Disability Adjusted Research Articles

Smartphone-based symbol-digit modalities test reliably captures brain damage in multiple sclerosis

As the burden of neurodegenerative diseases increases, time-limited clinic encounters do not allow quantification of complex neurological functions. Patient-collected digital biomarkers may remedy this, if they provide reliable information. However, psychometric properties of digital tools remain largely un-assessed. We developed a smartphone adaptation of the cognitive test, the Symbol-Digit Modalities Test (SDMT) by randomizing the test’s symbol-number codes and testing sequences. The smartphone SDMT showed comparable psychometric properties in 154 multiple sclerosis (MS) patients and 39 healthy volunteers (HV). E.g., smartphone SDMT achieved slightly higher correlations with cognitive subscores of neurological examinations and with brain injury measured by MRI (R2 = 0.75, Rho = 0.83, p < 0.0001) than traditional SDMT. Mathematical adjustment for motoric disability of the dominant hand, measured by another smartphone test, compensates for the disadvantage of touch-based test. Averaging granular home measurements of the digital biomarker also increases accuracy of identifying true neurological decline.

Relationship adjustment and quality among sexual minority persons with disabilities.

Little is known about romantic relationship adjustment or perceptions of relationship quality (e.g., commitment and trust) among sexual minority persons with disabilities. The purpose of this study was to explore if collective self-esteem, disability adjustment, attachment styles, and cultural humility served as unique correlates and predictors of relationship adjustment and relationship quality among sexual minority persons (e.g., lesbian, gay, bisexual, queer) with disabilities. Ninety-two participants identifying as sexual minority persons living with a variety of disabilities (e.g., physical, psychiatric, medical, neurological), and who were partnered with sexual minority persons not living with a disability, were recruited using Amazon Mechanical Turk to complete an electronic questionnaire. Responses of 92 participants were analyzed using bivariate correlations and 3 separate blockwise hierarchical regression models. To varying degrees, collective self-esteem, attachment styles, and cultural humility served as significant correlates and predictors of dyadic adjustment, commitment, and trust. Implications for clinical practice and future research are discussed. Rehabilitation psychologists and other health care providers are encouraged to consider collective self-esteem, attachment styles, and cultural humility when working with sexual minority persons with disabilities in romantic relationships. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alchajmerova bolest - epidemiološke karakteristike i prevencija

Alzheimer's disease is a progressive neurodegenerative brain disease that is of immense public health interest. Worldwide, according to data from 2018, the approximated number of people living with Alzheimer's was at a minimum 50 million. In the United States, according to data from 2021, there were as many as 6.2 million people age 65 and over living with Alzheimer's. In the last 20 years, Alzheimer's disease is being recorded 145.2% more frequently as the cause of death, partially due to the cause of death being more accurately attributed, but mostly due to the growing frequency of Alzheimer's disease due to the aging of the population. Based on years of life lost(YLL), Alzheimer's disease was the fourth, according to years of life with disability (YLD) nineteenth and according to the sum indicator DALY (Disability Adjusted Life Years) sixth leading cause of burden amongst diseases in the USA in 2016. The nonmodifiable risk factors for developing Alzheimer's disease are age, genetics, and family history, while the modifiable risk factors are smoking, diabetes, midlife obesity, hypertension, prehypertension, high cholesterol, insufficient physical activity, unhealthy diet, shorter length of formal education, low level of mental stimulation at work, traumatic brain injury, poor sleep, alcohol abuse, and hearing impairment. It is estimated that by reducing the modifiable risk factors, 40% of cases of Alzheimer's dementia can be prevented or postponed. The biomarkers that can be used for early detection of this disease are betaamyloid protein that forms beta-amyloid plaques, abnormal tau protein accumulated inside neurons, the existence of brain inflammation and atrophy. While we wait for researchers to find a cure for this illness, it is important to raise awareness of available screening methods for early detection of Alzheimer's disease and prevention opportunities.

The burden of disease and the cost of illness attributable to tuberculosis and HIV/aids associated to massive migration between colombia and venezuela

Aims &amp; objectives: The Venezuelan socio-political crisis has boosted massive exodus of Venezuelan citizens due to the shortage of medicines and spread of some preventable infectious diseases. We aimed to assess the impact of tuberculosis (TB) and HIV burden, health expenditure and the cost of illness under the framework of Colombian-Venezuelan migration flow focused on Norte de Santander, Santander, and La Guajira provinces. Methods: A retrospective study was conducted including TB and HIV data between 2009-2018. A database was made based on the records from the Colombian Surveillance System (SIVIGILA), official reports of the World Health Organization, Indexmundi, Global Health Observatory, IHME HIV Atlas and UNAIDS. Disability metrics in terms of DALYs (Disability Adjusted Life Years) and YLDs (Years Lived with Disability), were compared between both countries. Interactive maps were carried out by using ArcGIS program and the official migration data of Venezuelan citizens. We performed a phylogenetic analysis by retrieving pol sequences based in HIV cases from Venezuela and Colombia by using MEGA X and HIV Alamos database. Results: TB country profiles from Colombia and Venezuela were identical in terms of disease burden in 2017 and 2018. However, the Colombian public health settings reported an increase in the TB incidence above national average (22.1 cases per 100,000 inhabitants) in Santander, Norte de Santander and La Guajira provinces during the last years. Similar situation was observed regarding TB multidrug-resistant, prolonged hospital stays (150 days) and low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%). We identified an underfunding for HIV/AIDS control programs and patient care. Our DALY analysis showed an increased disability in HIV/AIDS patients (362.35 for 2017). Moreover, our phylogenetic analysis shows three defined clusters, which indicate specific linages through specific areas, and shared cluster in the Colombo-Venezuela border. Conclusions: This study suggests that the massive migration and program underfunding in Venezuela might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombo-Venezuelan border.

Advance Care Planning and Transitions to Comfort Measures after Stroke.

Background: Advance care planning (ACP) is recommended to align treatment with patient goals, although there has been little study of the impact of ACP on in-hospital stroke treatment. Objective: To examine the association between ACP and transitions to comfort measures after stroke. Design: Prospective cohort study. Setting/Subjects: Hospitalized stroke patients 45 years and older and surrogate decision makers from a population-based study in Corpus Christi, TX. Measurements: Surrogates were interviewed to assess presence of patient prestroke ACP, categorized as none, informal conversations only, or formal documentation. Patient records were reviewed for time from admission to transition to comfort measures only (CMO) (defined as in-hospital comfort measures or discharge with hospice services). Cox proportional-hazards models assessed the relationship between ACP and time to transition to CMO. Results: Of 148 included stroke patients, 37% transitioned to CMO (median time five days). For ACP, 44% had only informal conversations, 38% had formal documentation (98% of which also reported informal conversations), and 18% had neither. After adjustment for age, severity, and baseline disability, informal conversations alone (hazard ratio [HR] 3.55; 95% confidence interval [CI]: 1.35-9.33) and formal documentation (HR 2.85; 95% CI: 1.05-7.72) were associated with earlier transition to comfort measures compared to no ACP. There was no difference between formal documentation and informal conversations on time to comfort measures (HR 0.80, 95% CI: 0.40-1.63). Conclusions: There was no additional association of formal ACP documentation over informal conversations on time to transition to comfort measures after stroke. Further study of formal ACP is warranted.

Burden of Disease of Guillain-Barré Syndrome in Brazil before and during the Zika virus epidemic 2014-2016.

To estimate the burden of disease of Guillain-Barré syndrome (GBS) in Brazil in 2014, 1year before the Zika virus epidemic, and in 2015 and 2016 during the epidemic. The burden of disease of GBS was estimated using the summary measure of population health: Disability Adjusted Life Years (DALY), that combines both mortality (Years of Life Lost YLLs) and morbidity (Years Lived with Disability) components. The study population was composed of GBS hospitalised cases and deaths from the information systems of the Brazilian Unified Health System. The GBS incidence rate in 2014, 2015 and 2016 was 0.74, 0.96, 1.02/100000 respectively, and the mortality rate in the same period was 0.08, 0.009 and 0.11/100000 habitants. The DALYs calculated using the point estimate of GBS disability weight and its values of the confidence interval (0.198 and 0.414) were 5725.90 (5711.79-5742.89) in 2014, 6054.61 (6035.57-6077.54) in 2015 and 7588.49 (7570.20-7610.51) in 2016. The DALYs were high among the male population and in age groups between 20 and 50years. The increase in DALYs in the years 2015 and 2016 compared to 2014 probably resulted from the introduction of ZIKV in Brazil, reinforcing the importance of investments in the prevention of ZIKV infection and in the care of GBS patients.

Family-based Interventions Benefit Individuals With Musculoskeletal Pain in the Short-term but not in the Long-Term: A Systematic Review and Meta-Analysis.

The benefits of family-based interventions for patients with musculoskeletal pain have been previously shown in individual randomized controlled trials (RCTs), but no systematic review has summarized their effects. A systematic review was conducted to assess the effectiveness of family-based interventions on clinical and biopsychosocial outcomes in people with musculoskeletal pain (PROSPERO CRD42018118442). Meta-analyses were performed for the outcomes of pain intensity, disability, mood, self-efficacy, and marital adjustment. Of 1223 records identified, 18 reports representing 15 RCTs were included in the qualitative review and 10 in the meta-analyses. Family-based interventions were more effective to reduce pain (mean difference [MD], -3.55/100; 95% confidence intreval [CI], -4.03 to -3.06) and disability (MD, -1.51/100; 95% CI, -1.98 to -1.05) than individual-focused interventions at short-term, but not at mid term or long term. There were no effects on other outcomes. Family-based interventions were more effective to reduce pain (MD, -6.05/100; 95% CI, -6.78 to -5.33) compared with usual care only at short-term. No effects were found on disability and other outcomes. There is moderate-quality evidence that family-based interventions result in small, significantly better pain and disability outcomes in the short-term compared with individual-focused interventions in patients with musculoskeletal pain. Based on low-quality evidence, family-based interventions result in small improvements on pain in the short-term compared with usual care. Future studies should review the content and optimize the mechanisms underpinning family-based interventions in musculoskeletal pain so that the approach could be further tested in adequately powered RCTs.

Thinking about Disability Adjustment：Consideration from the Scene of Support

本稿は，第56回日本リハビリテーション医学会学術集会における指定パネル：障害受容の教育講演に大幅な加筆・修正をした内容となっている．「障害受容」のリハビリテーション医療の臨床場面での使用法について，2007年時と2020年時のインタビュー調査結果の比較検討を行い，「障害受容」の使用法からみえる今後の課題について考察を行った．

Social and Economic Costs of Attention-Deficit/Hyperactivity Disorder Across the Lifespan

Objective: To determine the financial and non-financial costs of Attention-Deficit/Hyperactivity Disorder (ADHD) across the lifespan. Method: The population costs of ADHD in Australia were estimated for the financial year 2018 to 2019 using a prevalence approach to cost estimation across all ages. Financial (healthcare, productivity, education and justice systems, and deadweight losses) and non-financial costs were measured (Disability Adjusted Life Years (DALYs)). Results: The total social and economic cost of ADHD in 2018 to 2019 were US$12.76 billion (range US$8.40 billion to US$17.44 billion, with per person costs of US$15,664 per year). Productivity costs made up 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was significant (US$5.31 billion). Conclusion: There is a need to raise public awareness of the considerable socioeconomic impact and burden of ADHD in order to drive investment and policy decisions that improve identification and treatment of ADHD.

The economic risk from COVID-19 in Pacific Island countries: very few infections but lots of pain

We forecast the economic loss from COVID-19 in Pacific Island countries using pre-pandemic data. Applying a risk measure proposed by Noy et al. (2020a. Measuring the Economic Risk of COVID-19. Global Policy. Forthcoming), we use pre-COVID data to compute principal component indices for exposure, vulnerability, and resilience to COVID risk in the Pacific. We rank all the Pacific Island Countries according to their risk profile. Alternatively, we use the concept of Lost Life-Years (LLY), developed in Noy (2016. A Global Comprehensive Measure of the Impact of Natural Hazards and Disasters. Global Policy, 7(1), 56–65), and derived from the World Health Organization’s Disability Adjusted Life Years (DALYs) method. We use the calculations of LLY to examine economic loss based on the forecasted losses associated with the declines in tourism, and with future growth, as predicted by the Asian Development Bank. The ranking of risk across the Pacific countries for each of these alternative measures is then compared.

Early Tuberculosis Screening in People Living with HIV: A Cost-Effectiveness Analysis Alongside a Pragmatic Clinical Trial in Brazil

Background: Although TB can be treated effectively, its early diagnosis in People Living with HIV (PLHIV) is still a challenge. We assessed the cost-effectiveness of a symptom-based screening for TB diagnosis in PLHIV compared with the hospital routine in Brazil. Methods: The economic evaluation was conducted alongside a randomized pragmatic clinical trial. We compared costs, Disability Adjusted Life Years (DALYs) and extra number of years lived between participants who were screened for TB at every appointment versus the hospital routine where TB screening is not mandatory. The cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER) per DALYs averted or life years saved. Sub-group analysis of the intervention group was conducted based on individuals who screened positive and negative at the first appointment. Lifelong costs and extra number of years lived were estimated through an individual-based simulation model. Findings: Between March 2014 and April 2017, 724 participants were included in the trial. The intervention did not avert DALYs (-0·1 [95% CI: -1·4, 1·3]), although it was cost saving by US$ 929 (95% CI: 342, 1 572) per patient. The intervention group with a negative screening at the first appointment had the highest cost-savings (US$ 1 324 [95% CI: 711, 1 977]) and more DALYs averted (1·1 [95% CI: -0·3, 2·6]) when compared with the control group. In the long term, screening for TB in HIV patients who reaced the health services at the earlier stages of the disease resulted in 3.8 life years gained (95% CI: 0·3, 7·4) and cost saving by $3 936 (95% CI: 2 317, $5 505) per patient. Interpretation: TB screening at every appointment was cost saving and more beneficial in HIV patients with less severe HIV disease both in the short term and for their full lifetime. Trial Registration: The clinical trial was registered at the Brazilian Registries for Clinical Trials (ReBec-22t943, http://www.ensaiosclinicos.gov.br/rg/RBR-22t943/). Funding Statement: CNPq, 470554/2013-4 and FACEPE, APQ-0184-4.06/13. We also thank the Institute for Health Technology Assessment (IATS) for the support with travel expenses and scholarships for the field work team. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Fundacao Oswaldo Cruz (No 279.324) and the London School of Hygiene and Tropical Medicine (Ref: 7371) ethics committees. All patients signed a consent form.

Dutch DALYs, current and future burden of disease in the Netherlands

BackgroundThe Disability Adjusted Life Year (DALY) is a measure to prioritize in the public health field. In the Netherlands, the DALY estimates are calculated since 1997 and are included in the Public Health Status and Foresight studies which is an input for public health priority setting and policy making. Over these 20 years, methodological advancements have been made, including accounting for multimorbidity and performing projections for DALYs into the future. Most important methodological choices and improvements are described and results are presented.MethodsThe DALY is composed of the two components years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Both the YLL and the YLD are distinguished by sex, age and health condition, allowing aggregation to the ICD-10 chapters. The YLD is corrected for multimorbidity, assuming independent occurrence of health conditions and a multiplicative method for the calculation of combined disability weights. Future DALYs are calculated based on projections for causes of death, and prevalence and incidence.ResultsThe results for 2015 show that cancer is the ICD-10 chapter with the highest disease burden, followed by cardiovascular diseases and mental disorders. For the individual health conditions, coronary heart disease had the highest disease burden in 2015. In 2040, we see a strong increase in disease burden of dementia and arthrosis. For dementia this is due to a threefold increase in dementia as a cause of death, while for arthrosis this is mainly due to the increase in prevalence.ConclusionsTo calculate the DALY requires a substantial amount of data, methodological choices, interpretation and presentation of results, and the personnel capacity to carry out all these tasks. However, doing a National Burden of Disease study, and especially doing that for more than 20 years, proved to have an enormous additional value in population health information and thus supports better public health policies.

Burden of foodborne disease in the Netherlands: from science to policy

Abstract In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.

Regional microglial activation in the substantia nigra is linked with fatigue in MS.

ObjectiveThe goal of our study is to assess the role of microglial activation in MS-associated fatigue (MSAF) using [F-18]PBR06-PET.MethodsFatigue severity was measured using the Modified Fatigue Impact Scale (MFIS) in 12 subjects with MS (7 relapsing-remitting and 5 secondary progressive) and 10 healthy control participants who underwent [F-18]PBR06-PET. The MFIS provides a total fatigue score as well as physical, cognitive, and psychosocial fatigue subscale scores. Standardized Uptake Value (SUV) 60–90 minute frame PET maps were coregistered to 3T MRI. Voxel-by-voxel analysis using Statistical Parametric Mapping and atlas-based regional analyses were performed. SUV ratios (SUVRs) were global brain normalized.ResultsPeak voxel-based level of significance for correlation between total fatigue score and PET uptake was localized to the right substantia nigra (T-score 4.67, p = 0.001). Similarly, SUVRs derived from atlas-based segmentation of the substantia nigra showed significant correlation with MFIS (r = 0.76, p = 0.004). On multiple regression, the right substantia nigra was an independent predictor of total MFIS (p = 0.02) and cognitive MFIS subscale values (p = 0.007), after adjustment for age, disability, and depression. Several additional areas of significant correlations with fatigue scores were identified, including the right parahippocampal gyrus, right precuneus, and juxtacortical white matter (all p < 0.05). There was no correlation between fatigue scores and brain atrophy and lesion load in patients with MS.ConclusionSubstantia nigra microglial activation is linked to fatigue in MS. Microglial activation across key brain regions may represent a unifying mechanism for MSAF, and further evaluation of neuroimmunologic basis of MSAF is warranted.

Delayed Thrombectomy Center Arrival is Associated with Decreased Treatment Probability.

Endovascular thrombectomy (EVT) is effective in reducing disability in selected patients with stroke and large vessel occlusion (LVO), but access to this treatment is suboptimal. We examined the proportion of patients with LVO who did not receive EVT, the reasons for non-treatment, and the association between time from onset and probability of treatment. We conducted a retrospective cohort study of consecutive patients with acute stroke and LVO presenting between January 2017 and June 2018. We used multivariable log-binomial models to determine the association between time and probability of treatment with and without adjustment for age, sex, dementia, active cancer, baseline disability, stroke severity, and evidence of ischemia on computerized tomography. We identified 256 patients (51% female, median age 74 [interquartile range, IQR 63.5, 82.5]), of whom 59% did not receive EVT. The main reasons for not treating with EVT were related to occlusion characteristics or infarct size. The median time from onset to EVT center arrival was longer among non-treated patients (218 minutes [142, 302]) than those who were treated (180 minutes [104, 265], p=0.03). Among patients presenting within 6 hours of onset, the relative risk (RR) of receiving EVT decreased by 3% with every 10-minute delay in arrival to EVT center (adjusted RR 0.97 CI95 [0.95, 0.99]). This association was not found in the overall cohort. The proportion of patients with acute stroke and confirmed LVO who do not undergo EVT is substantial. Minimizing delays in arrival to EVT center may optimize the delivery of this treatment.

Appraisals of disability and psychological adjustment in veterans with spinal cord injuries

Context/Objective: Following a spinal cord injury or disability (SCI/D), cognitive appraisals are a marker of psychological adjustment. The present study evaluated the clinical utility and discriminant validity of the Appraisals of DisAbility Primary and Secondary Scale – Short Form (ADAPSS-sf). The ADAPSS-sf was evaluated on 1. identification of individuals experiencing poor psychological adjustment and 2. prediction of life satisfaction beyond measures of emotional distress. Design: A retrospective study was completed using ROC analyses and odds ratios to identify the clinical utility of the ADAPSS-sf. In addition, blocked hierarchical regression explored the ADAPSS-sf predictive characteristics for satisfaction with life beyond measures of emotional distress. Setting: Veteran’s Health Administration SCI Center. Participants: Ninety outpatient veterans with SCI/Ds. Outcome Measures: Measures of psychological adjustment post-SCI/D included the PHQ-9, GAD-7, PC-PTSD, and the Diener Satisfaction with Life Scale (SWLS). The ADAPSS-sf was used as a measure of cognitive appraisals. Results: Results indicated the ADAPSS-sf is effective in identification of poor psychological adjustment, P < .001. Diagnostic odds ratios and ADAPSS-sf cut scores were selected to prioritize sensitivity (7.17, ≤ 11), specificity (68.25, ≥ 22), or a balance of the two (16.32, ≤ 19). Hierarchical regression indicated the ADAPSS-sf accounted for unique variance in life satisfaction beyond measures of emotional distress, (ΔR 2 = .20, β = −.66, t(89) = 6.54, P < .001). Conclusion: Results indicated SCI/D specific appraisals are predictive of concurrent poor psychological adjustment and provide insight into satisfaction with life beyond measures of emotional distress.

Modelling Global Burden of Disease Measures in Selected European Countries Using Robust Dynamic Spatial Panel Data Models

The aim of the paper is to study relationships between selected socio‑economic factors and health of European citizens. The health level is measured by selected global burden of disease measures – DALYs (Disability Adjusted Life Years) and its two components: YLL (Years of Life Lost) and YLD (Years Lived with Disability). We identify which factors significantly affect these indicators of health. The empirical study uses a panel data comprising 16 countries mostly from the old‑EU in the period 2003–2013. Fixed‑effects dynamic spatial panel data (DSPD) models are used to account for autocorrelations of the dependent variables across time and space. The models are estimated with a novel, modified quasi maximum likelihood Yang method based on M‑estimators. The approach is robust on the distribution of the initial observations. The empirical analysis covers specification, estimation, and verification of the models. The results show that changes in YLD are significantly related to alcohol consumption, healthcare spending, social spending, GDP growth rate and years of education. Exactly the same set of factors is associated with variation in DALYs. Sensitivity of the YLL component to the socio‑economic factors is considerably weaker.

Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China.

To assess the association between malnutrition and physical frailty among nursing home older adults in China. A cross-sectional study in 15 nursing homes in Changsha, China. A total of 705 nursing home residents who were aged 60 and older. Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty. The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60-106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty. Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.

Quantitative assessment of microbiological risks due to red meat consumption in France

As reported by the European Centre for Disease Prevention and Control and the European Food Safety Authority, red meat is a major food source that is responsible for foodborne illnesses due to microbiological hazards. The first objective of this study was to aggregate the available data in the literature in order to identify and characterise the main microbiological hazards associated with red meat consumption in France. Next, the associated numbers of foodborne illnesses, deaths and the subsequent burden of diseases, expressed in Disability Adjusted Life Years (DALY), were estimated. Using the eight foodborne pathogens kept in the assessment, a probabilistic risk model was built and uncertainty from the data was considered. Campylobacter spp. was ranked as the worst pathogen in terms of the number of human cases associated with red meat consumption, with 210 [95% confidence interval (CI) = 500–520] cases per 100,000 population. The pathogen that induced the highest mortality was non-typhoidal Salmonella enterica, with 0.04 [95% CI = 0.01–0.10] deaths per 100,000 population. These cases were mostly related to pork consumption. However, the major contributor to the number of years in good health lost from red meat consumption in France was hepatitis E, with 33 [95% CI = 1-64] DALY per 100,000 population; this effect was mainly due to pork liver consumption. In terms of foodborne bacteria, for beef and pork meat, Campylobacter spp., non-typhoidal S. enterica, Clostridium perfringens and shiga-toxin producing Escherichia coli (STEC) represented a mean of 2.2 [95% CI = 1.0–4.0] DALY per 100,000 individuals per year. The estimations provided in this study might help authorities to focus on these hazards and ultimately reduce their impact on the health of the French population.

Smoking-attributable burden of lung cancer in Mongolia a data synthesis study on differences between men and women.

BackgroundSmoking is widely recognized as one of the most prevalent and preventable causes of many cancer types. This study aimed to quantify the population attributable fraction (PAF) of the lung cancer burden for smoking in Mongolia.MethodsLung cancer incidence and lung cancer-related death data came from the population-based national registry covering the period 2007–2016. Smoking prevalence data came from the STEPwise approach (STEP) national survey. The lung cancer-related disease burden was calculated and expressed in Disability Adjusted Life Years (DALYs) lost by gender and by year. This was combined with current smoking and former smoking prevalence data, and relative risks (RR) of lung cancer-related deaths for current smokers and former smokers versus never smokers from region-specific cohort studies to estimate the PAF of lung cancer attributable to “ever-smoking” in Mongolia.ResultsBetween 2007 and 2016, lung cancer accounted for the loss of over 63,000 DALYs in Mongolia. The PAF of lung cancer-related deaths attributable to current and former smoking combined was 58.1% (95% IR = 43.1%-72.2%) for men and 8.9% (95% IR = 4.1% -13.5%) for women. Smoking-attributable DALYs loss amounted to 2589 years (95% IR = 1907–3226) in 2016.ConclusionsA considerable health loss may be prevented with an effective anti-smoking policy. In Mongolia, more than one third of lung cancer-related DALY loss is attributable to active smoking, and thus is potentially preventable. Furthermore, a gender-specific tobacco control policy may be worthwhile because of the large gender difference in smoking exposure in Mongolia. Next to this, age specific policy, including a smoke–free generation policy for adolescents, with targeted education, and mass media campaigns is needed.