Cause Of Disability-adjusted Life Years Research Articles

The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017

Neurological disorders account for a large and increasing health burden worldwide, as shown in the Global Burden of Diseases (GBD) Study 2016. Unpacking how this burden varies regionally and nationally is important to inform public health policy and prevention strategies. The population in the EU is older than that of the WHO European region (western, central, and eastern Europe) and even older than the global population, suggesting that it might be particularly vulnerable to an increasing burden of age-related neurological disorders. We aimed to compare the burden of neurological disorders in the EU between 1990 and 2017 with those of the WHO European region and worldwide. The burden of neurological disorders was calculated for the year 2017 as incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability for the countries in the EU and the WHO European region, totally and, separately. Diseases analysed were Alzheimer's disease and other dementias, epilepsy, headache (migraine and tension-type headache), multiple sclerosis, Parkinson's disease, brain cancer, motor neuron diseases, neuroinfectious diseases, and stroke. Data are presented as totals and by sex, age, year, location and socio-demographic context, and shown as counts and rates. In 2017, the total number of DALYs attributable to neurological disorders was 21·0 million (95% uncertainty interval 18·5-23·9) in the EU and 41·1 million (36·7-45·9) in the WHO European region, and the total number of deaths was 1·1 million (1·09-1·14) in the EU and 1·97 million (1·95-2·01) in the WHO European region. In the EU, neurological disorders ranked third after cardiovascular diseases and cancers representing 13·3% (10·3-17·1) of total DALYs and 19·5% (18·0-21·3) of total deaths. Stroke, dementias, and headache were the three commonest causes of DALYs in the EU. Stroke was also the leading cause of DALYs in the WHO European region. During the study period we found a substantial increase in the all-age burden of neurodegenerative diseases, despite a substantial decrease in the rates of stroke and infections. The burden of neurological disorders in Europe was higher in men than in women, peaked in individuals aged 80-84 years, and varied substantially with WHO European region and country. All-age DALYs, deaths, and prevalence of neurological disorders increased in all-age measures, but decreased when using age-standardised measures in all but three countries (Azerbaijan, Turkmenistan, and Uzbekistan). The decrease was mostly attributed to the reduction of premature mortality despite an overall increase in the number of DALYs. Neurological disorders are the third most common cause of disability and premature death in the EU and their prevalence and burden will likely increase with the progressive ageing of the European population. Greater attention to neurological diseases must be paid by health authorities for prevention and care. The data presented here suggest different priorities for health service development and resource allocation in different countries. European Academy of Neurology.

The Relevance of Right and Left Hemisphere Classification to Predict Cognitive Outcome After Stroke

Introduction: Stroke is the fifth leading cause of disability-adjusted life years (DALYs) in the world. Cognitive impairment is one of the disabilities found in the acute phase of stroke and persists in long-term outcomes which can be assessed using the Mini-Mental State Examination (MMSE). However, a clinical classification to predict the cognitive outcome remained unclear. This study is aimed to identify differences of MMSE results in stroke patients between right and left hemisphere lesions to ensure the mentioned location classifications may contribute to cognitive outcome prediction.Method: With the cross-sectional analytic observational design, 32 acute phase patients hospitalized in the Neurology Department Soetomo General Hospital from October–December 2019 were assessed using the Indonesian version of MMSE with purposive sampling and analyzed using the chi-square test.Result: There was no significant difference between MMSE scores in right or left hemisphere lesion. This might happen because (1) MMSE was insensitive and not a domain-specific test; (2) a more specific infarct location was needed to predict cognitive outcome post-stroke, including microarchitecture of the brain especially those involved in the cortico-striato-thalamocortical loop.Conclusion: The right or left hemisphere lesion classification did not contribute significantly to predict cognitive impairment.

The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study

BackgroundThe prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study.MethodsWe estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period.ResultsThe results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality.ConclusionsFindings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

Population trends and burden of disease profile in Somalia from 1990 to 2017

Abstract Background In Somalia, general health indicators and information on the health trends are lacking. Somalia and countries globally aim to attain the United Nations (UN) Sustainable Development Goals (SDGs) for health. This study aims to describe the trends in population health and disease burden in Somalia in the past 27 years and show the pattern of health transition across the country from 1990 to 2017. Methods This cross-sectional study retrieved secondary data from the Institute for Health Metrics and Evaluation (IHME) system. All health-related data were cleaned, captured, and descriptively analysed through SAS 9.4. We analysed Mortality rates, Disability-adjusted life years (DALYs), Years of Life Lost because of premature death (YLLs), Years lived with disability (YLDs), Health-Adjusted Life Expectancy (HALE), and Age-Standardised Death Rate (ASD). Causes and risks of mortality and morbidity were categorised in communicable diseases (CMNN), non-communicable diseases (NCD) and injuries. Results Life expectancy has improved from 52.5 to 60.7 years old for females and 48.0 to 56.6 years old for males. The total causes of DALYs declined by 52% (from 120 860,71 to 58 321,04); YLD declined by 8% (from 9 957,15 to 9 152,86); and the YLLs declined by 54% (110 903,56 to 49 168,18) for both sexes. The maternal mortality rate declined by 34% (522,99 to 343,86) and under 5 mortality rate by 64% (5 176,54 to 1 899,17). CMNNs was the main cause of DALYs, NCDs for YLDs and CMNNs for YLLs in 2017. HALE saw a steady increase. CMNNs was the main cause of ASD in 1990 then declined and NCDs became the main cause of ASD in 2017. Conclusions Somalia's health status has improved between 1990 and 2017, although certain geographically and societal factors still play an important role in rates not changing. Strengthened policies to address health and developmental challenges within Somalia is vital in achieving the SDG health goals. Key messages An analysis of the health system in Somalia was used to make recommendations and improvements in and for health outcomes. Information on health systems is an important topic and due to the challenges and changes in population demographics and patterns of disease, improving health care in a country like Somalia is vital.

Impact of clinical symptoms on the disability of patients with schizophrenia (Bulgaria, 2018-2019)

Abstract Background According to Global Burden of Disease Studies (1990-2017), schizophrenia causes globally 1.1% of DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). It is the 8th leading cause of DALYs in 15-44 years of age (WHR 2001). The aim of the study was to assess the impact of clinical symptoms on disability in hospitalised patients with paranoid schizophrenia (PS). Methods The study includes 108 patients treated in Psychiatric Clinic of Pleven University Hospital: 66 males and 42 females, mean age 38.9±10.0, duration of disease 12.8±8.2 years; mean onset of disease at 24 years (Me = 25 and Mo = 22). The research protocol was approved by University Ethical Committee. The disease burden was assessed by Positive and Negative Syndrome Scale (Ð ANSS), and level of disability - by 36-item self-administered WHO Disability Assessment Schedule 2.0. Pierson's r. was used for the relationship between both variables. Data processing was performed by IBM SPSS v.24. Results The average burden of disease based on Ð ANSS was 71,8±5,1. The increase of symptoms' burden leads to worsening in “participation in society” (r = 0.561), “life activities-household” (r = 0.554), “getting along with people” (r = 0.539). Positive symptoms correlate higher with “getting along with people” (r = 0.549), “life activities-household” (r = 0.578), “participation in society” (r = 0.623), and negative symptoms - with “participation in society” (r = 0.526) and “life activities-household” (r = 0.476). Symptoms of disorganisation have highest impact on “life activities-household” (r = 0.807),”getting along with people”(r = 0.556), and “participation in society” (r = 0.649. All correlations were significant at p = 0.0001. “Getting around” has no relation with disease burden. Conclusions Disorganisation symptoms and negative symptoms strongly affect the overall psychosocial functioning, while positive symptoms have less impact on it. Key messages Appropriate treatment schemes directed to negative symptoms would contribute to decrease of disability level in patients with paranoid schizophrenia. Prevention and rehabilitation in PS patients should emphasise promotion of professional and personal development for minimising of disease impact on overall social functioning.

Burden of cardiovascular diseases in the region of Monastir (Tunisia)

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in Tunisia. The aim of this study was to analyze CVD burden from 2002 to 2013 in the region of Monastir. Methods Using the Global Burden of Disease methodology, cardiovascular disease mortality and disability-adjusted life years (DALYs) were analyzed by age group and sex for all admissions at the university hospital of Monastir, using standardized approaches for data processing and statistical modeling. Data were retrieved from the regional register of hospital morbidity in Monastir and were analyzed from January 2002 to December 2013. Results CVDs caused 519 in-hospital deaths during the study period, accounting for 43.3 % (CI 95%: 40.6-46.1%) of all in-hospital non-communicable diseases-related mortality (n = 1197). The crude mortality rate of CVDs was 8.81 per 100,000 inh. The highest rate was recorded among patients aged ≥ 60 years-old. The age-standardized mortality rate was 11/100,000 PY (14 in men and 8 in women). CVD DALY per 100,000 was 176.4 (199.4 in men and 152.7 in women). The highest CVD DALY was in the age groupe of 60 years and older (929.7/100,000). The leading causes of DALYs for both sexes are coronary heart diseases and stroke with DALY rate of 112.6 and 47.4 per 100,000 inh, respectively. Conclusions The CVD burden was heavy in the study population, in particular in the elderly and in men. Prevention and control of modifiable risk factors should be taken actively to improve health for Tunisian adults. Key messages CVD burden was heavy in the region of Monastir. More efforts are needed to improve cardiovascular health in Tunisian adults.

Mortality analysis of burns in a developing country: a CAMEROONIAN experience

BackgroundBurns are a serious public health problem worldwide accounting for an estimated 265,000 deaths annually from fires alone. The vast majority (96%) of deaths from fire-related burns occur in low- and middle-income countries and burns are one of the leading causes of disability-adjusted life-years (DALYs) in the developing world. Most burn centres are situated in large cities and are inadequate for the high incidence of injuries. An 8 year review of 440 patients in the Douala General Hospital, showed that the majority of patients burned were males (n = 281, 68.9%), the mean age was 25.2 ± 17.77 years with an admission rate of 69.5% (306 patients). The modal and median age were 31.0 years and 25.0 years respectively, interquartile range (0.4–82). Majority of burns (n = 237, 53.9%) had burn surface area ≥ 10%, most burns were 2nd degree (n = 215, 48.9) and the commonest burn agents were flames (n = 170, 37.3%), electricity (n = 119, 26.3%) and water (n = 114, 25.2%). The paucity of data on burn mortality in Cameroon motivated this study and is aimed at determining the mortality rate, causes and factors associated with death of burnt patients in the burn unit of the Douala General Hospital (DGH).MethodsIt was a retrospective observational study carried out from the 1st of January 2008 to the 31st of December 2015 in the Burn Unit of the Douala General Hospital. An adapted questionnaire was used to collect demographic data, burn agents, burn depth; diagnostic delay, burn surface area, complications, comorbidity, mortality and its causes. Data was transferred to Microsoft Excel 2015 and the Statistical Package for Social Sciences (SPSS) version 20.0 for data analysis.ResultsDuring this 8 year period, 440 patients were studied and the mortality rate was 23.4% (103 patients). The fatal burn agents were, flames (n = 69, 67.0%), electricity (n = 15, 14.6%), water (n = 12, 11.6%), contact (n = 4, 3.9%), Oil (n = 2, 1.9%) and chemicals (n = 1, 1.0%). The causes of death were shock (n = 36, 35.0%), sepsis (n = 25, 24.3%), acute respiratory distress (n = 25, 24.3%), acute renal failure (n = 6, 5.8%), severe anaemia (n = 4, 3.9%) and unrecorded causes (n = 7, 6.7%).ConclusionA quarter of all patients died mostly from flame burns and to a lesser extent, electricity and scalds. Increase in burn depth and burn surface area worsened the prognosis. Shock (the commonest cause of death), sepsis, acute respiratory distress, acute renal failure and wound infection were significantly associated with mortality.

Mapping road traffic crash hotspots using GIS-based methods: A case study of Muscat Governorate in the Sultanate of Oman

Objective:Road traffic crashes (RTCs) are a major global public health problem and cause substantial burden on national economy and healthcare. There is little systematic understanding of the geography of RTCs and the spatial correlations of RTCs in the Middle-East region, particularly in Oman where RTCs are the leading cause of disability-adjusted life years lost. The overarching goal of this paper is to evaluate the spatial and temporal dimensions, identifying the high risk areas or hot-zones where RTCs are more frequent, using the geocoded data from the Muscat governorate. Data:This study is based on data drawn from the Royal Oman Police (ROP) sample iMAAP database and the National Road Traffic Crash (NRTC) database, managed by the ROP and made available for research use by The Research Council of the Sultanate of Oman. The data covered the period from 1st January 2010 to 2nd November 2014. Only RTCs occurred in Muscat Governorate were included in the study. The study is based on 12,438 registered incidents, however, due to disconnections found on road network, RTCs occurred on disconnected parts were removed and the final analysis considered only 9,357 incidents. Methods:We considered an adjacency network analysis integrating GIS and RTC data using robust estimation techniques including: Kernel Density Estimation (KDE) of both 1-D and 2-D space dimensions, Network-based Nearest Neighbour Distance (Net-NND), Network-based K-Function, Random Forest Algorithm (RF) and spatiotemporal Hot-zone analysis. Findings:The analysis highlight evidence of spatial clustering and recurrence of RTC hot-zones on long roads demarcated by intersections and roundabouts in Muscat. The findings confirm that road intersections elevate the risk of RTCs than other effects attributed to road geometry features. The results from GIS application of NRTC data are validated using the sample data generated by iMAAP database. Conclusion:The findings of this study provide statistical evidence and confirm our research hypothesis that road intersections (roundabouts, crosses and bridges) represent higher risk of causing RTCs than other road geometric features. The results also demonstrate systematic quantitative evidence of spatio-temporal patterns associated with the crash risk over different locations on road networks in Muscat. More importantly, the findings clearly pinpoint the importance and influence of the road and traffic related features in road crash spatial analysis.

Gender equality and global health: intersecting political challenges.

BackgroundWomen’s and men’s health outcomes are different. Some differences are biological, related to male and female sex, while others are related to their gender. Sex- and gender-related issues require different solutions, but policy makers lack straightforward heuristic strategies to identify gender-related health inequities.MethodsUsing 169 causes of disability-adjusted life years (DALYs) from the 2017 Global Burden of Disease, we calculated the female-to-male (f:m) and male-to-female (m:f) ratios of global DALYs, rank-ordered the ratios by size and calculated the proportion of all-cause DALYs that each cause explained, separately for males and females 15-49 years old. Gender-related vs sex-related causes were categorised using literature on the drivers for the 15 causes with highest f:m and m:f ratios.ResultsCauses of DALYs with high m:f ratios appear to be gendered and include: road injuries, interpersonal violence, and drowning – totaling 12.4% of men’s (15-49 years) all-cause DALYs. However, causes of DALYs with high f:m ratios are more likely a mix of sex-related and gender-related factors – including headache disorders, depressive disorders, and dietary iron deficiency – totaling 13.4% of women’s (15-49 years) all-cause DALYs. Ratios vary by age, geography and Socio-demographic Index.ConclusionsGender-related vs sex-related causes were categorised using available literature on the drivers for selected causes, illustrating that sex-disaggregated data represents a mix of social and biological influences. This analysis offers a model that policy makers can use to uncover potential gender inequalities in health, including intersections with other social factors. From it, new challenges emerge for global health policy makers and practitioners willing to address them. Global health actors will need to achieve a balance between the two agendas of global health and gender equality.

Determinants of substance use among young people attending an urban primary health center in Delhi.

Substance abuse remains one of the major challenges in young people, as it is one of the top five causes of disability-adjusted life years (DALY). The present study aims to find the prevalence and determinants of substance use among young people attending an urban primary health center in Delhi. Systematic random sampling was used to enroll the calculated sample size of 190. Substance use was assessed using ASSIST (an Alcohol Smoking Substance Involvement Screening Tool) and brief intervention was given based on the standard guidelines of ASSIST. The total score among the substance users is calculated and divided into Grades 1, 2 or 3. Log binomial regression was performed to quantify the association between substance use and covariates such as age, sex, education, occupation, family history of substance use, socio-economic status and family type. The association was expressed in odds ratio (OR) with 95 percent confidence interval (CI). The mean age of study participants was 18.6 ± 4.1, ranges from 10 to 24 years. Out of 48 substance users, 43.7% were consuming only tobacco, 22.9% were consuming only alcohol and 33.3% were polysubstance users. The history of substance use among family members of participants was found to be 46.3%. Median substance involvement score of tobacco, alcohol and cannabis users was 19 (IQR: 14.5-22), 19 (IQR: 13.5-25) and 22.5 (IQR: 22-23), respectively. Among tobacco users, 2.7% were Grade 1 and 7.2% were Grade 2. Four (16%), 20 (80%) and one (4%) of alcohol users were Grades 1, 2 and 3, respectively. Among the cannabis users, four (100%) were in the Grade 2 category. The median age of initiation of substance use among users was 16 (range 13-21) years. The analysis shows substance use was almost 25 times (adjusted OR = 25.84, 95% CI 5.65-118.09) more common among males and it increase by 2.5 times with a decrease in socio-economic status (adjusted OR = 2.52, 95% CI 1.27-5.02) and the result is significant. The substance use was almost 7 times higher when there is a family history of substance usage (adjusted OR = 7.40, 95% CI 2.15-25.4). Residential and marital status were not significantly associated with substance use. Male sex, lower socio-economic status, participants currently not going to school/college, family history of substance use were found to be significant predictors of substance use among the study participants.

<p>Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development</p>

The continued prevalence of chronic low back pain (CLBP) is a testament to our lack of understanding of the potential causes, leading to significant treatment challenges. CLBP is the leading cause of years lived with disability and the fifth leading cause of disability-adjusted life-years. No single non-pharmacologic, pharmacologic, or interventional therapy has proven effective as treatment for the majority of patients with CLBP. Although non-pharmacologic therapies are generally helpful, they are often ineffective as monotherapy and many patients lack adequate access to these treatments. Noninvasive treatment measures supported by evidence include physical and chiropractic therapy, yoga, acupuncture, and non-opioid and opioid pharmacologic therapy; data suggest a moderate benefit, at most, for any of these therapies. Until our understanding of the pathophysiology and treatment of CLBP advances, clinicians must continue to utilize rational multimodal treatment protocols. Recent Centers for Disease Control and Prevention guidelines for opioid prescribing recommend that opioids not be utilized as first-line therapy and to limit the doses when possible for fear of bothersome or dangerous adverse effects. In combination with the current opioid crisis, this has caused providers to minimize or eliminate opioid therapy when treating patients with chronic pain, leaving many patients suffering despite optimal nonopioid therapies. Therefore, there remains an unmet need for effective and tolerable opioid receptor agonists for the treatment of CLBP with improved safety properties over legacy opioids. There are several such agents in development, including opioids and other agents with novel mechanisms of action. This review critiques non-pharmacologic and pharmacologic treatment modalities for CLBP and examines the potential of novel opioids and other analgesics that may be a useful addition to the treatment options for patients with chronic pain.

The burden of disease in Saudi Arabia 1990–2017: results from the Global Burden of Disease Study 2017

SummaryBackgroundAvailability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country.MethodsWe used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990–2010 (before the health-care investments and reform) and 2010–17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries.FindingsAge-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of −0·58%), and this decrease was further accelerated from 2010 to 2017 (–2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010–17 the decrease was not as low as in Saudi Arabia (–1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990–2010 and 2010–17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region.InterpretationDecreases in mortality continued at greater rates in Saudi Arabia during the period of 2010–17 than in 1990–2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability.FundingBill & Melinda Gates Foundation.

The associations of economic growth and anaemia for school-aged children in China.

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school‐aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability‐adjusted life years for school‐aged children. In this study, we included 429,222 Chinese children aged 7–17 years from five consecutive national cross‐sectional surveys during 1995–2014. Using altitude‐adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban–rural location, regional socio‐economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non‐linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005–2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995–2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate‐to‐severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school‐aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed.

Burden of Mental and Substance Use Disorders — China, 1990−2019

What is already known about this topic? Mental and substance use disorders have notable contributions to the disease burden in China. What is added by this report? In China, mental disorders and substance use disorders accounted for 20.29 million and 5.76 million disability-adjusted life years (DALYs) in 2019, respectively; depressive disorders were the leading cause of DALYs. For mental disorders, the numbers of DALYs increased 12.06% from 2000 to 2019 while the standardized rates declined 5.24%; for substance use disorders, both the numbers and standardized rates of DALYs decreased 8.52% and 18.52%, respectively. What are the implications for public health practices? Mental and substance use disorders pose a challenge to the healthcare system in China. The government should take action and decrease the associated burden of disease.

Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study.

In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder–Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.

Abstract 310: National Institutes of Health Research Investment for the Leading Causes of Disability-Adjusted Life Years in the United States

Background: Cardiac arrest (CA) is a leading cause of disability-adjusted life years (DALY) in the United States (U.S.). The National Institutes of Health (NIH) does not report annual research funding for CA. Our objective was to calculate and compare the NIH research investment for CA to other leading causes of DALY in the U.S. Methods: A search within NIH RePORTER for the year 2016 was performed using the following terms: cardiac arrest, cardiopulmonary resuscitation, heart arrest, circulatory arrest, pulseless electrical activity, ventricular fibrillation, or resuscitation. Grants were individually reviewed and categorized as CA research (yes/no) using predefined criteria and the sum of funding for grants meeting inclusion criteria were tabulated. DALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD) using all adult non-traumatic EMS-treated out-of-hospital CA (OHCA) from the CARES database for 2016. Total DALY for the study population were extrapolated to a national level. The leading causes of DALY were obtained from the Global Burden of Disease study. Funding data were extracted from the 2016 NIH Categorical Spending Report. Research funding were compared using U.S. dollars invested per DALY as the outcome measure. Results: The search yielded 285 NIH-funded grants, of which 65 (22.8%) were classified as CA research. Total NIH funding for CA research in 2016 was $28.5M. A total of 59,752 cases from CARES met study inclusion criteria for the DALY analysis. The total DALY following adult OHCA in the U.S. were 4,354,192 (YLL 4,350,825; YLD 3,365). Per annual DALY, the NIH invested $284 for diabetes, $89 for stroke, $53 for ischemic heart disease, and $7 for CA research in 2016 (FIGURE). Conclusion: The NIH investment into CA research is less than other leading causes of death and disability in the U.S. These results should help inform the debate regarding how to best utilize limited resources to improve public health.

Burden of musculoskeletal-related disorders resulting from non-fatal road traffic collisions in Africa: a protocol of a systematic review

IntroductionIn addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as...

Multicomponent Short-Term Training of ASHAs for Stroke Risk Factor Management in Rural India.

Background Stroke is one of the leading causes of disability-adjusted life years and may be the leading cause of death in rural regions in India. We aim to train the ASHAs (Accredited Social Health activist) for nonpharmacological management of risk factors for secondary stroke prevention in rural India. We tested the hypothesis that focused, multicomponent, short-term training on secondary prevention of stroke enhances the knowledge of ASHAs about risk factor management. Objectives To test the hypothesis that focused, multicomponent, short-term training on secondary prevention of stroke enhances the knowledge of ASHAs about risk factor management. Materials and Methods This study is part of the ASSIST trial (Training ASHA to Assist in Secondary Stroke Prevention in Rural Population). The study design is quasi-experimental (pretest and posttest). Culturally appropriate and pragmatic training material was developed by the study team. Three focused group training sessions were conducted in Sidhwan Bet and Pakhowal blocks of Ludhiana district, Punjab. Results A total of 274 ASHAs from 164 villages with mean ± SD age of 39.5 ± 7.6 years participated in the three training sessions. The perceived knowledge of stroke risk factors and blood pressure assessment was 67.5 ± 18.3% and 84.4 ± 16.7%, respectively. The objective baseline knowledge about stroke prevention and management among ASHAs was lower 58.7 ± 19.7% compared with perceived knowledge ( p = 0.04). This increased to 82.5 ± 16.36% ( p < 0.001) after the mop-up training after a mean of 191 days. More than 30% increment was seen in knowledge about the stroke symptoms (35.9%, p < 0.001), avoiding opium after stroke for treatment (39.5%, p < 0.001), causes of stroke (53.3%, p < 0.001), modifiable risk factors for stroke (45.4%, p < 0.001), and lifestyle modifications for stroke prevention (42.1%, p < 0.001). Conclusions Focused group training can help enhance the knowledge of ASHAs about stroke prevention and management. ASHAs are also able to retain this complex multicomponent knowledge over a 6-month period. ASHA may be able to partake in reducing the secondary stroke burden in rural India.

Burden of dental caries and periodontal disease in South Korea: An analysis using the national health insurance claims database.

It is essential to measure and monitor the burden of dental caries and periodontal disease (PD) in Korea's ageing population due to their potential impact on morbidity, quality of life and economic condition. This study aimed to quantify the size of burden of dental caries and PD using the disability-adjusted life years (DALYs), and their trends. DALYs were estimated using incidence-based approaches to calculate the burden of dental caries and PD from 2013 to 2015 in Korea. Incidence and prevalence were estimated using medical claim data by specific algorithms. Additionally, sensitivity analysis was conducted to investigate possible weakness in the study methodology. To conduct the sensitivity analysis, we modified the algorithms to estimate prevalence and incidence. The burden of dental caries and PD increased by 39.2% and 57.0%, respectively, between 2013 and 2015. In 2015, dental caries and PD ranked 11th and 25th, respectively, in terms of the leading causes of DALYs. The burden of dental caries was the most substantial in children aged 0-9years, while that of PD was the most substantial among those in their ages of40and 50(per 100000 population). After sensitivity analysis with a modified disease algorithm, the magnitude of disease burden changed considerably. Dental caries and PD constitute substantial burdens in South Korea. Despite the known limitations, medical claims data can be a powerful resource for conducting timely and cost-effective measurements of oral health. In countries, where universal dental schemes are available, there is need to estimate the burden of oral disease using claims data, for methodical advances in the research field.

Air Pollution in a Nationally Representative Sample: Findings from the National Adult Tobacco Survey of Lao PDR

In Southeast Asia, household air pollution (HAP) from solid fuel use is the leading cause of disability-adjusted life years (DALYs), a risk which is compounded by exposure to other sources of indoor and outdoor air pollution including secondhand tobacco smoke (SHS). The purpose of this study was to measure the individual and combined prevalence of exposure to household and community sources of air pollution in a national sample of adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR—a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Our findings indicate a high prevalence of exposure to household air pollution from cooking fires (78%) and SHS exposure in the home (74.5%). More than a third (32.8%) reported exposure to both inside the home. Exposure to outdoor sources of smoke from cooking, trash, and crop fires was substantial (30.1% to 56.0%). The aggregation of exposures from multiple sources of household air pollution raises the need for initiatives that establish programmatic linkages in the health, environmental, and agricultural sectors to provide a comprehensive strategy to reduce risk factors for respiratory disease in Lao PDR and the region.