium radioactivity has been measured, such as soil, mushrooms, bilberries, deer and boar. In this work, the data are employed to predict how a model accident of the Temelin nuclear power plant in southern Bohemia (which is under construction) would affect selected forest ecosystems in its surroundings. The dose commitment to the critical population group is also estimated. (author)

MORBIDITY AND MORTALITY DUE TO AIDS: A STUDY OF BURDEN OF DISEASE AT A MUNICIPAL LEVEL

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Jane DA SILVA

2015-10-01

Full Text Available Introduction: The purpose of measuring the burden of disease involves aggregating morbidity and mortality components into a single indicator, the disability-adjusted life year (DALY, to measure how much and how people live and suffer the impact of a disease. Objective: To estimate the global burden of disease due to AIDS in a municipality of southern Brazil. Methods: An ecological study was conducted in 2009 to examine the incidence and AIDS-related deaths among the population residing in the city of Tubarao, Santa Catarina State, Brazil. Data from the Mortality Information System in the National Health System was used to calculate the years of life lost (YLL due to premature mortality. The calculation was based on the difference between a standardized life expectancy and age at death, with a discount rate of 3% per year. Data from the Information System for Notifiable Diseases were used to calculate the years lived with disability (YLD. The DALY was estimated by the sum of YLL and YLD. Indicator rates were estimated per 100,000 inhabitants, distributed by age and gender. Results: A total of 131 records were examined, and a 572.5 DALYs were estimated, which generated a rate of 593.1 DALYs/100,000 inhabitants. The rate among men amounted to 780.7 DALYs/100,000, whereas among women the rate was 417.1 DALYs/100,000. The most affected age groups were 30-44 years for men and 60-69 years for women. Conclusion: The burden of disease due to AIDS in the city of Tubarao was relatively high when considering the global trend. The mortality component accounted for more than 90% of the burden of disease.

Burden of Serious Fungal Infections in Argentina

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Fernando O. Riera

2018-04-01

Full Text Available The number of fungal infections at any given time in Argentina is not known. Here we estimate the burden of serious fungal infections in Argentina for the first time. Specific population statistics were searched from multiple sources, local literature was identified, and estimates made. Some additional data were sourced from the Ministry of Health, the Global Initiative for Asthma (GINA program, and national haematology and transplant societies. Argentina has a population of 43.8 million, with 25% of this total being children under 15 years. The predicted candidemia annual incidence is 2193 cases, with 50% occurring in the ICU. At a 6% prevalence rate, an estimated 593,695 women suffer from recurrent vulvovaginal candidiasis. Invasive aspergillosis is relatively common because of high smoking and chronic obstructive pulmonary disease (COPD rates, with 268 cases in immunocompromised patients and another 1938 in the 168,000 COPD patients admitted to hospital. Asthma is also common, affecting 14% of adults, and so allergic bronchopulmonary aspergillosis (ABPA and severe asthma with fungal sensitization (SAFS are major problems. An estimated 432 cases of cryptococcal meningitis (CM—90% of them in AIDS patients—and 1177 cases of Pneumocystis pneumonia (PCP occur each year. The estimated annual case number of disseminated histoplasmosis is 404 in AIDS patients, almost as frequent as CM. Paracoccidioidomycosis annual incidence is estimated at 219, and coccidioidomycosis at 16 cases. At least 881,023 people (>2.01% in Argentina are affected by a serious fungal disease annually, with considerable morbidity and mortality.

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011

NARCIS (Netherlands)

van Lier, Alies; McDonald, Scott A; Bouwknegt, Martijn; Kretzschmar, Mirjam E; Havelaar, Arie H; Mangen, Marie-Josée J; Wallinga, Jacco; de Melker, Hester E

2016-01-01

BACKGROUND: Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first

The burden of rotavirus disease in Denmark 2009-2010

DEFF Research Database (Denmark)

Fischer, Thea Kølsen; Rungø, Christine; Jensen, Claus Sixtus

2011-01-01

BACKGROUND: This study sought to determine the incidence and the burden of severe diarrheal disease in Denmark with emphasis on rotavirus (RV) disease. METHODS: This study was designed as a national prospective disease surveillance of children gastroenteritis...... in Denmark during March 2009 to April 2010, using rapid RV and adenovirus antigen detection. RESULTS: A total of 3100 hospitalizations annually among Danish children gastroenteritis and 1210 (39%) of these to RV disease. The majority of RV...... demonstrated RV-associated hospitalizations throughout the year. Genotyping of a subset of RV-samples demonstrated high frequency of G1 (39%) and G4 (32%). Adenovirus was detected in 350 acute gastroenteritis-associated hospitalizations (11.2%). CONCLUSION: In conclusion, we present national disease burden...

Epidemiology, associated burden, and current clinical practice for the diagnosis and management of Alzheimer's disease in Japan.

Science.gov (United States)

Montgomery, William; Ueda, Kaname; Jorgensen, Margaret; Stathis, Shari; Cheng, Yuanyuan; Nakamura, Tomomi

2018-01-01

The burden of dementia in Japan is large and growing. With the world's fastest aging population, it is estimated that one in five elderly people will be living with dementia in Japan by 2025. The most common form of dementia is Alzheimer's disease (AD), accounting for around two-thirds of dementia cases. A systematic review was conducted to examine the epidemiology and associated burden of AD in Japan and to identify how AD is diagnosed and managed in Japan. English and Japanese language databases were searched for articles published between January 2000 and November 2015. Relevant Japanese sources, clinical practice guideline registers, and reference lists were also searched. Systematic reviews and cohort and case-control studies were eligible for inclusion, with a total of 60 studies included. The most recent national survey conducted in six regions of Japan reported the mean prevalence of dementia in people aged ≥65 years to be 15.75% (95% CI: 12.4, 22.2%), which is much higher than the previous estimated rate of 10% in 2010. AD was confirmed as the predominant type of dementia, accounting for 65.8% of all cases. Advancing age and low education were the most consistently reported risk factors for AD dementia. Japanese guidelines for the management of dementia were released in 2010 providing specific guidance for AD about clinical signs, image findings, biochemical markers, and treatment approaches. Pharmacotherapies and non-pharmacotherapies to relieve cognitive symptoms were introduced, as were recommendations to achieve better patient care. No studies reporting treatment patterns were identified. Due to population aging and growing awareness of AD in Japan, health care expenditure and associated burden are expected to soar. This review highlights the importance of early detection, diagnosis, and treatment of AD as strategies to minimize the impact of AD on society in Japan.

Useful indicators to interpret the cancer burden in Italy.

Science.gov (United States)

Vercelli, Marina; Quaglia, Alberto; Lillini, Roberto

2013-01-01

In the last decades the demographics of most Western countries have undergone a deep transformation, which has caused a steady increase in degenerative chronic diseases and has made maintaining health and social support by the welfare system difficult. This paper aims to present a set of indicators pertaining to the health status of the Italian population and to the national economic and social systems, as an aid to a better interpretation of the cancer burden impact and of its future tendencies. All indicators were derived from the ISTAT Health for All database. They were presented by region or macro area, globally or by gender, considering the most recent regional distribution and their time trends. The following features of the Italian population were chosen: percent of people aged over 65 years; life expectancy at birth; birth rate; crude and age-standardized overall mortality rates; dependency ratio; percent of single persons; percent of people with no more than a junior high school diploma; percent of people attaining at least the short first university degree; percent of people employed in the service and tertiary sectors; unemployment rate; incidence of poverty; total health expenditure (THE) as an absolute value and as percent of GDP; percent of public THE; percent of out-of-pocket THE of households; percent of smokers; proportion of overweight and obese people aged ≥18 years. Italy presented an unbalanced demographic situation with an increasingly old population, a decreasing middle-aged age group, a low birth rate, high crude overall mortality rates, and decreasing standardized overall mortality rates. The Italian population is characterized by a constant increase in the dependency ratio and in the percentage of people living alone, together with increasing expenses for health care, both at the public and households levels. Smoking has reduced its impact in men but not yet in women. The increasing proportion of overweight and obese people may explain

The size and burden of mental disorders and other disorders of the brain in Europe 2010.

Science.gov (United States)

Wittchen, H U; Jacobi, F; Rehm, J; Gustavsson, A; Svensson, M; Jönsson, B; Olesen, J; Allgulander, C; Alonso, J; Faravelli, C; Fratiglioni, L; Jennum, P; Lieb, R; Maercker, A; van Os, J; Preisig, M; Salvador-Carulla, L; Simon, R; Steinhausen, H-C

2011-09-01

, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century. Copyright © 2011. Published by Elsevier B.V.

Economic Burden of Pediatric Asthma: Annual Cost of Disease in Iran.

Science.gov (United States)

Sharifi, Laleh; Dashti, Raheleh; Pourpak, Zahra; Fazlollahi, Mohammad Reza; Movahedi, Masoud; Chavoshzadeh, Zahra; Soheili, Habib; Bokaie, Saied; Kazemnejad, Anoushiravan; Moin, Mostafa

2018-02-01

Asthma is the first cause of children hospitalization and need for emergency and impose high economic burden on the families and governments. We aimed to investigate the economic burden of pediatric asthma and its contribution to family health budget in Iran. Overall, 283 pediatric asthmatic patients, who referred to two tertiary pediatric referral centers in Tehran capital of Iran, included from 2010-2012. Direct and indirect asthma-related costs were recorded during one-year period. Data were statistically analyzed for finding association between the costs and factors that affect this cost (demographic variables, tobacco smoke exposure, control status of asthma and asthma concomitant diseases). Ninety-two (32.5%) females and 191(67.5%) males with the age range of 1-16 yr old were included. We found the annual total pediatrics asthma related costs were 367.97±23.06 USD. The highest cost belonged to the medications (69%) and the lowest one to the emergency (2%). We noticed a significant increasing in boys' total costs ( P =0.011), and 7-11 yr old age group ( P =0.018). In addition, we found significant association between total asthma costs and asthma control status ( P =0.011). The presence of an asthmatic child can consume nearly half of the health budget of a family. Our results emphasis on improving asthma management programs, which leads to successful control status of the disease and reduction in economic burden of pediatric asthma.

National Economic Burden Associated with Management of Periodontitis in Malaysia.

Science.gov (United States)

Mohd Dom, Tuti Ningseh; Ayob, Rasidah; Abd Muttalib, Khairiyah; Aljunid, Syed Mohamed

2016-01-01

Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted.

National Economic Burden Associated with Management of Periodontitis in Malaysia

Directory of Open Access Journals (Sweden)

Tuti Ningseh Mohd Dom

2016-01-01

Full Text Available Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010 data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted.

Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative Medicare population.

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Chen, Shih-Yin; Crivera, Concetta; Stokes, Michael; Boulanger, Luke; Schein, Jeffrey

2013-01-01

To evaluate the clinical and economic burden of acute coronary syndrome (ACS), a common cardiovascular illness, in the Medicare population. Data from the Medicare Current Beneficiary Survey were analyzed. Patients with incident hospitalization for ACS without similar events during the 6 months prior were included. Outcomes evaluated included inpatient mortality, 30-day mortality and readmission, subsequent hospitalization events, and total direct health care costs. Sample population weights were applied, accounting for multistage sampling design to obtain nationally representative estimates for the US Medicare population. Between March 1, 2002 and December 31, 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male) representing 2,542,211 Medicare beneficiaries. The inpatient mortality rate was 9.71% and the 30-day mortality ranged from 10.96% to 13.93%. The 30-day readmission rate for surviving patients was 18.56% for all causes and 17.90% for cardiovascular disease (CVD)-related diagnoses. The incidence of death since admission was 309 cases per 1000 person-years. Among patients discharged alive, the incidence was 197 for death, 847 for CVD-related admission, and 906 for all-cause admission. During the year when the ACS event occurred, mean annual total direct health care costs per person were US$50,458, with more than half attributable to inpatient hospitalization ($27,609). In this national representative Medicare population, we found a substantial clinical and economic burden for ACS. These findings suggest a continuing unmet medical need for more effective management of patients with ACS. The continuous burden underscores the importance of development of new interventions and/or strategies to improve long-term outcomes.

Atlas of the Global Burden of Stroke (1990-2013)

DEFF Research Database (Denmark)

Feigin, Valery L; Mensah, George A; Norrving, Bo

2015-01-01

for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality......BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends...... estimates of global population. All estimates have been computed with 95% uncertainty intervals. RESULTS: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across...

Burden and outcome of acute otitis media in rural Bangladesh | Roy ...

African Journals Online (AJOL)

Objectives. To report on the burden and outcome of episodes of acute otitis media (AOM) based on awareness of AOM and compliance to referral by community health workers (CHWs) in rural children aged under 2 in Bangladesh. Study design. Retrospective population-based cohort study. Method. Secondary data ...

Cost and economic burden of illness over 15 years in Nepal: A comparative analysis.

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Swe, Khin Thet; Rahman, Md Mizanur; Rahman, Md Shafiur; Saito, Eiko; Abe, Sarah K; Gilmour, Stuart; Shibuya, Kenji

2018-01-01

With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. To minimize the economic burden of illness, several approaches need to be

The Burden of Influenza-Associated Hospitalizations in Oman, January 2008-June 2013.

Science.gov (United States)

Al-Awaidy, Salah; Hamid, Sarah; Al Obaidani, Idris; Al Baqlani, Said; Al Busaidi, Suleiman; Bawikar, Shyam; El-Shoubary, Waleed; Dueger, Erica L; Said, Mayar M; Elamin, Emdeldin; Shah, Parag; Talaat, Maha

2015-01-01

Acute respiratory infections (ARI), including influenza, comprise a leading cause of morbidity and mortality worldwide. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza virus in Oman. Using syndromic case definitions and protocols, patients from four regional hospitals in Oman were enrolled in a descriptive prospective study to characterize the burden of severe acute respiratory infections (SARI) and influenza. Eligible patients provided demographic information as well as oropharyngeal (OP) and nasopharyngeal (NP) swabs. Specimens were tested for influenza A and influenza B; influenza A viruses were subtyped using RT-PCR. From January 2008 through June 2013, a total of 5,147 cases were enrolled and tested for influenza. Influenza strains were detected in 8% of cases for whom samples were available. Annual incidence rates ranged from 0.5 to 15.4 cases of influenza-associated SARI per 100,000 population. The median age of influenza patients was 6 years with children 0-2 years accounting for 34% of all influenza-associated hospitalizations. By contrast, the median age of non-influenza SARI cases was 1 year with children 0-2 years comprising 59% of SARI. Compared to non-influenza SARI cases, a greater proportion of influenza cases had pre-existing chronic conditions and underwent ventilation during hospitalization. Influenza virus is associated with a substantial proportion of SARI in Oman. Influenza in Oman approximately follows northern hemisphere seasonality, with major peaks in October to December and a lesser peak around April. The burden of influenza was greatest in children and the elderly. Future efforts should examine the burden of influenza in other potential risk groups such as pregnant women to

Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative Medicare population

Directory of Open Access Journals (Sweden)

Chen SY

2013-05-01

Full Text Available Shih-Yin Chen,1 Concetta Crivera,2 Michael Stokes,1 Luke Boulanger,1 Jeffrey Schein2 1United BioSource Corporation, Lexington, MA, USA; 2Janssen Scientific Affairs, LLC, Raritan, NJ, USA Objective: To evaluate the clinical and economic burden of acute coronary syndrome (ACS, a common cardiovascular illness, in the Medicare population. Methods: Data from the Medicare Current Beneficiary Survey were analyzed. Patients with incident hospitalization for ACS without similar events during the 6 months prior were included. Outcomes evaluated included inpatient mortality, 30-day mortality and readmission, subsequent hospitalization events, and total direct health care costs. Sample population weights were applied, accounting for multistage sampling design to obtain nationally representative estimates for the US Medicare population. Results: Between March 1, 2002 and December 31, 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male representing 2,542,211 Medicare beneficiaries. The inpatient mortality rate was 9.71% and the 30-day mortality ranged from 10.96% to 13.93%. The 30-day readmission rate for surviving patients was 18.56% for all causes and 17.90% for cardiovascular disease (CVD-related diagnoses. The incidence of death since admission was 309 cases per 1000 person–years. Among patients discharged alive, the incidence was 197 for death, 847 for CVD-related admission, and 906 for all-cause admission. During the year when the ACS event occurred, mean annual total direct health care costs per person were US$50,458, with more than half attributable to inpatient hospitalization ($27,609. Conclusion: In this national representative Medicare population, we found a substantial clinical and economic burden for ACS. These findings suggest a continuing unmet medical need for more effective management of patients with ACS. The continuous burden underscores the importance of development of new interventions and/or strategies to

Serum Total Tryptase Level Confirms Itself as a More Reliable Marker of Mast Cells Burden in Mast Cell Leukaemia (Aleukaemic Variant

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P. Savini

2015-01-01

Full Text Available Mast cell leukemia (MCL is a very rare form of systemic mastocytosis (SM with a short median survival of 6 months. We describe a case of a 65-year-old woman with aleukaemic variant of MCL with a very high serum total tryptase level of 2255 μg/L at diagnosis, which occurred following an episode of hypotensive shock. She fulfilled the diagnostic criteria of SM, with a bone marrow smear infiltration of 50–60% of atypical mast cells (MCs. She tested negative for the KIT D816V mutation, without any sign of organ damage (no B- or C-findings and only few mediator-related symptoms. She was treated with antihistamine alone and then with imatinib for the appearance of anemia. She maintained stable tryptase level and a very indolent clinical course for twenty-two months; then, she suddenly progressed to acute MCL with a serum tryptase level up to 12960 μg/L. The patient died due to haemorrhagic diathesis twenty-four months after diagnosis. This clinical case maybe represents an example of the chronic form of mast cell leukemia, described as unpredictable disease, in which the serum total tryptase level has confirmed itself as a reliable marker of mast cells burden regardless of the presence of other signs or symptoms.

Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.

Science.gov (United States)

Whiteford, Harvey A; Degenhardt, Louisa; Rehm, Jürgen; Baxter, Amanda J; Ferrari, Alize J; Erskine, Holly E; Charlson, Fiona J; Norman, Rosana E; Flaxman, Abraham D; Johns, Nicole; Burstein, Roy; Murray, Christopher J L; Vos, Theo

2013-11-09

We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the burden of disease attributable to mental and substance use disorders in terms of disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs). For each of the 20 mental and substance use disorders included in GBD 2010, we systematically reviewed epidemiological data and used a Bayesian meta-regression tool, DisMod-MR, to model prevalence by age, sex, country, region, and year. We obtained disability weights from representative community surveys and an internet-based survey to calculate YLDs. We calculated premature mortality as YLLs from cause of death estimates for 1980-2010 for 20 age groups, both sexes, and 187 countries. We derived DALYs from the sum of YLDs and YLLs. We adjusted burden estimates for comorbidity and present them with 95% uncertainty intervals. In 2010, mental and substance use disorders accounted for 183·9 million DALYs (95% UI 153·5 million-216·7 million), or 7·4% (6·2-8·6) of all DALYs worldwide. Such disorders accounted for 8·6 million YLLs (6·5 million-12·1 million; 0·5% [0·4-0·7] of all YLLs) and 175·3 million YLDs (144·5 million-207·8 million; 22·9% [18·6-27·2] of all YLDs). Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive disorders accounted for 40·5% (31·7-49·2) of DALYs caused by mental and substance use disorders, with anxiety disorders accounting for 14·6% (11·2-18·4), illicit drug use disorders for 10·9% (8·9-13·2), alcohol use disorders for 9·6% (7·7-11·8), schizophrenia for 7·4% (5·0-9·8), bipolar disorder for 7·0% (4·4-10·3), pervasive developmental disorders for 4·2% (3·2-5·3), childhood behavioural disorders for 3·4% (2·2-4·7), and eating disorders for 1·2% (0·9-1·5). DALYs varied by age and sex, with the highest proportion of total DALYs occurring in people aged 10

The global burden of dengue: an analysis from the Global Burden of Disease Study 2013

NARCIS (Netherlands)

J.D. Stanaway (Jeffrey D.); D.S. Shepard (Donald); E.A. Undurraga (Eduardo); Halasa, Y.A. (Yara A); L.E. Coffeng (Luc); Brady, O.J. (Oliver J); Hay, S.I. (Simon I); Bedi, N. (Neeraj); I.M. Bensenor (Isabela M.); C.A. Castañeda-Orjuela (Carlos A); T.-W. Chuang (Ting-Wu); K.B. Gibney (Katherine B); Z.A. Memish (Ziad); A. Rafay (Anwar); K.N. Ukwaja (Kingsley N); N. Yonemoto (Naohiro); C.J.L. Murray (Christopher)

2016-01-01

textabstractBackground Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013. Methods We modelled mortality from vital registration, verbal autopsy, and

Costing of a State-Wide Population Based Cancer Awareness and Early Detection Campaign in a 2.67 Million Population of Punjab State in Northern India.

Science.gov (United States)

Thakur, Js; Prinja, Shankar; Jeet, Gursimer; Bhatnagar, Nidhi

2016-01-01

Punjab state is particularly reporting a rising burden of cancer. A 'door to door cancer awareness and early detection campaign' was therefore launched in the Punjab covering about 2.67 million population, wherein after initial training accredited social health activists (ASHAs) and other health staff conducted a survey for early detection of cancer cases based on a twelve point clinical algorithm. To ascertain unit cost for undertaking a population-based cancer awareness and early detection campaign. Data were collected using bottom-up costing methods. Full economic costs of implementing the campaign from the health system perspective were calculated. Options to meet the likely demand for project activities were further evaluated to examine their worth from the point of view of long-term sustainability. The campaign covered 97% of the state population. A total of 24,659 cases were suspected to have cancer and were referred to health facilities. At the state level, incidence and prevalence of cancer were found to be 90 and 216 per 100,000, respectively. Full economic cost of implementing the campaign in pilot district was USD 117,524. However, the financial cost was approximately USD 6,301. Start-up phase of campaign was more resource intensive (63% of total) than the implementation phase. The economic cost per person contacted and suspected by clinical algorithm was found to be USD 0.20 and USD 40 respectively. Cost per confirmed case under the campaign was 7,043 USD. The campaign was able to screen a reasonably large population. High to high economic cost points towards the fact that the opportunity cost of campaign put a significant burden on health system and other programs. However, generating awareness and early detection strategy adopted in this campaign seems promising in light of fact that organized screening is not in place in India and in many developing countries.

Caregiver burden from caring for impaired elderly: a cross-sectional study in rural Lower Egypt

OpenAIRE

Salama, Rasha

2012-01-01

Background: increased life expectancy and an aging population have made home care for the elderly a major responsibility for families. Caring for a chronically ill or physically disabled person has been referred to as physically or emotionally stressful, placing the caregiver at a heightened risk of burden. This study aimed to identify factors related to caregiving burden among caregivers who care for their disabled older family members. Methods: a cross sectional descriptive study was conduc...

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review.

Science.gov (United States)

Abd ElHafeez, Samar; Bolignano, Davide; D'Arrigo, Graziella; Dounousi, Evangelia; Tripepi, Giovanni; Zoccali, Carmine

2018-01-10

While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%-90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%-51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights

Disease burden of infectious diseases in Europe: a pilot study

NARCIS (Netherlands)

Lier EA van; Havelaar AH; LZO

2007-01-01

Consequences of different infectious diseases cannot be adequately compared with each other on the basis of the number of patients or mortality data only. It is better to combine all health effects and express the total impact as disease burden, which also takes duration and severity of diseases

40 CFR 22.24 - Burden of presentation; burden of persuasion; preponderance of the evidence standard.

Science.gov (United States)

2010-07-01

... persuasion; preponderance of the evidence standard. 22.24 Section 22.24 Protection of Environment... Burden of presentation; burden of persuasion; preponderance of the evidence standard. (a) The complainant has the burdens of presentation and persuasion that the violation occurred as set forth in the...

Monetary burden of health impacts of air pollution in Mumbai, India: implications for public health policy.

Science.gov (United States)

Patankar, A M; Trivedi, P L

2011-03-01

Mumbai, a mega city with a population of more than 12 million, is experiencing acute air pollution due to commercial activity, a boom in construction and vehicular traffic. This study was undertaken to investigate the link between air pollution and health impacts for Mumbai, and estimate the monetary burden of these impacts. Cross-sectional data were subjected to logistic regression to analyse the link between air pollution and health impacts, and the cost of illness approach was used to measure the monetary burden of these impacts. Data collected by the Environmental Pollution Research Centre at King Edward Memorial Hospital in Mumbai were analysed using logistic regression to investigate the link between air pollution and morbidity impacts. The monetary burden of morbidity was estimated through the cost of illness approach. For this purpose, information on treatment costs and foregone earnings due to illness was obtained through the household survey and interviews with medical practitioners. Particulate matter (PM(10)) and nitrogen dioxide (NO(2)) emerged as the critical pollutants for a range of health impacts, including symptoms such as cough, breathlessness, wheezing and cold, and illnesses such as allergic rhinitis and chronic obstructive pulmonary disease (COPD). This study developed the concentration-response coefficients for these health impacts. The total monetary burden of these impacts, including personal burden, government expenditure and societal cost, is estimated at 4522.96 million Indian Rupees (INR) or US$ 113.08 million for a 50-μg/m(3) increase in PM(10), and INR 8723.59 million or US$ 218.10 million for a similar increase in NO(2). The estimated monetary burden of health impacts associated with air pollution in Mumbai mainly comprises out-of-pocket expenses of city residents. These expenses form a sizable proportion of the annual income of individuals, particularly those belonging to poor households. These findings have implications for public

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013

Science.gov (United States)

Stanaway, Jeffrey D; Flaxman, Abraham D; Naghavi, Mohsen; Fitzmaurice, Christina; Vos, Theo; Abubakar, Ibrahim; Abu-Raddad, Laith J; Assadi, Reza; Bhala, Neeraj; Cowie, Benjamin; Forouzanfour, Mohammad H; Groeger, Justina; Hanafiah, Khayriyyah Mohd; Jacobsen, Kathryn H; James, Spencer L; MacLachlan, Jennifer; Malekzadeh, Reza; Martin, Natasha K; Mokdad, Ali A; Mokdad, Ali H; Murray, Christopher J L; Plass, Dietrich; Rana, Saleem; Rein, David B; Richardus, Jan Hendrik; Sanabria, Juan; Saylan, Mete; Shahraz, Saeid; So, Samuel; Vlassov, Vasiliy V; Weiderpass, Elisabete; Wiersma, Steven T; Younis, Mustafa; Yu, Chuanhua; Zaki, Maysaa El Sayed; Cooke, Graham S

2016-01-01

Summary Background With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. Methods We estimated mortality using natural history models for acute hepatitis infections and GBD’s cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). Findings Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86–0·94) to 1·45 million (1·38–1·54); YLLs from 31·0 million (29·6–32·6) to 41·6 million (39·1–44·7); YLDs from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18); and DALYs from 31·7 million (30·2–33·3) to 42·5 million (39·9–45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. Interpretation Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. Funding Bill & Melinda

The humanistic and economic burden of systemic lupus erythematosus : a systematic review.

Science.gov (United States)

Meacock, Rachel; Dale, Nicola; Harrison, Mark J

2013-01-01

Increased survival in patients with systemic lupus erythematosus (SLE) has shifted attention towards the burden that SLE imposes upon patients, healthcare systems and society. New interventions aimed at alleviating this burden will require economic evaluation. A summary of the current evidence of the humanistic and economic burden provides a platform for such subsequent studies. The objective of this study was to systematically review the current evidence on the humanistic and economic burden of SLE in terms of health-related quality of life (HR-QOL) and costs, and summarize the evidence on the factors found to be associated with this burden. Relevant literature for the years 1990 to February 2011 were obtained from systematic searches of MEDLINE, EMBASE and Web of Science. Articles reporting the humanistic (preference-based outcome measures or an SLE disease-specific HR-QOL measure) or economic burden (costs) of SLE in adult populations published in English were identified. The following exclusion criteria were applied: studies specifically examining lupus nephritis, SLE not being the main condition of focus (e.g. SLE is a co-existing condition), studies focusing on diagnostics or tests (including genetics and antibodies), mixed patient groups from which SLE could not be separated, paediatric populations, case studies, abstract unavailable, and non-English language studies. Estimates of the burden in terms of either HR-QOL or costs were extracted, tabulated and reported narratively. Annual cost figures were also converted into year 2010 US dollars using the consumer price index (CPI) and the purchasing power parity (PPP) conversion factor to allow for greater comparability across studies. Evidence on the factors found to be independently associated with either HR-QOL or costs was also examined. Of the 1969 studies initially identified as being potentially relevant, 32 papers were retained for the final review. Eighteen of these presented estimates of the burden in

Neuropsychiatric Symptoms in Parkinson’s Disease Dementia Are Associated with Increased Caregiver Burden

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Yoon-Sang Oh

2015-01-01

Full Text Available Objective Neuropsychiatric symptoms are common in Parkinson’s disease dementia (PDD. Frequent and severe neuropsychiatric symptoms create high levels of distress for patients and caregivers, decreasing their quality of life. The aim of this study was to investigate neuropsychiatric symptoms that may contribute to increased caregiver burden in PDD patients. Methods Forty-eight PDD patients were assessed using the 12-item Neuropsychiatric Inventory (NPI to determine the frequency and severity of mental and behavioral problems. The Burden Interview and Caregiver Burden Inventory were used to evaluate caregiver burden. Results All but one patient showed one or more neuropsychiatric symptoms. The three most frequent neuropsychiatric symptoms were apathy (70.8% and anxiety (70.8%, followed by depression (68.7%. More severe neuropsychiatric symptoms were significantly correlated with increased caregiver burden. The domains of delusion, hallucination, agitation and aggression, anxiety, irritability and lability, and aberrant motor behavior were associated with caregiver stress. After controlling for age and other potential confounding variables, total NPI score was significantly associated with caregiver burden. Conclusions The results of this study confirm that neuropsychiatric symptoms are frequent and severe in patients with PDD and are associated with increased caregiver distress. A detailed evaluation and management of neuropsychiatric symptoms in PDD patients appears necessary to improve patient quality of life and reduce caregiver burden.

Emotional Problems, Quality of Life, and Symptom Burden in Patients With Lung Cancer.

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Morrison, Eleshia J; Novotny, Paul J; Sloan, Jeff A; Yang, Ping; Patten, Christi A; Ruddy, Kathryn J; Clark, Matthew M

2017-09-01

Lung cancer is associated with a greater symptom burden than other cancers, yet little is known about the prevalence of emotional problems and how emotional problems may be related to the physical symptom burden and quality of life in newly diagnosed patients with lung cancer. This study aimed to identify the patient and disease characteristics of patients with lung cancer experiencing emotional problems and to examine how emotional problems relate to quality of life and symptom burden. A total of 2205 newly diagnosed patients with lung cancer completed questionnaires on emotional problems, quality of life, and symptom burden. Emotional problems at diagnosis were associated with younger age, female gender, current cigarette smoking, current employment, advanced lung cancer disease, surgical or chemotherapy treatment, and a lower Eastern Cooperative Oncology Group performance score. Additionally, strong associations were found between greater severity of emotional problems, lower quality of life, and greater symptom burden. Certain characteristics place patients with lung cancer at greater risk for emotional problems, which are associated with a reduced quality of life and greater symptom burden. Assessment of the presence of emotional problems at the time of lung cancer diagnosis provides the opportunity to offer tailored strategies for managing negative mood, and for improving the quality of life and symptom burden management of patients with lung cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

Economic burden of irritable bowel syndrome with constipation: a retrospective analysis of health care costs in a commercially insured population.

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Doshi, Jalpa A; Cai, Qian; Buono, Jessica L; Spalding, William M; Sarocco, Phil; Tan, Hiangkiat; Stephenson, Judith J; Carson, Robyn T

2014-04-01

total all-cause or disease-specific health care costs for patients with IBS-C, while the incremental cost approach was used to examine the excess all-cause costs of IBS-C by comparing IBS-C patients with matched controls. Generalized linear models with bootstrapping were used to assess the incremental all-cause costs attributable solely to IBS-C after adjusting for demographics, Elixhauser Comorbidity Index (ECI) score, and other general and GI-related comorbidities not included in the ECI score. A total of 7,652 patients (n = 3,826 each in the IBS-C and control cohorts) were included in the analysis. The mean (± SD) age was 48 (± 17) years, and 83.6% were female. The mean annual all-cause health care costs for IBS-C patients were $11,182, with over half (53.7%) of the costs attributable to outpatient services, including physician office visits and other outpatient services (13.1% and 40.6%, respectively). Remaining total all-cause costs were attributable to hospitalizations (21.8%), prescriptions (19.1%), and ER visits (5.4%). GI-related costs ($4,456) comprised 39.8% of total all-cause costs, while IBS-C-related costs ($1,335) accounted for 11.9% and were primarily driven by costs of other outpatient services (50.3%). After adjusting for demographics and comorbidities, the incremental annual all-cause health care costs associated with IBS-C were $3,856 ($8,621 for IBS-C patients vs. $4,765 for controls, P less than 0.01) per patient per year, of which 78.1% of the incremental costs were due to medical services, and 21.9% were due to prescription fills. IBS-C imposes a substantial economic burden in terms of direct health care costs in a commercially insured population. Compared with matched controls, IBS-C patients incurred significantly higher total annual all-cause health care costs even after controlling for general and GI-related comorbidities. Incremental all-cause costs associated with IBS-C were mainly driven by costs related to more frequent use of medical

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life

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Eliana Lourenço Borges

Full Text Available ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36. Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50. Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.

Burden of waiting for surveillance CT colonography in patients with screen-detected 6-9 mm polyps

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Tutein Nolthenius, Charlotte J. [University of Amsterdam, Department of Radiology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Boellaard, Thierry N.; Nio, C.Y.; Bipat, Shandra; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Haan, Margriet C. de [Meander Medical Center, Department of Radiology, Amersfoort (Netherlands); Thomeer, Maarten G.J. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Montauban van Swijndregt, Alexander D. [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Essink-Bot, Marie-Louise [University of Amsterdam, Public Health, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Kuipers, Ernst J. [Erasmus University Medical Center, Gastroenterology and Hepatology, Rotterdam (Netherlands); Erasmus University Medical Center, Internal medicine, Rotterdam (Netherlands); Dekker, Evelien [University of Amsterdam, Gastroenterology and Hepatology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands)

2016-11-15

We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC. In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization. Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012). Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable. (orig.)

The burden of chronic mercury intoxication in artisanal small-scale gold mining in Zimbabwe: data availability and preliminary estimates.

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Steckling, Nadine; Bose-O'Reilly, Stephan; Pinheiro, Paulo; Plass, Dietrich; Shoko, Dennis; Drasch, Gustav; Bernaudat, Ludovic; Siebert, Uwe; Hornberg, Claudia

2014-12-13

Artisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe. Cases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms. Miners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe's total population in 2004. This analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population

High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA.

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Harch, Susan A J; MacMorran, Eleanor; Tong, Steven Y C; Holt, Deborah C; Wilson, Judith; Athan, Eugene; Hewagama, Saliya

2017-06-07

Superficial skin and soft tissue infections (SSTIs) are common among the Indigenous population of the desert regions of Central Australia. However, the overall burden of disease and molecular epidemiology of Staphylococcus aureus complicated SSTIs has yet to be described in this unique population. Alice Springs Hospital (ASH) admission data was interrogated to establish the population incidence of SSTIs. A prospective observational study was conducted on a subset of S. aureus complicated SSTIs (carbuncles and furuncles requiring surgical intervention) presenting during a one month period to further characterize the clinical and molecular epidemiology. High resolution melting analysis was used for clonal complex discrimination. Real-time polymerase chain reaction identifying the lukF component of the Panton Valentine leucocidin (pvl) gene determined pvl status. Clinical and outcome data was obtained from the ASH medical and Northern Territory shared electronic health records. SSTIs represented 2.1% of ASH admissions during 2014. 82.6% occurred in Indigenous patients (n = 382) with an estimated incidence of 18.9 per 1, 000 people years compared to the non-Indigenous population of 2.9 per 1000, with an incident rate ratio of 6.6 (95% confidence interval 5.1-8.5). Clinical and molecular analysis was performed on 50 isolates from 47 patients. Community-associated methicillin-resistant S. aureus (CA-MRSA) predominated (57% of isolates). The high burden of SSTIs is partly explained by the prevalence of pvl positive strains of S. aureus (90% isolates) for both CA-MRSA and methicillin-susceptible S. aureus (MSSA). ST93-MRSA and CC121-MSSA were the most prevalent clones. SSTIs due to ST93-MRSA were more likely to require further debridement (p = 0.039), however they also more frequently received inactive antimicrobial therapy (p population when antimicrobial therapy is indicated. Prompt surgical intervention remains the cornerstone of treatment.

Allostatic load but not medical burden predicts memory performance in late-life bipolar disorder.

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Vaccarino, Sophie R; Rajji, Tarek K; Gildengers, Ariel G; Waters, Sarah E S; Butters, Meryl A; Menon, Mahesh; Blumberger, Daniel M; Voineskos, Aristotle N; Miranda, Dielle; Mulsant, Benoit H

2018-03-01

Older patients with bipolar disorder (BD) present with variable degrees of cognitive impairment. Over time, stress, mood episodes, and comorbidities increase the body's allostatic load. We assessed the extent to which allostatic load vs more traditional measures of medical burden account for the heterogeneity in cognition in this population. Thirty-five older euthymic patients with BD and 30 age-equated, gender-equated, and education-equated comparison participants were administered a comprehensive assessment including a neuropsychological battery, and 9 physiological measures to determine allostatic load. The relationship among allostatic load, medical burden, and cognition was assessed. Compared with the mentally healthy comparators, patients were impaired globally, and in 4 cognitive domains-information-processing speed / executive functioning, delayed memory, language, and visuomotor ability, and presented with greater medical burden but not a different allostatic load. Allostatic load, but not medical burden, was associated with delayed memory performance both in a correlational analysis and in a multivariate regression analysis. Euthymic older patients with BD are impaired on several cognitive domains and have high medical burden. Their memory performance is more strongly associated with allostatic load than with traditional measures of medical burden. These findings need to be replicated and extended longitudinally. Copyright © 2017 John Wiley & Sons, Ltd.

[Relationship between research funding in the Spanish National Health System and the burden of disease].

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Catalá López, Ferrán; Alvarez Martín, Elena; Gènova Maleras, Ricard; Morant Ginestar, Consuelo

2009-01-01

The Carlos III Health Institute (Instituto de Salud Carlos III - Spain) allocates funding to health research support in the Spanish National Health System (NHS). This study aimed to analyse the correlation of health research fund allocations in the NHS and the burden of disease in Spanish population. Cross-sectional study. Burden of disease measures were calculated: disability-adjusted life-years (DALYs), years of life lost (YLLs) and mortality by cause. A correlation analysis (Spearman s Rho) was applied to test the association between these measures and 2006/2007 health research funding. Using disease categories (n=21), the correlation between funding and disease-burden measures is: DALY (r=0.72; p funding support. However, the higher funds allocated per DALY lost ratios were for blood and endocrine disorders, infectious and parasitic diseases and congenital anomalies. Our analysis suggests that NHS research funding is positive moderately high-associated with the burden of disease in Spain, although there exists certain diseases categories that are over or under-funded in relation to their burden generated. In health planning, burden of disease studies contributes with useful information for setting health research priorities.

Projections of global mortality and burden of disease from 2002 to 2030.

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Mathers, Colin D; Loncar, Dejan

2006-11-01

also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

Projections of global mortality and burden of disease from 2002 to 2030.

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Colin D Mathers

2006-11-01

reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. CONCLUSIONS: These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

Projections of Global Mortality and Burden of Disease from 2002 to 2030

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Mathers, Colin D; Loncar, Dejan

2006-01-01

. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. Conclusions These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries. PMID:17132052

Economic burden of burn injuries in the Netherlands: A 3 months follow-up study.

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Hop, M Jenda; Wijnen, Ben F M; Nieuwenhuis, Marianne K; Dokter, Jan; Middelkoop, Esther; Polinder, Suzanne; van Baar, Margriet E

2016-01-01

Burn care has rapidly improved in the past decades. However, healthcare innovations can be expensive, demanding careful choices on their implementation. Obtaining knowledge on the extent of the costs of burn injuries is an essential first step for economic evaluations within burn care. The objective of this study was to determine the economic burden of patients with burns admitted to a burn centre and to identify important cost categories until 3 months post-burn. A prospective cohort study was conducted in the burn centre of Maasstad Hospital Rotterdam, the Netherlands, including all patients with acute burn related injuries from August 2011 until July 2012. Total costs were calculated from a societal perspective, until 3 months post injury. Subgroup analyses were performed to examine whether the mean total costs per patient differed by age, aetiology or percentage total body surface area (TBSA) burned. In our population, with a mean burn size of 8%, mean total costs were €26,540 per patient varying from €742 to €235,557. Most important cost categories were burn centre days (62%), surgical interventions (5%) and work absence (20%). Flame burns were significantly more costly than other types of burns, adult patients were significantly more costly than children and adolescents and a higher percentage TBSA burned also corresponded to significantly higher costs. Mean total costs of burn care in the first 3 months post injury were estimated at €26,540 and depended on age, aetiology and TBSA. Mean total costs in our population probably apply to other high-income countries as well, although we should realise that patients with burn injuries are diverse and represent a broad range of total costs. To reduce costs of burn care, future intervention studies should focus on a timely wound healing, reducing length of stay and enabling an early return to work. Copyright © 2015 Elsevier Ltd. All rights reserved.

Caregiver Burden in Alcohol Dependence Syndrome

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Ramanujam Vaishnavi

2017-01-01

Full Text Available Background. Alcoholism is a major threat to the individual as well as the society and the maximum burden of the illness is borne by the family. Aim. The study is aimed at assessing the pattern of burden on the caregivers of alcohol dependent patients and at assessing the relationship between the severity of dependence and the burden on caregivers. Settings and Design. Cross-sectional descriptive study conducted in the Department of Psychiatry, Sri Ramachandra Medical College and Research Institute. Materials and Methods. A cross-sectional assessment was done in 200 patients with alcohol dependence and their caregivers. The severity of dependence and the pattern of burden on caregivers were assessed. Statistical Analysis. The data thus collected was analyzed using SPSS version 20. Results. The study demonstrates that caregivers of alcohol dependent patients reported significant objective burden and subjective burden. Furthermore, the severity of alcohol dependence and the domains of burden such as financial burden, disruption of family interaction, and disruption of family routine activities were positively correlated with high level of significance. Conclusion. The current study has illustrated that all the caregivers experienced significant amount of burden which has to be addressed for better treatment outcome of the patients.

EAMJ Jan. Burden.indd

African Journals Online (AJOL)

2009-01-01

Jan 1, 2009 ... developed world where the burden of disease is accurately determined. ... Projections indicate an expected yearly incidence of 15 to 20 million new .... of global mortality and burden of diseases from 2002 to 2030. Plos. Med.

Identification of environmentally derived cesium-137 burdens in a worker population

International Nuclear Information System (INIS)

MacLellan, J.A.; Lynch, T.P.; Rieksts, G.A.; Brodzinski, R.L.

1993-01-01

During 1990, whole body measurements of a number of workers with little probability of onsite occupational exposure showed positive evidence of 137 Cs. Further investigation revealed that many of these workers supplemented their diet with a significant portion of wild game, mainly deer and elk. To validate the assumption of an environmental source, donated samples of venison and other game were analyzed by gamma spectroscopy. Results ranged from less than 0.1 to almost 100 Bq kg -l (0.003 to 2.7 nCi kg -1 ) and showed a correlation with the habitat from which the game was taken. Venison samples obtained from the two workers with the highest body burdens showed the highest activity. A questionnaire is now used to identify workers with an elevated potential for environmental-intakes

The Hierarchical Clustering of Tax Burden in the EU27

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Simkova Nikola

2015-09-01

Full Text Available The issue of taxation has become more important due to a significant share of the government revenue. There are several ways of expressing the tax burden of countries. This paper describes the traditional approach as a share of tax revenue to GDP which is applied to the total taxation and the capital taxation as a part of tax systems affecting investment decisions. The implicit tax rate on capital created by Eurostat also offers a possible explanation of the tax burden on capital, so its components are analysed in detail. This study uses one of the econometric methods called the hierarchical clustering. The data on which the clustering is based comprises countries in the EU27 for the period of 1995 – 2012. The aim of this paper is to reveal clusters of countries in the EU27 with similar tax burden or tax changes. The findings suggest that mainly newly acceding countries (2004 and 2007 are in a group of countries with a low tax burden which tried to encourage investors by favourable tax rates. On the other hand, there are mostly countries from the original EU15. Some clusters may be explained by similar historical development, geographic and demographic characteristics.

The high burden of cholera in children: comparison of incidence from endemic areas in Asia and Africa.

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Jacqueline L Deen

Full Text Available BACKGROUND: Cholera remains an important public health problem. Yet there are few reliable population-based estimates of laboratory-confirmed cholera incidence in endemic areas around the world. METHODS: We established treatment facility-based cholera surveillance in three sites in Jakarta (Indonesia, Kolkata (India, and Beira (Mozambique. The annual incidence of cholera was estimated using the population census as the denominator and the age-specific number of cholera cases among the study cohort as the numerator. FINDINGS: The lowest overall rate was found in Jakarta, where the estimated incidence was 0.5/1000 population/year. The incidence was three times higher in Kolkata (1.6/1000/year and eight times higher in Beira (4.0/1000/year. In all study sites, the greatest burden was in children under 5 years of age. CONCLUSION: There are considerable differences in cholera incidence across these endemic areas but in all sites, children are the most affected. The study site in Africa had the highest cholera incidence consistent with a growing impression of the large cholera burden in Africa. Burden estimates are useful when considering where and among whom interventions such as vaccination would be most needed.

The burden of disease and injury in the United States 1996

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Salomon Joshua A

2006-10-01

Full Text Available Abstract Background Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context. Methods We applied methods developed for the Global Burden of Disease (GBD to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world. Results In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries. Conclusion Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.

Caregiving in first-episode psychosis: social characteristics associated with perceived 'burden' and associations with compulsory treatment.

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Boydell, Jane; Onwumere, Juliana; Dutta, Rina; Bhavsar, Vishal; Hill, Nathan; Morgan, Craig; Dazzan, Paola; Morgan, Kevin; Pararajan, Madonna; Kuipers, Elizabeth; Jones, Peter; Murray, Robin; Fearon, Paul

2014-05-01

High incidence of psychosis and compulsory treatment within black and minority ethnic (BME) groups in the UK remain a concern. Psychosis has an impact on families and family involvement is important in predicting compulsory treatment. We therefore aimed to report the levels and predictors of caregiver burden in first-episode psychosis, in white British, and BME groups of carers, and investigate their relevance to compulsory treatment. A total of 124 caregivers were interviewed soon after the onset of psychosis using the General Health Questionnaire, GHQ-28, the Experience of Caregiving Inventory, the Personal and Psychiatric History Schedule, and the MRC Sociodemographic Schedule. The overall level of distress as measured by GHQ-28 was high (mean 50, SD 11.4). Feelings of carer burden were also high (mean total negative score 72.5, SD 34.8), increased in men, and with carer age. Neither ethnicity nor social class nor social support was associated with distress or burden. Compulsory treatment was predicted by carer burden (as indicated by carer reports of 'problems with services' (OR 1.08; 95% CI 1.01, 1.15; P = 0.023)); this was particularly evident in the black Caribbean group of carers (OR 1.28; 95% CI 1.04, 1.57; P = 0.02) CONCLUSION: Carers of adults with first-episode psychosis experience considerable psychological distress and feelings of burden. There was a specific association between carer burden, specifically in terms of experience of services, and compulsory admission of service users, particularly in the black Caribbean group. Better ways of liaising with carers and targeted efforts to reduce carer burden at illness onset are needed. © 2013 Wiley Publishing Asia Pty Ltd.

A comparability analysis of global burden sharing GHG reduction scenarios

International Nuclear Information System (INIS)

Ciscar, Juan-Carlos; Saveyn, Bert; Soria, Antonio; Szabo, Laszlo; Van Regemorter, Denise; Van Ierland, Tom

2013-01-01

The distribution of the mitigation burden across countries is a key issue regarding the post-2012 global climate policies. This article explores the economic implications of alternative allocation rules, an assessment made in the run-up to the COP15 in Copenhagen (December 2009). We analyse the comparability of the allocations across countries based on four single indicators: GDP per capita, GHG emissions per GDP, GHG emission trends in the recent past, and population growth. The multi-sectoral computable general equilibrium model of the global economy, GEM-E3, is used for that purpose. Further, the article also compares a perfect carbon market without transaction costs with the case of a gradually developing carbon market, i.e. a carbon market with (gradually diminishing) transaction costs. - Highlights: ► Burden sharing of global mitigation efforts should consider equity and efficiency. ► The comparability of allocations across countries is based on four indicators. ► The four indicators are GDP/capita, GHG/GDP, population growth, and GHG trend. ► Any possible agreement on effort comparability needs a combination of indicators. ► We analyse the role played by the degree of flexibility in global carbon trading

The economic burden of smoking and secondhand smoke exposure in rural South-West China.

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Cai, Le; Cui, Wenlong; He, Jianhui; Wu, Xinan

2014-06-01

To estimate the direct and indirect costs of chronic diseases attributed to smoking and exposure to secondhand smoke (SHS) in a given year (2011) in rural southwest China. A prevalence-based, disease-specific attributable-risk approach was used to estimate the economic burden of chronic diseases attributable to both smoking and exposure to secondhand smoke (SHS). A cross-sectional questionnaire survey of 17 158 consenting adults aged ≥18 years was used to derive prevalence of smoking and exposure to SHS, as well as direct and indirect costs of chronic diseases. In the study population, the prevalence rates of smoking and exposure to SHS are 73.1 and 38.2% for males and 1.4 and 43.4% for females, respectively. The total costs of illness are $25.85 million for COPD, $18.80 million for asthma, $37.25 million for CHD, $17.91 million for stroke, $264.35 million for hypertension and $17.11 million for peptic ulcer. The estimated costs attributable to smoking and exposure to SHS are $95.51 million and $79.35 million, accounting for 7.15 and 5.94% of local healthcare costs, respectively. Of the total costs of tobacco, direct costs and indirect costs are $94.66 million and $0.85 million for smoking, and $78.22 million and $1.36 million for exposure to SHS. Smoking contributes more cost of illness than exposure to SHS in men, whereas exposure to SHS contributes more cost of illness than smoking in women. Smoking and exposure to SHS produce substantial economic burden as well as have a considerable public health impact in rural southwest China.

Disease Burden from Hepatitis B Virus Infection in Guangdong Province, China

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Jianpeng Xiao

2015-11-01

Full Text Available Objective: To estimate the disease burden and financial burden attributed to hepatitis B virus (HBV infection in Guangdong Province. Methods: Based on the data of incidence, mortality and healthcare cost of HBV-related diseases and other socio-economic data in Guangdong Province, we estimated deaths, disability-adjusted life-years (DALYs and economic cost for the three HBV-related diseases—hepatitis B, liver cirrhosis and liver cancer—in Guangdong following the procedures developed for the global burden of disease study. Then disease burden and economic cost attributed to HBV infection was estimated. Results: HBV infection was estimated to have caused 33,600 (95% confidence interval (CI: 29,300–37,800 premature deaths and the loss of 583,200 (95% CI: 495,200–671,100 DALYs in Guangdong in 2005. The greatest loss of deaths and DALYs were from liver cancer. The 45–59 years age group had the greatest burden attributable to HBV infection. The estimated total annual cost of HBV-related diseases in Guangdong was RMB 10.8 (95% CI: 8.7–13.0 billion，the direct and indirect cost were RMB 2.6 (95% CI: 2.1–3.2 and 8.2 (95% CI: 6.6–9.8 billion. Conclusions: HBV infection is a great medical challenge as well as a significant economic burden to Guangdong Province. The results suggest that substantial health benefits could be gained by extending effective public health and clinical interventions to reduce HBV infection in Guangdong Province.

Burden of Respiratory Syncytial Virus Hospitalizations in Canada

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Ian Mitchell

2017-01-01

Full Text Available Objective. To examine the socioeconomic burden of respiratory syncytial virus (RSV disease for Canadian infants hospitalized for the condition. Data and Methods. The descriptive study used data collected in Alberta, Canada, during 2 consecutive RSV seasons. Infants (<1 year of age were included if they had not received palivizumab and were hospitalized with a confirmed diagnosis of RSV. Hospitalization resource use and parental time burden, out-of-pocket costs, lost work productivity, and stress and anxiety were assessed. Results. 13.4% of all infants (n = 67 had intensive care unit (ICU admission, and average ICU stay for these infants was 6.5 days. Families had average out-of-pocket expenses of 736.69 Canadian dollars (CAD $, and the average time both parents spent in hospital was nearly 7 days (164.0 hours. For working parents (n = 43, average absenteeism was 49% and overall work impairment was 77.8%. Parents also exhibited significant parental stress (3.6 on the Parental Stressor Scale: 43.9 state anxiety and 36.9 trait anxiety scores. Conclusions. Results indicate a high burden associated with the hospitalization of an infant due to RSV disease in terms of resource use, time, productivity, costs, and stress, even among a population of infants not considered to be at risk for the condition.

Association of homocysteine level and vascular burden and cognitive function in middle-aged and older adults with chronic kidney disease.

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Yeh, Yi-Chun; Huang, Mei-Feng; Hwang, Shang-Jyh; Tsai, Jer-Chia; Liu, Tai-Ling; Hsiao, Shih-Ming; Yang, Yi-Hsin; Kuo, Mei-Chuan; Chen, Cheng-Sheng

2016-07-01

Patients with chronic kidney disease (CKD) have been found to have cognitive impairment. However, the core features and clinical correlates of cognitive impairment are still unclear. Elevated homocysteine levels are present in CKD, and this is a risk factor for cognitive impairment and vascular diseases in the general population. Thus, this study investigated the core domains of cognitive impairment and investigated the associations of homocysteine level and vascular burden with cognitive function in patients with CKD. Patients with CKD aged ≥ 50 years and age- and sex-matched normal comparisons were enrolled. The total fasting serum homocysteine level was measured. Vascular burden was assessed using the Framingham Cardiovascular Risk Scale. Cognitive function was evaluated using comprehensive neuropsychological tests. A total of 230 patients with CKD and 92 comparisons completed the study. Memory impairment and executive dysfunction were identified as core features of cognitive impairment in the CKD patients. Among the patients with CKD, higher serum homocysteine levels (β = -0.17, p = 0.035) and higher Framingham Cardiovascular Risk Scale scores (β = -0.18, p = 0.013) were correlated with poor executive function independently. However, an association with memory function was not noted. Our results showed that an elevated homocysteine level and an increased vascular burden were independently associated with executive function, but not memory, in CKD patients. This findings suggested the co-existence of vascular and non-vascular hypotheses regarding executive dysfunction in CKD patients. Meanwhile, other risk factors related to CKD itself should be investigated in the future. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The economic burden of advanced gastric cancer in Taiwan.

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Hong, Jihyung; Tsai, Yiling; Novick, Diego; Hsiao, Frank Chi-Huang; Cheng, Rebecca; Chen, Jen-Shi

2017-09-16

Gastric cancer is one of the leading causes of cancer-related deaths in both sexes worldwide, especially in Eastern Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan. The costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs, where patients' follow-up periods were adjusted for, were estimated with 82 patients who had complete resource use data. The costs were composed of direct medical costs, direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. A broad definition of morbidity and mortality costs was employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Their narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2611) in Taiwan in 2013. The mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4669 for direct non-medical costs, US$5758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million at the national-level. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%). AGC was found to exert a significant economic burden in Taiwan, incurring US$423 million in 2013. This represents about 0.08% of

The Global Cancer Burden

Centers for Disease Control (CDC) Podcasts

2012-02-02

This podcast describes the global burden of cancer and efforts by CDC and others to reduce that burden.  Created: 2/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 2/2/2012.

Environmental Health Related Socio-Spatial Inequalities: Identifying “Hotspots” of Environmental Burdens and Social Vulnerability

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Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

2016-01-01

Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

The economic burden of physical inactivity: a global analysis of major non-communicable diseases.

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Ding, Ding; Lawson, Kenny D; Kolbe-Alexander, Tracy L; Finkelstein, Eric A; Katzmarzyk, Peter T; van Mechelen, Willem; Pratt, Michael

2016-09-24

The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide. Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality. Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates. In addition to morbidity and premature mortality, physical inactivity is

The geographical distribution and burden of trachoma in Africa.

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Jennifer L Smith

Full Text Available There remains a lack of epidemiological data on the geographical distribution of trachoma to support global mapping and scale up of interventions for the elimination of trachoma. The Global Atlas of Trachoma (GAT was launched in 2011 to address these needs and provide standardised, updated and accessible maps. This paper uses data included in the GAT to describe the geographical distribution and burden of trachoma in Africa.Data assembly used structured searches of published and unpublished literature to identify cross-sectional epidemiological data on the burden of trachoma since 1980. Survey data were abstracted into a standardised database and mapped using geographical information systems (GIS software. The characteristics of all surveys were summarized by country according to data source, time period, and survey methodology. Estimates of the current population at risk were calculated for each country and stratified by endemicity class.At the time of writing, 1342 records are included in the database representing surveys conducted between 1985 and 2012. These data were provided by direct contact with national control programmes and academic researchers (67%, peer-reviewed publications (17% and unpublished reports or theses (16%. Prevalence data on active trachoma are available in 29 of the 33 countries in Africa classified as endemic for trachoma, and 1095 (20.6% districts have representative data collected through population-based prevalence surveys. The highest prevalence of active trachoma and trichiasis remains in the Sahel area of West Africa and Savannah areas of East and Central Africa and an estimated 129.4 million people live in areas of Africa confirmed to be trachoma endemic.The Global Atlas of Trachoma provides the most contemporary and comprehensive summary of the burden of trachoma within Africa. The GAT highlights where future mapping is required and provides an important planning tool for scale-up and surveillance of trachoma

Russia-specific relative risks and their effects on the estimated alcohol-attributable burden of disease.

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Shield, Kevin D; Rehm, Jürgen

2015-05-10

Alcohol consumption is a major risk factor for the burden of disease globally. This burden is estimated using Relative Risk (RR) functions for alcohol from meta-analyses that use data from all countries; however, for Russia and surrounding countries, country-specific risk data may need to be used. The objective of this paper is to compare the estimated burden of alcohol consumption calculated using Russia-specific alcohol RRs with the estimated burden of alcohol consumption calculated using alcohol RRs from meta-analyses. Data for 2012 on drinking indicators were calculated based on the Global Information System on Alcohol and Health. Data for 2012 on mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years (DALYs) lost by cause were obtained by country from the World Health Organization. Alcohol Population-Attributable Fractions (PAFs) were calculated based on a risk modelling methodology from Russia. These PAFs were compared to PAFs calculated using methods applied for all other countries. The 95% Uncertainty Intervals (UIs) for the alcohol PAFs were calculated using a Monte Carlo-like method. Using Russia-specific alcohol RR functions, in Russia in 2012 alcohol caused an estimated 231,900 deaths (95% UI: 185,600 to 278,200) (70,800 deaths among women and 161,100 deaths among men) and 13,295,000 DALYs lost (95% UI: 11,242,000 to 15,348,000) (3,670,000 DALYs lost among women and 9,625,000 DALYs lost among men) among people 0 to 64 years of age. This compares to an estimated 165,600 deaths (95% UI: 97,200 to 228,100) (29,700 deaths among women and 135,900 deaths among men) and 10,623,000 DALYs lost (95% UI: 7,265,000 to 13,754,000) (1,783,000 DALYs lost among women and 8,840,000 DALYs lost among men) among people 0 to 64 years of age caused by alcohol when non-Russia-specific alcohol RRs were used. Results indicate that if the Russia-specific RRs are used when estimating the health burden attributable to alcohol consumption in

Metal accumulation in marine bivalves under various tributyltin burdens.

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Tang, Chuan-Ho; Lin, Chan-Shing; Wang, Wei-Hsien

2009-11-01

In the present study, a field survey was conducted to measure the accumulation of butyltin, Cu, Zn, and Cd in green mussels (Perna viridis) and Pacific oysters (Crassostrea gigas) at the regions along a tributyltin pollution gradient. A negative correlation was found between the tributyltin/total butyltin ratio (0.87-0.31) and tributyltin content (114-5,817 ng/g as tin dry wt) in oysters, while the Cu content (44.2-381 mg/kg dry wt) was positively correlated with the logarithm of tributyltin content during the summer and winter. This suggests that as the tributyltin burden increases, the rates of tributyltin metabolism may be elevated, leading to enhanced Cu accumulation. A similar accumulation pattern for Zn was also found in oysters. In mussels, however, the tributyltin/total butyltin ratio and the Cu and Zn contents remained relatively constant (~ 0.7, 12, and 100 mg/kg dry wt, respectively) regardless of the tributyltin burden. Clearly, the butyltin and Cu/Zn accumulation processes in oysters differ from those in mussels under tributyltin pollution. These observations provide valuable information for those who evaluate or compare tributyltin and/or Cu/Zn pollution using oysters and mussels as bioindicators.

The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya.

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Daniel R Feikin

Full Text Available BACKGROUND: Characterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions. METHODS: From June 1, 2006 to May 31, 2008, we estimated rates of acute lower respiratory tract illness (ALRI, diarrhea and acute febrile illness (AFI among >50,000 persons participating in population-based surveillance in impoverished, rural western Kenya (Asembo and an informal settlement in Nairobi, Kenya (Kibera. Field workers visited households every two weeks, collecting recent illness information and performing limited exams. Participants could access free high-quality care in a designated referral clinic in each site. Incidence and longitudinal prevalence were calculated and compared using Poisson regression. RESULTS: INCIDENCE RATES RESULTING IN CLINIC VISITATION WERE THE FOLLOWING: ALRI--0.36 and 0.51 episodes per year for children <5 years and 0.067 and 0.026 for persons ≥ 5 years in Asembo and Kibera, respectively; diarrhea--0.40 and 0.71 episodes per year for children <5 years and 0.09 and 0.062 for persons ≥ 5 years in Asembo and Kibera, respectively; AFI--0.17 and 0.09 episodes per year for children <5 years and 0.03 and 0.015 for persons ≥ 5 years in Asembo and Kibera, respectively. Annually, based on household visits, children <5 years in Asembo and Kibera had 60 and 27 cough days, 10 and 8 diarrhea days, and 37 and 11 fever days, respectively. Household-based rates were higher than clinic rates for diarrhea and AFI, this difference being several-fold greater in the rural than urban site. CONCLUSIONS: Individuals in poor Kenyan communities still suffer from a high burden of infectious diseases, which likely hampers their development. Urban slum and rural disease incidence and clinic utilization are sufficiently disparate in Africa to warrant data from both settings for estimating burden and focusing interventions.

Socioeconomic Risk Factors for Celiac Disease Burden and Symptoms.

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Oza, Sveta S; Akbari, Mona; Kelly, Ciarán P; Hansen, Joshua; Theethira, Thimmaiah; Tariq, Sohaib; Dennis, Melinda; Leffler, Daniel A

2016-04-01

Celiac disease (CD) affects approximately 1% of the population and negatively affects aspects of life including physical and social function. The relationship between socioeconomic (SE) factors, symptom severity, and perceived burden of living with CD is not well understood. The objective of this study was to assess the relationships between income, symptoms, and perceived burden of CD. In this survey study conducted at a tertiary care center, 773 patients 18 years of age or more with biopsy confirmed CD were eligible to participate. Patients completed a survey with information on SE data, the validated Celiac Symptom Index (CSI), and visual analog scales (VAS) assessing overall health, CD-related health, difficulty in following a gluten-free diet (GFD), and importance of following a GFD. Three hundred forty one patients completed the survey. Higher income predicted better overall health, better CD related health, and fewer symptoms. In the logistic regression model, low income was associated with greater CD symptoms (odds ratio=6.04, P=0.002). Other factors associated with greater symptoms were younger age, poor overall health state, and more physician visits. Factors associated with increased burden of CD included hospitalizations, more symptoms, poor overall health state, and burden of following a GFD. Patients with lower incomes have worse CD-related health and greater symptoms. Those with low income had 6 times the odds of greater symptoms compared with those with high income. Our data suggest that income is associated with perceived overall health, CD-related health, and CD symptoms.

Total Body Capacitance for Estimating Human Basal Metabolic Rate in an Egyptian Population

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M. Abdel-Mageed, Samir; I. Mohamed, Ehab

2016-01-01

Determining basal metabolic rate (BMR) is important for estimating total energy needs in the human being yet, concerns have been raised regarding the suitability of sex-specific equations based on age and weight for its calculation on an individual or population basis. It has been shown that body cell mass (BCM) is the body compartment responsible for BMR. The objectives of this study were to investigate the relationship between total body capacitance (TBC), which is considered as an expression for BCM, and BMR and to develop a formula for calculating BMR in comparison with widely used equations. Fifty healthy nonsmoking male volunteers [mean age (± SD): 24.93 ± 4.15 year and body mass index (BMI): 25.63 ± 3.59 kg/m2] and an equal number of healthy nonsmoking females matched for age and BMI were recruited for the study. TBC and BMR were measured for all participants using octopolar bioelectric impedance analysis and indirect calorimetry techniques, respectively. A significant regressing equation based on the covariates: sex, weight, and TBC for estimating BMR was derived (R=0.96, SEE=48.59 kcal, and P<0.0001), which will be useful for nutritional and health status assessment for both individuals and populations. PMID:27127453

Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study.

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Lou, Peian; Zhu, Yanan; Chen, Peipei; Zhang, Pan; Yu, Jiaxi; Zhang, Ning; Chen, Na; Zhang, Lei; Wu, Hongmin; Zhao, Jing

2012-04-20

The incidence of chronic obstructive pulmonary disease (COPD) in China is very high. This study aimed to assess the vulnerability of COPD patients in rural areas outside Xuzhou City, Jiangsu province, in order to provide helpful guidance for future research and public policies. The vulnerability of 8,217 COPD patients was evaluated using a face-to-face questionnaire to obtain information on general characteristics, awareness, beliefs, medication usage, acute exacerbation of the disease, and economic burdens. Direct economic burdens were calculated based on the questionnaire, and indirect economic burdens were estimated using local per capita income and life expectancy in 2008. The years of potential life lost were calculated using loss of life years for each age group and multiplying by the number of deaths in a given age group. Of the 8,217 patients, 7,921 (96.4%) had not heard of COPD, and 2,638 (32.1%) did not understand that smoking was a risk factor for COPD. No patients had used inhalers, nebulizer drugs or oxygen therapy, either regularly or sporadically. No patients had undergone pulmonary rehabilitation or surgical treatment, while 4,215 (51.3%) took theophylline to relieve dyspnea, and 3,418 (41.6%) used antibiotics to treat exacerbations. A total of 2,925 (35.6%) patients had been admitted to hospital during the past year because of respiratory symptoms. The average direct and indirect economic burdens on COPD patients were 1,090 and 20,605 yuan, respectively. The vulnerability of patients in rural Xuzhou to COPD was high. Their awareness of COPD was poor, their treatment during both the stable and acute exacerbation stages did not meet standards, and the economic burdens were large. Interventions are therefore needed to improve the prevention and management of COPD in this population. Further studies are required to verify these findings.

Body burden of Hg in different bio-samples of mothers in Shenyang city, China.

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Min-Ming Li

Full Text Available Hg is an accumulative and neuro-toxic heavy metal which has a wide range of adverse effects in human health. However, few studies are available on body burden of Hg level in different bio-samples of pregnant women in Chinese population. Therefore, this study evaluated Hg levels in different maternal bio-samples in Shenyang city, China and investigated the correlation of Hg levels in different bio-samples. From October to December 2008, 200 pregnant women about to deliver their babies at ShengJing Hospital (Shenyang city, northeast of China participated in this study. The geometric mean (GM of Hg levels in cord blood, maternal venous blood, breast milk, and maternal urine were 2.18 µg/L, 1.17 µg/L, 1.14 µg/L, and 0.73 µg/L, respectively, and the GM of maternal hair Hg level was 404.45 µg/kg. There was a strong correlation between cord blood and maternal blood total Hg level (r = 0.713, P<0.001. Frequency of fish consumption more than or equal to 3 times per week during pregnancy was suggested as a significant risk factor of prenatal Hg exposure (unadjusted OR 3.5, adjusted OR 2.94, P<0.05. This study provides evidence about Hg burden of mothers and the risk factors of prenatal Hg exposure in Shenyang city, China.

One world health: socioeconomic burden and parasitic disease control priorities.

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Torgerson, Paul R

2013-08-01

Parasitic diseases present a considerable socio-economic impact to society. Zoonotic parasites can result in a considerable burden of disease in people and substantive economic losses to livestock populations. Ameliorating the effects of these diseases may consist of attempts at eradicating specific diseases at a global level, eliminating them at a national or local level or controlling them to minimise incidence. Alternatively with some parasitic zoonoses it may only be possible to treat human and animal cases as they arise. The choice of approach will be determined by the potential effectiveness of a disease control programme, its cost and the cost effectiveness or cost benefit of undertaking the intervention. Furthermore human disease burden is being increasingly measured by egalitarian non-financial measures which are difficult to apply to livestock. This adds additional challenges to the assessment of socio-economic burdens of zoonotic diseases. Using examples from the group of neglected zoonotic diseases, information regarding the socio-economic effects is reviewed together with how this information is used in decision making with regard to disease control and treatment. Copyright © 2013 Elsevier B.V. All rights reserved.

The burden of gunshot injuries on orthopaedic healthcare resources in South Africa.

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Martin, Case; Thiart, Gerhard; McCollum, Graham; Roche, Stephen; Maqungo, Sithombo

2017-06-30

Injuries inflicted by gunshot wounds (GSWs) are an immense burden on the South African (SA) healthcare system. In 2005, Allard and Burch estimated SA state hospitals treated approximately 127 000 firearm victims annually and concluded that the cost of treating an abdominal GSW was approximately USD1 467 per patient. While the annual number of GSW injuries has decreased over the past decade, an estimated 54 870 firearm-related injuries occurred in SA in 2012. No study has estimated the burden of these GSWs from an orthopaedic perspective. To estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in an SA tertiary level hospital. This retrospective study surveyed more than 1 500 orthopaedic admissions over a 12-month period (2012) at Groote Schuur Hospital, Cape Town, SA. Chart review subsequently yielded data that allowed analysis of cost, theatre time, number and type of implants, duration of admission, diagnostic imaging studies performed, blood products used, laboratory studies ordered and medications administered. A total of 111 patients with an average age of 28 years (range 13 - 74) were identified. Each patient was hit by an average of 1.69 bullets (range 1 - 7). These patients sustained a total of 147 fractures, the majority in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures, with a cumulative surgical theatre time of >306 hours. Theatre costs, excluding implants, were in excess of USD94 490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD53 381 cumulatively, or USD667 per patient. Patients remained hospitalised for an average of 9.75 days, and total ward costs exceeded USD130 400. Individual patient costs averaged about USD2 940 (ZAR24 945) per patient. This study assessed the burden of orthopaedic firearm injuries in SA. It was estimated that on average, treating an orthopaedic GSW patient

Burden experience of caregivers of acute lymphoblastic leukemia: Impact of coping and spirituality

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Usha Chivukula

2018-01-01

Full Text Available Background: When a child is diagnosed with cancer the parents as caregivers experience severe anxiety, trauma, ambiguity, and grief. Caregivers of cancer patients thus deal with the management of their own psychological distress along with the child's illness.Aim: Coping plays a crucial role in improving the caregivers' physical and emotional well-being. Spirituality is an important means of consolation, strength, and emotional support during this phase. The present study aims to investigate the impact of coping and spirituality on caregiver burden.Methods: A total of 100 caregivers of children between the age group of 3–11 years, diagnosed with acute lymphoblastic leukemia were the participants of the study. The participants were recruited from cancer hospitals in Hyderabad. The study adopted a between-group design to find out if mothers and fathers differed in their coping strategies, spirituality, and caregiver burden. The study also adopted a correlation design to find the relationship between coping, spirituality, and caregiver burden. Descriptive statistics and multiple linear regression analysis were conducted to identify if coping and spirituality predict caregiver burden.Results: The results showed no significant difference in the burden experienced by both mothers and fathers; however, mothers and fathers used different coping strategies and differed on the dimensions of spirituality. The results of multiple linear regression indicated that dimensions of coping and spirituality were significant predictors of caregiver burden.Conclusion: Cancer in the child impacts the parent's burden but providing sufficient support and implementing effective coping strategies, will help in mitigating the intensity of caregiver burden. It is essential that the hospital authorities and policymakers understand that a professional health psychologist could be a liaison between the doctor, patient, and the caregiver in bringing down the levels of burden

Economic burden of deep infiltrating endometriosis of the bowel and the bladder in Germany: The statutory health insurance perspective.

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Koltermann, Katharina C; Schlotmann, Andreas; Schröder, Helmut; Willich, Stefan N; Reinhold, Thomas

2016-12-01

Until now, there has been little discussion of the costs of the deep infiltrating endometriosis (DIE) of the bowel or the bladder. The aim of the present secondary data analysis was to describe the population affected by this disease and to determine the economic burden in Germany from a payer's perspective. Health claims data of women diagnosed with DIE of the bladder or bowel, who were surgically treated as inpatients between Jan 1, 2008 and Dec 31, 2012, were evaluated retrospectively. All data were extrapolated on a national statutory health insurance (SHI) level and normalized based on the year of surgery (index year). Case-individual information on age, comorbidities and prescribed drugs were presented for the index year. Direct medical cost data were analysed before and after the index year, differentiated by cost sector and age group. The data of 825 women with DIE were analysed. Sample size for different time points varied depending on insurance eligibility and continuous case information. The average age at surgery was 39 years. Besides DIE, 41 % of the women had at least one additional disease of the peritoneum. The mean annual total healthcare costs per DIE case were 12,868 Euros in the index year. Before surgery, mean annual costs varied between 548 and 2,475 Euros per case and after surgery between 1,739 and 2,818 Euros per case. In total, mean costs were higher in younger women as compared to older women, with a cost difference of 616 Euros over all time points. Direct costs are highest during the year of surgical treatment, but DIE of the bowel and bladder places a substantial burden on the SHI also before and after surgery. Further studies on indirect costs would be desirable to complete the knowledge on the economic burden of DIE. Copyright © 2016. Published by Elsevier GmbH.

Rationale, Design, and Methodological Aspects of the BUDAPEST-GLOBAL Study (Burden of Atherosclerotic Plaques Study in Twins-Genetic Loci and the Burden of Atherosclerotic Lesions).

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Maurovich-Horvat, Pál; Tárnoki, Dávid L; Tárnoki, Ádám D; Horváth, Tamás; Jermendy, Ádám L; Kolossváry, Márton; Szilveszter, Bálint; Voros, Viktor; Kovács, Attila; Molnár, Andrea Á; Littvay, Levente; Lamb, Hildo J; Voros, Szilard; Jermendy, György; Merkely, Béla

2015-12-01

The heritability of coronary atherosclerotic plaque burden, coronary geometry, and phenotypes associated with increased cardiometabolic risk are largely unknown. The primary aim of the Burden of Atherosclerotic Plaques Study in Twins-Genetic Loci and the Burden of Atherosclerotic Lesions (BUDAPEST-GLOBAL) study is to evaluate the influence of genetic and environmental factors on the burden of coronary artery disease. By design this is a prospective, single-center, classical twin study. In total, 202 twins (61 monozygotic pairs, 40 dizygotic same-sex pairs) were enrolled from the Hungarian Twin Registry database. All twins underwent non-contrast-enhanced computed tomography (CT) for the detection and quantification of coronary artery calcium and for the measurement of epicardial fat volumes. In addition, a single non-contrast-enhanced image slice was acquired at the level of L3-L4 to assess abdominal fat distribution. Coronary CT angiography was used for the detection and quantification of plaque, stenosis, and overall coronary artery disease burden. For the primary analysis, we will assess the presence and volume of atherosclerotic plaques. Furthermore, the 3-dimensional coronary geometry will be assessed based on the coronary CT angiography datasets. Additional phenotypic analyses will include per-patient epicardial and abdominal fat quantity measurements. Measurements obtained from monozygotic and dizygotic twin pairs will be compared to evaluate the genetic or environmental effects of the given phenotype. The BUDAPEST-GLOBAL study provides a unique framework to shed some light on the genetic and environmental influences of cardiometabolic disorders. © 2015 Wiley Periodicals, Inc.

Burden of thalassemia in India: The road map for control

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Roshan Colah

2017-12-01

Full Text Available The thalassemias and structural haemoglobin variants are the commonest monogenic disorders globally. India has a huge burden with an estimated 100,000 patients with a β thalassemia syndrome and around 150,000 patients with sickle cell disease, but few among them are optimally managed, and allogeneic stem cell transplant is unaffordable for the majority of families. A feasible option for control is to promote education and awareness programmes, intensify screening in all the states with micromapping to assess the true burden, and develop adequate facilities for genetic counselling and prenatal diagnosis in public sector Institutions. Government and non-government organizations have been working towards this goal for the last 3 to 4 decades but community control in a vast and diverse country is challenging and a national programme reaching all rural regions where almost 70% of the population resides is yet to begin. Strategies to control thalassemia need to include 1 Educating health professionals, school and college students, pregnant women and the population at large 2 Establishing prenatal diagnosis facilities in different regions of the country 3 Setting up a greater number of Day Care Centres for managing existing thalassemia patients 4 Developing cost-effective facilities for stem cell transplantation across the country. This review explores strategies by which Central and State Governments, NGOs, Parents-Patients Societies and Corporate Houses can work together to successfully reduce the burden of hemoglobinopathies in India. Guidelines for implementation of such a national programme have recently been prepared by the National Health Mission, Ministry of Health and Family Welfare with the help of several experts in the country.

The global nutrition transition: trends, disease burdens and policy interventions.

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Ronto, Rimante; Wu, Jason Hy; Singh, Gitanjali M

2018-03-06

Non-communicable diseases (NCD) have increased dramatically in developed and developing countries. Unhealthy diet is one of the major factors contributing to NCD development. Recent evidence has identified deterioration in aspects of dietary quality across many world regions, including low- and middle-income countries (LMIC). Most burdens of disease attributable to poor diet can be prevented or delayed as they occur prematurely. Therefore, it is important to identify and target unhealthy dietary behaviours in order to have the greatest impact. National dietary-related programmes have traditionally focused on micronutrient deficiency and food security and failed to acknowledge unhealthy dietary intakes as a risk factor that contributes to the development of NCD. Inadequate intakes of healthy foods and nutrients and excess intakes of unhealthy ones are commonly observed across the world, and efforts to reduce the double burden of micronutrient deficiency and unhealthy diets should be a particular focus for LMIC. Interventions and policies targeting whole populations are likely to be the most effective and sustainable, and should be prioritized. Population-based approaches such as health information and communication campaigns, fiscal measures such as taxes on sugar-sweetened beverages, direct restrictions and mandates, reformulation and improving the nutrient profile of food products, and standards regulating marketing to children can have significant and large impacts to improve diets and reduce the incidence of NCD. There is a need for more countries to implement population-based effective approaches to improve current diets.

Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study.

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Mueller, Martin; Strobl, Ralf; Jahn, Klaus; Linkohr, Birgit; Peters, Annette; Grill, Eva

2014-10-01

Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5% (6.6 to 15.1) in men and 9.0% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Financial burden is associated with worse health-related quality of life in adults with multiple endocrine neoplasia type 1.

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Peipert, Benjamin J; Goswami, Sneha; Helenowski, Irene; Yount, Susan E; Sturgeon, Cord

2017-12-01

Health-related quality of life and financial burden among patients with multiple endocrine neoplasia type 1 is poorly described. It is not known how financial burden influences health-related quality of life in this population. We hypothesized that the financial burden attributable to multiple endocrine neoplasia type 1 is associated with worse health-related quality of life. United States adults (≥18 years) with multiple endocrine neoplasia type 1 were recruited from the AMENSupport MEN online support group. Patient demographics, clinical characteristics, and financial burden were assessed via an online survey. The instrument Patient-Reported Outcomes Measurement Information System 29-item profile measure was used to assess health-related quality of life. Multivariable linear regression was used to identify significant variables in each Patient-Reported Outcomes Measurement Information System domain. Out of 1,378 members in AMENSupport, our survey link was accessed 449 times (33%). Of 153 US respondents who completed our survey, 84% reported financial burden attributable to multiple endocrine neoplasia type 1. The degree of financial burden had a linear relationship with worse health-related quality of life across all Patient-Reported Outcomes Measurement Information System domains (r = 0.36-0.55, P financial event(s). Borrowing money from friends/family (30%), unemployment (13%), and spending >$100/month out-of-pocket on prescription medications (46%) were associated consistently with impaired health-related quality of life (ß = 3.75-6.77, P times more likely to be unemployed and declare bankruptcy than the US population, respectively. This study characterizes the financial burden in patients with multiple endocrine neoplasia type 1. Individuals with multiple endocrine neoplasia type 1 report a high degree of financial burden, negative financial events, and unemployment. Each of these factors was associated with worse health-related quality of life

Validating a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for dementia caregivers.

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Tang, Jennifer Yee-Man; Ho, Andy Hau-Yan; Luo, Hao; Wong, Gloria Hoi-Yan; Lau, Bobo Hi-Po; Lum, Terry Yat-Sang; Cheung, Karen Siu-Lan

2016-09-01

The present study aimed to develop and validate a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for Hong Kong Chinese dementia caregivers. The 12-item Zarit Burden Interview (ZBI) was translated into spoken Cantonese and back-translated by two bilingual research assistants and face validated by a panel of experts. Five hundred Chinese dementia caregivers showing signs of stress reported their burden using the translated ZBI and rated their depressive symptoms, overall health, and care recipients' physical functioning and behavioral problems. The factor structure of the translated scale was identified using principal component analysis and confirmatory factor analysis; internal consistency and item-total correlations were assessed; and concurrent validity was tested by correlating the ZBI with depressive symptoms, self-rated health, and care recipients' physical functioning and behavioral problems. The principal component analysis resulted in 11 items loading on a three-factor model comprised role strain, self-criticism, and negative emotion, which accounted for 59% of the variance. The confirmatory factor analysis supported the three-factor model (CZBI-Short) that explained 61% of the total variance. Cronbach's alpha (0.84) and item-total correlations (rho = 0.39-0.71) indicated CZBI-Short had good reliability. CZBI-Short showed correlations with depressive symptoms (r = 0.50), self-rated health (r = -0.26) and care recipients' physical functioning (r = 0.18-0.26) and disruptive behaviors (r = 0.36). The 12-item CZBI-Short is a concise, reliable, and valid instrument to assess burden in Chinese dementia caregivers in clinical and social care settings.

Plasma based markers of [11C] PiB-PET brain amyloid burden.

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Steven John Kiddle

Full Text Available Changes in brain amyloid burden have been shown to relate to Alzheimer's disease pathology, and are believed to precede the development of cognitive decline. There is thus a need for inexpensive and non-invasive screening methods that are able to accurately estimate brain amyloid burden as a marker of Alzheimer's disease. One potential method would involve using demographic information and measurements on plasma samples to establish biomarkers of brain amyloid burden; in this study data from the Alzheimer's Disease Neuroimaging Initiative was used to explore this possibility. Sixteen of the analytes on the Rules Based Medicine Human Discovery Multi-Analyte Profile 1.0 panel were found to associate with [(11C]-PiB PET measurements. Some of these markers of brain amyloid burden were also found to associate with other AD related phenotypes. Thirteen of these markers of brain amyloid burden--c-peptide, fibrinogen, alpha-1-antitrypsin, pancreatic polypeptide, complement C3, vitronectin, cortisol, AXL receptor kinase, interleukin-3, interleukin-13, matrix metalloproteinase-9 total, apolipoprotein E and immunoglobulin E--were used along with co-variates in multiple linear regression, and were shown by cross-validation to explain >30% of the variance of brain amyloid burden. When a threshold was used to classify subjects as PiB positive, the regression model was found to predict actual PiB positive individuals with a sensitivity of 0.918 and a specificity of 0.545. The number of APOE [Symbol: see text] 4 alleles and plasma apolipoprotein E level were found to contribute most to this model, and the relationship between these variables and brain amyloid burden was explored.

The economic burden of cancer in Korea in 2009.

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Kim, So Young; Park, Jong-Hyock; Kang, Kyoung Hee; Hwang, Inuk; Yang, Hyung Kook; Won, Young-Joo; Seo, Hong-Gwan; Lee, Dukhyoung; Yoon, Seok-Jun

2015-01-01

Cancer imposes a significant economic burden on individuals, families and society. The purpose of this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry data in Korea in 2009. The economic burden of cancer was estimated using the prevalence data where patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical, morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claims data obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included the cost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs for complementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office and Ministry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wages on average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed to derive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical care accounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%) costs. Given that the direct medical cost sharply increased over the last decade, we must strive to construct a sustainable health care system that provides better care while lowering the cost. In addition, a comprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work has become more important than previously considered.

Does published research on non-communicable disease (NCD in Arab countries reflect NCD disease burden?

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Abla M Sibai

Full Text Available To review trends in non-communicable (NCD research output in the Arab region, in terms of quantity and quality, study design, setting and focus. We also examined differences by time and place, and assessed gaps between research output and NCD burden.A scoping review of a total of 3,776 NCD-related reports published between 2000 and 2013 was conducted for seven Arab countries. Countries were selected to represent diverse socio-economic development levels in the region: Regression analyses were used to assess trends in publications over time and by country. Research gaps were assessed by examining the degree of match between proportionate literature coverage of the four main NCDs (CVD, cancer, DM, and COPD and cause-specific proportional mortality rates (PMR.The annual number of NCD publications rose nearly 5-fold during the study period, with higher income countries having the higher publication rates (per million populations and the most rapid increases. The increase in the publication rate was particularly prominent for descriptive observational studies, while interventional studies and systematic reviews remained infrequent (slope coefficients = 13.484 and 0.883, respectively. Gap analysis showed a mismatch between cause-specific PMR burden and NCD research output, with a relative surplus of reports on cancer (pooled estimate +38.3% and a relative deficit of reports on CVDs (pooled estimate -30.3%.The widening disparity between higher and lower-income countries and the discordance between research output and disease burden call for the need for ongoing collaboration among Arab academic institutions, funding agencies and researchers to guide country-specific and regional research agendas, support and conduct.

Exploring caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in Nigeria

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Yemisi Okikiade Oyegbile

Full Text Available Background: Family caregivers in many African countries bear the burden of caregiving alone, with the paucity of research, especially for caregivers of End-Stage Renal Disease patients, having concealed their needs. Aim: To explore the caregiver burden of family caregivers of End-Stage Renal Disease (ESRD patients in South-West Nigeria. Design: Following a complementary mixed method data collection strategy, the quantitative data was collected using the Zarit Burden Interview questionnaire to measure the burden of caregiving. Qualitative data was thereafter obtained through in-depth, individual interviews and was analysed using content analysis. Settings: The three research settings consisted of two state hospitals and one private hospital that provide renal care in South-West Nigeria. Result: The mean burden of caregiving for the sample was 50.18 thus indicating that family caregivers experienced moderate to severe burden, which is high compared to the other studies. The participants’ experiences of caregiving revealed the following categories: total dependence, acceptance of caregiving role, competing responsibilities, financial sacrifice and “not making mistakes”. Conclusion: Understanding the extent of caregiver burden, what constitutes burden to family caregivers in low/middle-income countries, and the difficulties associated with caregiving for care-recipients with ESRD, allows appropriate strategies and interventions to be developed. Keywords: End Stage Renal Disease, Family caregivers, Caregiver burden, Complementary mixed methods, Nigeria

The social and economic burden of frontotemporal degeneration.

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Galvin, James E; Howard, David H; Denny, Sharon S; Dickinson, Susan; Tatton, Nadine

2017-11-14

To quantify the socioeconomic burden of frontotemporal degeneration (FTD) compared to previously published data for Alzheimer disease (AD). A 250-item internet survey was administered to primary caregivers of patients with behavioral-variant FTD (bvFTD), primary progressive aphasia, FTD with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. The survey included validated scales for disease staging, behavior, activities of daily living, caregiver burden, and health economics, as well as investigator-designed questions to capture patient and caregiver experience with FTD. The entire survey was completed by 674 of 956 respondents (70.5%). Direct costs (2016 US dollars) equaled $47,916 and indirect costs $71,737, for a total annual per-patient cost of $119,654, nearly 2 times higher than reported costs for AD. Patients ≥65 years of age, with later stages of disease, and with bvFTD correlated with higher direct costs, while patients <65 years of age and men were associated with higher indirect costs. An FTD diagnosis produced a mean decrease in household income from $75,000 to $99,000 12 months before diagnosis to $50,000 to $59,999 12 months after diagnosis, resulting from lost days of work and early departure from the workforce. The economic burden of FTD is substantial. Counting productivity-related costs, per-patient costs for FTD appear to be greater than per-patient costs reported for AD. There is a need for biomarkers for accurate and timely diagnosis, effective treatments, and services to reduce this socioeconomic burden. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

The burden of non-melanoma skin cancers in Auckland, New Zealand.

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Pondicherry, Ashwini; Martin, Richard; Meredith, Ineke; Rolfe, Jack; Emanuel, Patrick; Elwood, Mark

2018-01-19

As the New Zealand Cancer Registry does not require mandatory reporting of non-melanoma skin cancers (NMSC), basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), the clinical burden of these diseases is unknown. A retrospective review of all patients with histopathology performed allowed us to estimate invasive BCC and SCC in the Auckland region in 2008 (population 1.44 million). During this period, a total of 21 236 NMSC were diagnosed among 13 996 patients, consisting of 5611 SCC lesions (26%) and 15 525 (74%) BCC. The Auckland incidence rates per 100 000 were 425 for SCC and 1177 for BCC. The overall rate of NMSC per 100 000 was 1906.5 (standardised to the census data of Australia 2001); 1385 for BCC and 522 for SCC. Using published data on incidence trends and population growth, we estimate that 29 000-33 000 NMSC would have been excised in Auckland in 2016, and 78 000-87 000 in New Zealand. Auckland has the highest reported incidence of invasive NMSC in the world. We believe that high-risk cutaneous SCC and complex BCC should be recorded. Our study provides information for clinicians and health economists on the scale of the problem. © 2018 The Australasian College of Dermatologists.

Study of Burden Among Caregivers of Children with Cleft Lip and Palate

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Ana Paula Ribeiro Razera

Full Text Available Abstract: The psychological and physical health of caregivers of children with cleft lip and palate can be strongly influenced by the child’s condition and behavior, and care required by the treatment. This study’s objective was to identify overload levels among these caregivers. A total of 100 caregivers, whose children were in the perioperative period of cheiloplasty and/or palatoplasty, were interviewed using the Scale Burden Interview. The data were analyzed quantitatively. Moderate and moderate severe burden levels were identified in 43% of the sample. The mothers of children aged around 12 months presented significantly higher overload. The results indicate that children in this developmental stage present greater care demand because they seek autonomy in locomotion, explore objects in their surrounding environment, and continually request communicative and affective-social interaction with their reference to greater attachment (the caregiver, which may have contributed to higher burden.

Economic losses and burden of disease by medical conditions in Norway.

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Kinge, Jonas Minet; Sælensminde, Kjartan; Dieleman, Joseph; Vollset, Stein Emil; Norheim, Ole Frithjof

2017-06-01

We explore the correlation between disease specific estimates of economic losses and the burden of disease. This is based on data for Norway in 2013 from the Global Burden of Disease (GBD) project and the Norwegian Directorate of Health. The diagnostic categories were equivalent to the ICD-10 chapters. Mental disorders topped the list of the costliest conditions in Norway in 2013, and musculoskeletal disorders caused the highest production loss, while neoplasms caused the greatest burden in terms of DALYs. There was a positive and significant association between economic losses and burden of disease. Neoplasms, circulatory diseases, mental and musculoskeletal disorders all contributed to large health care expenditures. Non-fatal conditions with a high prevalence in working populations, like musculoskeletal and mental disorders, caused the largest production loss, while fatal conditions such as neoplasms and circulatory disease did not, since they occur mostly at old age. The magnitude of the production loss varied with the estimation method. The estimations presented in this study did not include reductions in future consumption, by net-recipients, due to premature deaths. Non-fatal diseases are thus even more burdensome, relative to fatal diseases, than the production loss in this study suggests. Hence, ignoring production losses may underestimate the economic losses from chronic diseases in countries with an epidemiological profile similar to Norway. Copyright © 2017 Elsevier B.V. All rights reserved.

The burden of serious fungal diseases in Russia.

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Klimko, N; Kozlova, Y; Khostelidi, S; Shadrivova, O; Borzova, Y; Burygina, E; Vasilieva, N; Denning, D W

2015-10-01

The incidence and prevalence of fungal infections in Russia is unknown. We estimated the burden of fungal infections in Russia according to the methodology of the LIFE program (www.LIFE-worldwide.org). The total number of patients with serious and chronic mycoses in Russia in 2011 was three million. Most of these patients (2,607,494) had superficial fungal infections (recurrent vulvovaginal candidiasis, oral and oesophageal candidiasis with HIV infection and tinea capitis). Invasive and chronic fungal infections (invasive candidiasis, invasive and chronic aspergillosis, cryptococcal meningitis, mucormycosis and Pneumocystis pneumonia) affected 69,331 patients. The total number of adults with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation was 406,082. © 2015 Blackwell Verlag GmbH.

Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: An opportunity for awareness creation

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Musa Ibrahim

2014-01-01

Full Text Available Background: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Materials and Methods: Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. Results: A total of 811 patients aged from 3 months (0.25 years to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1% were successfully operated, while the remaining 640 (78.9% could not benefit from a surgical procedure during the missions. There were n = 46 (26.9% patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. Conclusion: The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.

Burden of medically attended influenza infection and cases averted by vaccination — United States, 2013/14 through 2015/16 influenza seasons

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Jackson, Michael L.; Phillips, C. Hallie; Benoit, Joyce; Jackson, Lisa A.; Gaglani, Manjusha; Murthy, Kempapura; McLean, Huong Q.; Belongia, Edward A.; Malosh, Ryan; Zimmerman, Richard; Flannery, Brendan

2018-01-01

Background In addition to preventing hospitalizations and deaths due to influenza, influenza vaccination programs can reduce the burden of outpatient visits for influenza. We estimated the incidence of medically-attended influenza at three geographically diverse sites in the United States, and the cases averted by vaccination, for the 2013/14 through 2015/16 influenza seasons. Methods We defined surveillance populations at three sites from the United States Influenza Vaccine Effectiveness Network. Among these populations, we identified outpatient visits laboratory-confirmed influenza via active surveillance, and identified all outpatient visits for acute respiratory illness from healthcare databases. We extrapolated the total number of outpatient visits for influenza from the proportion of surveillance visits with a positive influenza test. We combined estimates of incidence, vaccine coverage, and vaccine effectiveness to estimate outpatient visits averted by vaccination. Results Across the three sites and seasons, incidence of medically attended influenza ranged from 14 to 54 per 1,000 population. Incidence was highest in children aged 6 months to 9 years (33 to 70 per 1,000) and lowest in adults aged 18-49 years (21 to 27 per 1,000). Cases averted ranged from 9 per 1,000 vaccinees (Washington, 2014/15) to 28 per 1,000 (Wisconsin, 2013/14). Discussion Seasonal influenza epidemics cause a considerable burden of outpatient medical visits. The United States influenza vaccination program has caused meaningful reductions in outpatient visits for influenza, even in years when the vaccine is not well-matched to the dominant circulating influenza strain. PMID:29249545

The burden of parasitic zoonoses in Nepal: a systematic review.

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Brecht Devleesschauwer

Full Text Available Parasitic zoonoses (PZs pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY. However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI: 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively, followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]. Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more

Assessment of the Future Health Burden Attributable to Undernutrition under the Latest Scenario Framework for Climate Change Research

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Ishida, Hiroyuki; Kobayashi, Shota; Yoshikawa, Sayaka; Kanae, Shinjiro; Hasegawa, Tomoko; Fujimori, Shinichiro; Shin, Yonghee; Takahashi, Kiyoshi; Masui, Toshihiko; Tanaka, Akemi; Honda, Yasushi

2014-05-01

There are growing concerns that future food security will be negatively affected by various factors, such as changes in socioeconomic and climate conditions. The health burden attributable to childhood undernutrition is among the most severe problems related to food crisis in the world. This study assessed the health burden attributable to childhood underweight through 2050 focusing on disability-adjusted life years (DALYs), by considering the latest scenarios for climate change studies (Representative Concentration Pathways (RCPs) and Shared Socioeconomic Pathways (SSPs)) and conducting sensitivity analysis. We used three SSPs (SSP1, SSP2 and SSP3) as future population and gross domestic products (GDP), three RCPs (RCP2.6, RCP4.5 and RCP8.5) for a greenhouse gas emissions constraint, and 12 Global Circulation Models (12 GCMs) to estimate climate conditions. A regression model for estimating DALYs attributable to childhood underweight (DAtU) was developed using the relationship between DAtU and childhood stunting. A logarithmic relationship was proposed for the regression model. We combined a global computable general equilibrium model, a crop model (M-GAEZ), and two regression models to assess the future health burden. We found that i) world total DAtU decreases from 2005 by 23 ~ 60% in 2030 depending on the socioeconomic scenarios. DAtU decreases further by 2050 for SSP1 and SSP2 scenario, whereas it slightly increases for SSP3. Per capita DAtU also decreases in all regions under either scenario in 2050, but the decreases vary significantly by regions and scenarios. ii) the impact of climate change is relatively small in the framework of this study but, on the other hand, socioeconomic conditions have a great impact on the future health burden. The impact of changes in socioeconomic conditions on the health burden is greater in the regions where current health burden is high. iii) parameter uncertainty of the regression models is the second largest factor on

Human leukocyte antigen class I (A, B and C) allele and haplotype variation in a South African Mixed ancestry population.

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Loubser, Shayne; Paximadis, Maria; Tiemessen, Caroline T

South Africa has a large (∼53million), ethnically diverse population (black African, Caucasian, Indian/Asian and Mixed ancestry) and a high disease burden (particularly HIV-1 and Mycobacterium tuberculosis). The Mixed ancestry population constitutes ∼9% of the total population and was established ∼365years ago in the Western Cape region through interracial mixing of black Africans, Europeans and Asians. Admixed populations present unique opportunities to identify genetic factors involved in disease susceptibility. Since HLA genes are important mediators of host immunity, we investigated HLA-A, -B and -C allele and haplotype diversity in 50 healthy, unrelated individuals recruited from the Mixed ancestry population. Copyright © 2017. Published by Elsevier Inc.

Asthma-chronic obstructive pulmonary disease overlap syndrome in the urban Chinese population: prevalence and disease burden using the 2010, 2012, and 2013 China National Health and Wellness Surveys.

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Ding, Bo; DiBonaventura, Marco; Karlsson, Niklas; Ling, Xia

2016-01-01

Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, few studies have studied this population in the People's Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China. Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935). Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD). A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls) who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls) were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2), work productivity, and health care resource use using generalized linear models. Patients with ACOS (N=366) comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People's Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively) and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively) and health care resource use (eg, physician visits in the past 6 months =5.13, 3.84, 4.65, and 2.39, respectively) compared with matched controls and patients with COPD only. Few significant differences were observed between patients with ACOS and asthma only. Patients with ACOS have a greater comorbidity burden and significantly worse health

Pathway to care for drug resistant tuberculosis cases identified during a retrospective study conducted in high TB burden wards in Mumbai.

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Lobo, Eunice; Shah, Shimoni; Rangan, Sheela; Dholakia, Yatin; Mistry, Nerges

2018-05-10

Background: Mumbai is witnessing a rising incidence of all forms of drug resistant tuberculosis (DR-TB). Methods: A population-based, retrospective study was conducted between April and July 2014, in 15 high TB burden wards in Mumbai, to capture the patient pathways to TB care. A total of 23 DR-TB patients were identified and their pathways to access DR-TB care were recorded using semi-structured interviews. Results: The total DR-TB pathway time of new patients (who did not report any past episode of TB) (180 days; IQR 123,346) was found to be more than twice that of retreatment patients (who reported a past episode of TB) (69 days; IQR 42,128). Conclusions: The unacceptable delay for diagnosis and treatment of DR-TB in Mumbai advocates for consistent implementation of early screening of patients using rapid gene-based technologies.

Tumor segmentation of whole-body magnetic resonance imaging in neurofibromatosis type 1 patients: tumor burden correlates

Energy Technology Data Exchange (ETDEWEB)

Heffler, Michael A.; Xi, Yin; Chhabra, Avneesh [University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Le, Lu Q. [University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, TX (United States)

2017-01-15

Segmentation of whole-body MRI (WBMRI) to assess the feasibility, quantitate the total tumor volume (tumor burden) in patients with neurofibromatosis type 1 (NF1) and examine associations with demographic, disease-related and anthropomorphic features. A consecutive series of patients with NF1 underwent WBMRI and were reviewed for tumors. Tumors were segmented using a semiautomated software-based tool. Tumors were classified as superficial or deep and discrete or plexiform. Segmentation times were recorded. Segmentation yielded the quantity and tumor burden of superficial, internal and plexiform tumors. Correlations between segmentation data and demographic, disease-related and anthropomorphic features were examined. Fifteen patients were evaluated (42.3 ± 13.6 years, 10 female, 5 male). Segmentation times were a median of 30 min and yielded 2,328 tumors (1,582 superficial, 746 internal and 23 plexiform). One tumor was malignant. Tumor counts ranged from 14 to 397. Tumor burden ranged from 6.95 cm3 to 571 cm3. Individual tumor volume ranged from 0.0120 cm3 to 298 cm3. Significant correlation was found between the total volume of superficial tumors and height (ρ = 0.5966, p < 0.02). Male patients had higher overall tumor burdens (p < 0.05) and higher superficial tumor burden (p < 0.03). Patients with negative family history had more tumors (p < 0.05). Segmentation of WBMRI in patients with NF1 is feasible and elucidates meaningful relationships among disease phenotype, anthropomorphic and demographic features. (orig.)

Tumor segmentation of whole-body magnetic resonance imaging in neurofibromatosis type 1 patients: tumor burden correlates

International Nuclear Information System (INIS)

Heffler, Michael A.; Xi, Yin; Chhabra, Avneesh; Le, Lu Q.

2017-01-01

Segmentation of whole-body MRI (WBMRI) to assess the feasibility, quantitate the total tumor volume (tumor burden) in patients with neurofibromatosis type 1 (NF1) and examine associations with demographic, disease-related and anthropomorphic features. A consecutive series of patients with NF1 underwent WBMRI and were reviewed for tumors. Tumors were segmented using a semiautomated software-based tool. Tumors were classified as superficial or deep and discrete or plexiform. Segmentation times were recorded. Segmentation yielded the quantity and tumor burden of superficial, internal and plexiform tumors. Correlations between segmentation data and demographic, disease-related and anthropomorphic features were examined. Fifteen patients were evaluated (42.3 ± 13.6 years, 10 female, 5 male). Segmentation times were a median of 30 min and yielded 2,328 tumors (1,582 superficial, 746 internal and 23 plexiform). One tumor was malignant. Tumor counts ranged from 14 to 397. Tumor burden ranged from 6.95 cm3 to 571 cm3. Individual tumor volume ranged from 0.0120 cm3 to 298 cm3. Significant correlation was found between the total volume of superficial tumors and height (ρ = 0.5966, p < 0.02). Male patients had higher overall tumor burdens (p < 0.05) and higher superficial tumor burden (p < 0.03). Patients with negative family history had more tumors (p < 0.05). Segmentation of WBMRI in patients with NF1 is feasible and elucidates meaningful relationships among disease phenotype, anthropomorphic and demographic features. (orig.)

Radiation burden of population in nuclear power plant siting

International Nuclear Information System (INIS)

Navratil, J.

The significance is discussed of the determination of the radiobiological consequences of normal operation and design basis accidents in nuclear power plant siting. The basic diagram and brief description is given of the programme for calculating the radiation load of the population in the surroundings of the nuclear power plant. The programme consists of two subprogrammes, i.e., the dispersion of radioactive gases (for normal operation and for accidents), the main programme for the determination of biological consequences and one auxiliary programme (the distribution of the population in the surroundings of the power plant). The four most important types of exposure to ionizing radiation are considered, namely inhalation, external irradiation from a cloud, ingestion (water, milk, vegetables), external irradiation from the deposit. (B.S.)

Economic Burden of Herpes Zoster ("culebrilla") in Latin America.

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Rampakakis, Emmanouil; Pollock, Clare; Vujacich, Claudia; Toniolo Neto, Joao; Ortiz Covarrubias, Alejandro; Monsanto, Homero; Johnson, Kelly D

2017-05-01

of this difference. The sensitivity analysis was generally robust to changes in the assumptions made. HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America. Copyright © 2017 Merck Research Labs. Published by Elsevier Ltd.. All rights reserved.

Financial Burden in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

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Nipp, Ryan D; Kirchhoff, Anne C; Fair, Douglas; Rabin, Julia; Hyland, Kelly A; Kuhlthau, Karen; Perez, Giselle K; Robison, Leslie L; Armstrong, Gregory T; Nathan, Paul C; Oeffinger, Kevin C; Leisenring, Wendy M; Park, Elyse R

2017-10-20

Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.

Macroeconomic implications of population ageing and selected policy responses.

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Bloom, David E; Chatterji, Somnath; Kowal, Paul; Lloyd-Sherlock, Peter; McKee, Martin; Rechel, Bernd; Rosenberg, Larry; Smith, James P

2015-02-14

Between now and 2030, every country will experience population ageing-a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population-a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries' economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties. Copyright © 2015 World Health Organization. Published by Elsevier Ltd

Caregiver burden among primary caregivers of patients undergoing peripheral blood stem cell transplantation: a cross sectional study.

Science.gov (United States)

Akgul, Nur; Ozdemir, Leyla

2014-08-01

This study aimed to identify caregiver burden and influencing factors on the burden in primary caregivers of peripheral blood stem cell transplantation patients within 2-12 months following transplant, indicating early recovery period after discharge. This descriptive cross sectional study was carried out at hematopoietic stem cell transplantation outpatient units of three university hospitals in Turkey. A total of 55 patient and caregiver dyads were recruited and interviewed. The data were collected using questionnaires developed by the researchers and caregiver burden was measured with the Zarit Burden Interview. The mean score of Zarit Burden Interview was 28.41 (SD = 13.90). Patients' symptoms including nausea and self depreciation feeling were related to greater caregiver burden. Self-depreciation was referred to feeling undervalued. The mean score of the tool was significantly higher in caregivers who have not been educated beyond primary school and also caregivers who had lower income. Caregivers who supported their patients to fulfill physical needs and who did not receive help for meeting patients' psychological needs had statistically more elevated levels of burden. Moreover, the extent of care giving activities undertaken was positively correlated with caregiver burden scores. While positive impact of the care giving process on family relations decreased caregiver burden; negative effect increased the burden. This study suggests that caregiver burden of primary caregivers caring for peripheral blood stem cell transplantation patients varies by education, income status, and the extent of care giving activities undertaken. Changes in family ties and relations due to care giving effected caregiver burden. Copyright © 2014 Elsevier Ltd. All rights reserved.

Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population.

Science.gov (United States)

Van Regenmortel, Niels; Verbrugghe, Walter; Roelant, Ella; Van den Wyngaert, Tim; Jorens, Philippe G

2018-04-01

Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes. We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity. Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids. Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.