Cause Of Burden Research Articles

Mental health spillovers and the Millennium Development Goals: The case of perinatal depression in Khayelitsha, South Africa.

Mental illness currently ranks among the top ten causes of burden of disease in low-income countries [1]. In the African region specifically, neuropsychiatric disorders account for approximately 5% of disability-adjusted life years lost, with nearly one-quarter of this burden attributable to unipolar depressive disorders [1]. Furthermore, this burden is projected to increase by 2030 [2]. There is accumulating evidence on the potential public health impact of scalable mental health treatments involving non-psychiatrists [3-5], with more studies under way [6-8], but overall the prevention and treatment of mental disorders have been relatively neglected in the global agenda [9,10]. A substantive portion of the burden of mental disorders in low-income countries is thought to be attributable to many of the failures of human development as targeted through the Millennium Development Goals (MDGs), including poverty, HIV, and gender inequality. The evidence on depressive disorders and depressed mood is most well developed in this respect (see Figure 1). Depression has been associated with economic deprivation, especially in low-income countries and with regards to specific indicators of deprivation such as food insecurity [12,13]. Depression is also a known consequent of poor physical health [14]. And finally, gender inequality [15], often manifested starkly as violence against women in low-income countries [16], is commonly conceptualized as a risk factor for poor mental health among women [17]. Figure 1 Conceptual framework of multilevel influences on depression and corresponding types of interventions. Adapted from McKinlay & Marceau [11]. If these relationships were causal and unidirectional, then interventions targeting MDG indicators related to poverty, HIV, and gender inequality would be expected to reduce the burden of disease from mental disorders. However, some of these relationships are bidirectional, suggesting that scaling up interventions to improve mental health may support efforts to achieve the MDGs. Emphasizing these spillover effects on other health outcomes of greater political interest may be one effective strategy to build support for mental health programming [18]. For example, depressive disorders and depressed mood are associated with significant psychosocial disability resulting in reduced economic productivity [19]. Depressed mood among women in the postnatal period has been associated with elevated risks for diarrhea and poorer growth among their newborn infants [20-23]. And, among persons living with HIV/AIDS, psychological stress and poor mental health have been associated with reduced adherence to HIV antiretroviral therapy [24] and worsened HIV-related outcomes [25]. Photo: Courtesy of Dr Mark Tomlinson, personal collection

Is it merely a myth that alcoholic beverages such as red wine can be cardioprotective?

It has been suggested that although the negative impact of alcohol consumption varies from person to person, on a global level the adverse effect of alcohol on cardiovascular disease outweighs any protective effect by between two- and three-fold. This is inaccurate. There is a proven positive relationship between alcohol consumption and cardiovascular disease that is acknowledged by the World Health Organization. For example, moderate alcohol consumption reduces the risk of cardiovascular disease by approximately 25%, such that alcohol consumption per se accounts for -4.7% of the total cardiovascular disease burden in Australia. Correspondingly, cardiovascular disease accounted for 34% of the total number of deaths in Australia in 2008, and 18% of the overall burden of disease in Australia in 2003, with coronary heart disease and stroke contributing over 80% of this burden. Australia is not substantially different from other developed countries having similar demographics to, and the same leading causes of burden as, other high-income developed countries. This article examines the suggestions and evidence surrounding the relationship between light-to-moderate alcohol consumption and benefits to human health.

Tackling burden in ART: an integrated approach for medical staff

Discontinuation is a problem in fertility clinics. Many couples discontinue assisted reproductive technologies (ART) without achieving a live birth for reasons other than poor prognosis or the cost of treatment. Discontinuation has been attributed to the burden of treatment. The causes of burden can be broadly classified according to whether they originate in the patient, clinic or treatment. Interventions to alleviate these burdens include provision of comprehensive educational material, screening to identify highly distressed patients, provision of tailored coping tools and improvements in the clinic environment and medical interventions. Practical interventions to reduce the different causes of burden in ART exist, but further development and evaluation of the efficacy of these interventions requires more precise definition of terms and theory. In this paper, we propose a general integrated approach to cover different perspectives in dealing with burden in ART clinics. We firstly describe the integrated approach and present common sources of burden. We then describe interventions that could help reduce the burden in ART. Our paper is aimed at fertility clinic staff because of their day-to-day involvement with patients. However, this discussion should also be relevant to companies that develop treatments and to psychosocial experts. Reducing the burden of treatment should lead to improved outcomes, namely better quality of life during treatment and lower discontinuation rates.

Prevalence of chronic obstructive pulmonary disease in rural women of Tamilnadu: implications for refining disease burden assessments attributable to household biomass combustion

BackgroundChronic obstructive11This paper was orally presented in the Annual conference International Society of Environmental Epidemiology held in Pasadena in 2008. pulmonary disease (COPD) is the 13th leading cause of burden of disease worldwide and is expected to become 5th by 2020. Biomass fuel combustion significantly contributes to COPD, although smoking is recognized as the most important risk factor. Rural women in developing countries bear the largest share of this burden resulting from chronic exposures to biomass fuel smoke. Although there is considerable strength of evidence for the association between COPD and biomass smoke exposure, limited information is available on the background prevalence of COPD in these populations.ObjectiveThis study was conducted to estimate the prevalence of COPD and its associated factors among non-smoking rural women in Tiruvallur district of Tamilnadu in Southern India.DesignThis cross-sectional study was conducted among 900 non-smoking women aged above 30 years, from 45 rural villages of Tiruvallur district of Tamilnadu in Southern India in the period between January and May 2007. COPD assessments were done using a combination of clinical examination and spirometry. Logistic regression analysis was performed to examine the association between COPD and use of biomass for cooking. R software was used for statistical analysis.ResultsThe overall prevalence of COPD in this study was found to be 2.44% (95% CI: 1.43–3.45). COPD prevalence was higher in biomass fuel users than the clean fuel users 2.5 vs. 2%, (OR: 1.24; 95% CI: 0.36–6.64) and it was two times higher (3%) in women who spend >2 hours/day in the kitchen involved in cooking. Use of solid fuel was associated with higher risk for COPD, although no statistically significant results were obtained in this study.ConclusionThe estimates generated in this study will contribute significantly to the growing database of available information on COPD prevalence in rural women. Moreover, with concomitant indoor air pollution measurements, it may be possible to increase the resolution of the association between biomass use and COPD prevalence and refine available attributable burden of disease estimates.

Plenary V Predicting the global burden of disease in 2030

Understanding the leading causes of death and disability and how these are changing, is fundamental for informing health policy debates. The first Global Burden of Disease Study published 15 years ago suggested that non-communicable diseases had overtaken communicable diseases as leading causes of burden, causing twice as many DALYs worldwide. The extent and pace of epidemiological transition varied across major world regions, being most advanced in East Asia and Latin America and least advanced in South Asia and Sub-Saharan Africa. The study identified major vascular diseases such as ischaemic heart disease and stroke as being among the leading causes of death globally and also in the top 10 causes of disease burden, along with HIV/AIDS, lung cancer and COPD. Depression and injuries also ranked among the leading causes of health loss in both rich and poor countries, with significant non-fatal contributions to estimated DALYs. Global mortality and disability trends over the past 2 decades suggest that disease control priorities will continue to evolve over the next 2 decades and argue for a much greater emphasis on developing reliable mortality surveillance and health information systems to better understand comparative health sector priorities, particularly in developing countries. Child survival has accelerated over the past decade, including in Sub-Saharan Africa, due largely to the success of vaccine programs and technologies to reduce diarrhoea and pneumonia deaths in children. Treated bednets have had a more recent impact, although it is likely that malaria deaths in children remain high and represent an increasing proportion of child deaths. Adult mortality has been declining, but important reversals to this trend are possible unless major risks to adult health, particularly tobacco, excess body weight and HIV, are more rapidly brought under control.

The cause of burden in caregivers of Alzheimer's disease patients

The cause of burden in caregivers of Alzheimer's disease patients

Impact of Human Papillomavirus-Related Lesions on Quality of Life: A Multicenter Hospital-Based Study of Women in Mainland China

To date, few studies using a human papillomavirus (HPV)-specific questionnaire have focused on the impact of quality of life (QoL) among women with HPV-related lesions in developing countries. A multicenter, hospital-based survey was conducted from 2007 to 2008. Women 18 to 65 years old who had HPV-related lesions or underwent HPV-related screening interventions during the past 3 months were recruited and divided into 6 groups based on different diagnoses: (1) normal Papanicolaou (Pap) test result, (2) abnormal Pap test result without HPV test, (3) external genital warts (GWs), (4) precancerous cervical lesions (confirmed by histological diagnoses), (5) HPV positive (HPV+) after abnormal Pap test result, and (6) HPV negative (HPV-) after abnormal Pap test result. Psychosocial burdens were assessed by the HPV impact profile (HIP). The HIP contains 7 domains and 29 questions, and its scores reversely relates to the subjects' QoL. A total of 2605 eligible women were enrolled. Women with GWs had the highest mean HIP scores (52.2), followed by the group with precancerous cervical lesions (48.6), HPV+ after abnormal Pap (45.8), abnormal Pap test result without HPV test (44.1), HPV- after abnormal Pap (43.1), and women with normal Pap endured the least (33.1). "Sexual impact," "self-image," and "control/life impact" were the 3 QoL-related domains that affected women the most. The psychosocial burden of urban residents was heavier than that of rural women. Women with GWs and precancerous cervical lesions had the worst psychological burden, and sexual-related concern was the primary cause of burdens regarding HPV-related diseases for Chinese women. In addition to basic medical treatments, psychosocial support systems should be established, and consultation services should be generalized to help alleviate these burdens.

Hospitalised burn injuries in 870 children in Tehran

IntroductionBurn injuries were the 13th cause of burden of disease in all age groups and the 7th cause in 5–14 years children in Iran in 2003. The objective of this...

Evaluation of random drug tests among public vehicle drivers of Iran

Road traffic injuries and opioid use-related mental disorders were the first and fifth cause of burden of disease in 2003 accordingly. In 2007, a media campaign was carried out to...

Injury prevention in Islamic Republic of Iran – role of health sector

Injuries are one of the most important challenges in public health with great socioeconomic burden especially in developing countries. In Islamic Republic of Iran, road traffic injuries are known as...

Health Financing in Brazil, Russia and India: What Role Does the International Community Play?

In this paper we examine whether Brazil, Russia and India have similar financing patterns to those observed globally. We assess how national health allocations compare with epidemiological estimates for burden of disease. We identify the major causes of burden of disease in each country, as well as the contribution HIV/AIDS, tuberculosis and malaria make to the total burden of disease estimates. We then use budgetary allocation information to assess the alignment of funding with burden of disease data. We focus on central government allocations through the Ministry of Health or its equivalent. We found that of the three cases examined, Brazil and India showed the most bias when it came to financing HIV/AIDS over other diseases. And this occurred despite evidence indicating that HIV/AIDS (among all three countries) was not the highest burden of disease when measured in terms of age-standardized DALY rates. We put forth several factors building on Reich's (2002) framework on 'reshaping the state from above, from within and from below' to help explain this bias in favour of HIV/AIDS in Brazil and India, but not in Russia: 'above' influences include the availability of external funding, the impact of the media coupled with recognition and attention from philanthropic institutions, the government's close relationship with UNAIDS (UN Joint Programme on HIV/AIDS), WHO (World Health Organization) and other UN bodies; 'within' influences include political and bureaucratic incentives to devote resources to certain issues and relationships between ministries; and 'below' influences include civil society activism and relationships with government. Two additional factors explaining our findings cross-cutting all three levels are the strength of the private sector in health, specifically the pharmaceutical industry, and the influence of transnational advocacy movements emanating from the USA and Western Europe for particular diseases.

La carga de enfermedad y lesiones en el Perú y las prioridades del plan esencial de aseguramiento universal

for the implementation of universal health assurance in Peru, we must have a package of benefits coverage to be financed on a obligatory, which is called the Health Assurance Essential Plan (PEAS, Plan Esencial de Aseguramiento en Salud). The development of the PEAS must correspond to the conditions that major cause of burden of disease. This is a review of the main results of the study of burden of disease and injury in Peru, noting that non-communicable diseases are those that generate the greatest amount of healthy life years lost (DALys) are neuropsychiatric diseases category that comes first and the diagnosis of greatest loss of DAL ys are traffic accidents. This information has been used to regularly include diseases not covered by basic insurance packages in the PEAS.

Die Belastungen pflegender Eltern von Kindern und Jugendlichen mit schweren Behinderungen in Südtirol

As part of their Master's degree course in Nursing Science at the Private University for Health Sciences, Medical Informatics and Technology (UMIT), the authors carried out a quantitative (written questionnaire) and qualitative (semi-structured interviews) research on parents in South Tyrol caring for their severely handicapped young and adolescent children. The aim of the study was to assess the extent and cause of burden in care-giving parents. The extent of burden was assessed using the the "FaBel"-questionnaire (Impact on Family Scale). Semi-structured interviews were used to investigate the phenomenon of burden in these parents. By triangulation of current literature with the quantitative and qualitative data, an attempt was made to reveal the complexity of the problem. The present contribution is a report on the results of the qualitative part of the study. As shown by the category system of the investigation, families with severely handicapped children and adolescents are exposed to a variety of burden in social (everyday life and public institutions), physical, psychological (impairment of health) as well as financial and emotional (future perspectives) areas. These parents find relief with their own families (partner and children) and public institutions (school, kindergarten, care facilities). Nursing interventions such as schooling, training and empowerment programmes must be adjusted by professional care givers (family health nurse) to the special needs of the care giving parents. Federal, provincial and social institutions should implement and optimise appropriate support possibilities and offers.

Stress and Depression: Preclinical Research and Clinical Implications

Major depression (MD) is a severe, life-threatening, and widespread psychiatric disorder having an incidence of about 340 million cases worldwide. MD ranks fifth among leading causes of global disease burden including developing countries, and by year 2030 it is predicted to represent one of the three leading causes of burden of disease worldwide [1], [2]. MD is also a risk factor for cardiovascular and metabolic diseases, and a major risk factor for suicide [3]. Despite extensive investigations, the exact mechanisms responsible for MD have not been identified, and current therapeutics are based on serendipitous discoveries rather than on bench-to-bedside, targeted drug discovery [4]. In addition, although clinically efficient antidepressant drugs do exist, the situation is in many cases far from ideal. Shortcomings such as low remission and/or high treatment-resistance rates, slow onset of action, side effects, and drug–drug interactions merit the exploration of all plausible agents that are effective, tolerable, and safe, and that improve maintenance of wellness [5]–[8]. Accordingly, there is an enormous need for joint experimental efforts between preclinical and clinical scientists. Understanding MD in its etiology and biological phenomenological characteristics could improve its recognition and treatment [8]–[11]. The present Overview highlights current trends in modern biological psychiatry, neuroscience, and neuroendocrinology by discussing key aspects presented in research papers included in the Special Collection “Stress-Induced Depression and Comorbidities: From Bench to Bedside,” published in this issue of PLoS ONE.

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

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.

Use of national health interview data to measure the burden of disease and injuries

Background: Although it is acknowledged that injuries place a substantial burden on populations throughout the world, few studies have measured the burden of non-fatal injuries and compared it with that...

Incidence of hip fracture over a 10-year period (1991–2000): Reversal of a secular trend

Introduction Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. With the ageing of the population, a marked increase in the number of fractures is expected. Furthermore, many studies reveal an increase of the age-adjusted hip fracture incidence. We specifically examined secular changes in the incidence of hip fracture in women and men aged 50 years and over in the well-defined area of Geneva, Switzerland. Materials and methods All hip fractured patients were retrospectively identified from the computer medical records of the main hospital, which is receiving 95% of hip fractures occurring in a well-defined area. Results From 1991 to 2000, 4115 hip fractures were recorded in 2981 women and 822 men with a mean age (± S.D.) of 83.1 ± 8.9 and 78.3 ± 11.6 years, respectively. A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1 ± 1.9 (median 1.44) years after the first event without gender difference. The overall incidence of hip fractures was 455 (95% CI: 439–471) per 100,000 person-years in women and 153 (95% CI: 143–163) in men. The number of hip fractures remained constant (412 (95% CI: 397–426)), but the mean age of these patients increased each year by 0.13 year in women ( p = 0.019) and by 0.04 year in men (NS). Furthermore, the age-adjusted incidence of hip fractures, standardized to the 2000 Geneva population, decreased significantly by 1.4% (95% CI: − 2.6 to − 0.1) per year in women ( p = 0.021), but remained stable in men (0.5% (95% CI: − 1.7 to + 2.8) per year, p = 0.66). The overall female/male ratio of hip fracture incidence was 2.99 (95% CI: 2.80–3.18, p < 0.001) and significantly decreased by 0.07 (95% CI: − 0.13 to − 0.01) per year ( p = 0.024). Conclusion Despite an increase in the population at risk and in the mean age of hip fractured women, there was a significant decrease in age-adjusted incidence in women but not in men. These results may suggest a reversal of the previously observed secular trend.

Projections of Global Mortality and Burden of Disease from 2002 to 2030

BackgroundGlobal and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results.Methods and FindingsRelatively simple models were used to project future health trends under three scenarios—baseline, optimistic, and pessimistic—based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs 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.ConclusionsThese 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.

Are infant size and growth related to burden of disease in adulthood? A systematic review of literature

Slower rates of infant growth are associated with increased rates of death from ischaemic heart disease (IHD) in later life. We carried out a systematic review to assess the association between infant size or growth and leading causes of adult burden of disease to contribute to the debate on the potential of the promotion of infant growth to prevent ischaemic heart disease. We searched Medline, Embase, CINAHL, PsycINFO, and bibliographies of included studies. First authors of included studies and other experts were contacted to locate unpublished analyses. Outcome measures for the review were leading causes of adult burden of disease selected from the Global Burden of Disease study. We included studies that assessed the relationship between infant size or growth during the first 2 years and the leading causes of adult burden of disease. Nineteen studies relating to 10 causes of burden of disease met inclusion criteria. Most studies reported data on infant size. Larger size in infancy was associated with increased risk of insulin-dependent diabetes. Larger infant size was associated with reduced rates of IHD in men but not in women. There were considerable gaps in the evidence and many conditions that account for a high burden of disease, such as cancer, mental illness, stroke, chronic obstructive pulmonary disease, and non-insulin-dependent diabetes, had few or no studies associating them with infant size or growth. Our findings suggest that there is no single optimal pattern of infant growth that is associated with beneficial adult health outcomes. There is insufficient evidence to recommend prevention of adult disease through strategies to alter infant growth.

Public disclosure of clinical trials in children

Background: Although randomized controlled trials (RCTs) are considered the most reliable way to assess a drug's safety and effectiveness, they are not always necessary or feasible for assessing the effects of health care on pediatric patients. Recent legislation passed in the United States has led to an increase in the number of RCTs in pediatric populations, but the drugs studied in these trials have not always proven useful to pediatric patients. Objective: This study was undertaken to identify the specific areas addressed by clinical research in the European pediatric therapeutic field. Methods: A literature search was conducted on EMBASE for therapeutic clinical trials in children, performed in the 15 European Union countries and published from 1995 to 2000, using the search terms child, infant, clinical trial, comparative studies, drug, and drug therapy. A general analysis of all the studies was performed, as well as a more in-depth analysis of the RCTs. Two researchers reviewed each study independently using a standard form. Data on methodology, diseases, and outcomes were extracted. All studies published in 5 general pediatric journals were assessed for reporting status of ethical committee approval and informed consent. Results: A total of 338 articles were identified as being therapeutic, pediatric, clinical trials. Of these, 139 were RCTs. These 139 studies were performed in 12 countries; most addressed the treatment of asthma, acute otitis media, acute upper and lower respiratory infections, and vaccine-preventable diseases. Of the 37 studies published in 5 chosen general pediatrics journals, 24 and 30 did not report ethical committee approval or informed consent, respectively. Conclusions: The diseases addressed by the RCTs identified in this review are among the leading causes of burden of disease in European children. However, ample knowledge of the physiopathologic and therapeutic variables of these diseases already exists. More research is needed on new drugs and disease states as they relate to pediatric patients. Moreover, information about these trials must be made readily available to parents and family physicians, both to increase enrollment and to uphold the highest ethical standards of providing optimal treatment to all patients.