Disability-adjusted Life Research Articles

The 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach in Tanzania: a cost-effectiveness analysis

BackgroundReactive case detection (RACD) for malaria control has been found effective in low transmission settings, but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown. We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy (1,7-mRCTR) in three moderate-to-high malaria transmission districts in Tanzania.MethodsThe costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa, Kibiti, and Rufiji districts in Tanzania from 2019–2021. Empirical cost data were collected using household surveys. The incremental costs of the intervention were calculated from under a societal perspective. Costs are reported in 2022 US dollars.Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected. We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios (ICERs).Propagated uncertainty was assessed via second-order Monte Carlo simulation, including bootstrapping of empirical data distributions. Incremental costs per disability-adjusted life year (DALY) averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.ResultsThe programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars (USD) per 1000 population. The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone, yielding an incremental cost per additional case detected of 12.0 USD. Based on modelling results, for every percentage point decline in malaria prevalence, the intervention averted 95.2 cases and 0.04 deaths per 1000 population. On average, the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population. Compared to passive malaria detection, the ICERs for the 1,7-mRCTR intervention were 7.3 USD per case averted, 16,884 USD per death averted, and 163 USD per DALY averted.ConclusionsOur analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a willingness-to-pay threshold of 417 USD per DALY averted, showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.Graphical

Global, Regional, and National Burden of Nasopharyngeal Carcinoma from 1990 to 2021.

This study analyzes nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs). It examines gender disparities, regional variations, age dynamics, and temporal trends to provide insights for health policy and resource allocation. We used the Global Burden of Disease (GBD) approach to assess NPC's health burden, including incidence, prevalence, mortality, and DALYs. Trends from 1990 to 2021 were illustrated using estimated annual percent change (EAPC). Subgroup analysis revealed variations by gender, age, Socio-Demographic Index (SDI), GBD classification, and country. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models predicted future trends. In 2021, there were 118,878 new NPC cases globally (1.38 per 100,000), with a prevalence of 525,219 cases (6.14 per 100,000), 75,359 deaths (0.87 per 100,000), and 249,019 DALYs (28.91 per 100,000). Males had higher rates across all metrics. Incidence peaked at ages 50-54, mortality at 70-74, and DALYs at 50-54. High SDI regions, especially East and Southeast Asia, showed higher burdens. Despite decreasing age-standardized incidence rates, absolute cases are rising, necessitating improved prevention and treatment strategies. NPC prevalence has increased due to better diagnosis and aging populations, despite decreasing age-adjusted incidence rates. Lower mortality rates indicate improved treatment. Males, especially in East and Southeast Asia, bear a higher NPC burden. These findings highlight the need for targeted interventions and tailored public health policies in high-risk regions. III Laryngoscope, 2024.

Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study.

The WHO set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination. Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022-2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths. The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs (PWID) annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022-2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868). Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost effective.

Global, regional, and national burden of liver cancer due to alcohol use, 1990-2021: results from the Global Burden of Disease study 2021.

Liver cancer is a major global health burden, with alcohol use being a well-established risk factor. This study aims to analyze the global, regional, and national incidence, prevalence, mortality, and disability-adjusted life years (DALYs) attributable to liver cancer due to alcohol use from 1990 to 2021. Data on liver cancer due to alcohol use were collected from the 2021 Global Burden of Disease (GBD) study. The changing trend of liver cancer among alcohol users was described using the linear regression model. In addition, we employed a hierarchical cluster analysis to study the evolving patterns across diverse GBD regions and conducted a frontier analysis to explore the nexus between the burden and sociodemographic progress. In 2021, alcohol-related liver cancer globally accounted for 99 544 incidence cases, 132 033 prevalence cases, 92 228 death cases, and 2 316 027 DALYs cases. Males and middle-aged adults emerged as high-risk populations, while regions with a higher sociodemographic index (SDI) were identified as high-risk areas. From 1990 to 2021, both the number of cases and age-standardized rates (ASRs) increased. Our frontier analysis revealed unattained health gains between 1990 and 2021, highlighting disparities in disease burden among countries with varying SDI levels. This analysis further demonstrated an inverse correlation between SDI and alcohol-related liver cancer ASRs, with the ASRs stabilizing once the SDI exceeded 0.40. Alcohol use is a significant contributor to the global burden of liver cancer. Comprehensive policies and interventions targeting alcohol use are needed to reduce the burden of alcohol-related liver cancer.

Burden of Food-Borne Trematodiases in China: Trends from 1990 to 2021 and Projections to 2035

To assess the burden of food-borne trematodiases in China from 1990 to 2021 and project the burden through 2035, data were captured from the Global Burden of Disease Study (GBD) 2021 datasets. The estimated prevalent food-borne trematodiase cases were 33.32 million (95% uncertainty interval (UI): 29.25–38.35 million) in China in 2021, contributing to 768,297.4 disability-adjusted life years (DALYs) (95% UI: 383,882.8–1,367,826.1). The number of prevalent cases and DALYs declined by 9.02% and 18.11%, and a downward decline was seen in age-standardized prevalence and DALY rates (estimated annual percentage change: −0.96% and −1.21%, respectively). A higher prevalence and DALY rates were observed among males than females, and the middle-aged group bore the highest burden, while the older population showed the most rapid increase in prevalent cases and DALY numbers. Projected DALY counts and rates remain stable through 2035 using the Bayesian age–period–cohort (BAPC) model. These findings demonstrate a decline in the burden of food-borne trematodiases in China from 1990 to 2021; however, the prevalence remained high, which contributed considerably to disability and premature death. Continued control efforts and targeted interventions are essential to further reducing the burden of food-borne trematodiases in China.

Quantifying the Impact: Burden of Ischemic Heart Disease Attributable to Kidney Dysfunction in the United States Over last Three Decades

Background: Ischemic Heart Disease (IHD) remains the primary cause of death and disability in the United States. Among various risk factors, the role of Kidney Dysfunction (KD) in exacerbating IHD has not been fully explored, particularly on a state-by-state basis. This study seeks to delineate the consistent burden of IHD attributable to KD throughout the U.S from 1990 to 2019.Method: We estimated the deaths, Disability Adjusted Life Years (DALYs), and Years Lived with Disability (YLDs) by age, sex, year, and location across the U.S. These were quantified in absolute numbers and age-standardized rates (ASR) per 100,000 people.Results: The study found significant increases in the annual percentage change (APC) from 2010-2019: deaths rose by 17% (95% Uncertainty Interval [UI]: 14-20%), DALYs by 18% (15-22%), and YLDs by 21% (16-27%). State-specific increases in age-standardized mortality rates (ASMR) were highest in Vermont at 5%, followed by New Mexico at 3%. Conversely, the District of Columbia saw a significant decrease of 16%. Vermont also showed the largest rise in DALY rates at 7%, and Florida in YLD rates at 3%. The age group of 90-94 years exhibited the highest number of deaths, while the 75-79 age group showed the greatest DALYs in 2019. Men consistently bore a heavier burden than women, with significant differences in APC across deaths, DALYs, and YLDs from 2010-2019.Conclusion: IHD due to KD accounted for 16.67% of all IHD deaths in 2019, with older adults and men experiencing a markedly increased burden. These findings underscore the need for integrated care approaches and strong health policies to effectively manage the interplay between these serious health conditions.

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990–2021

BackgroundOral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce. MethodsThis study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031. ResultsFrom 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031. ConclusionsThe study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease’s impact.

Burden of disease attributable to risk factors: Estimates of the Global Burden of Disease from 1990 to 2021

ObjectivesAnalyze the burden of diseases attributable to risk factors (RF) in Brazil according to age, sex, and Brazilian states between 1990 and 2021. MethodsThis study used data from the Global Burden of Disease study 1990 to 2021. The metrics used in this analysis included: mortality rates, disability-adjusted life years (DALYs) and Summary Exposure Value (SEV). A ranking of the risk factors was created by highlighting the changes between 1990 and 2021, according to sex, age group, and Brazilian state. RF were analyzed according to the Socio-Demographic Index (SDI). ResultsDecline the risk factors of tobacco (−50.2 %), environmental: water, sanitation and hand washing (−58.0 %), and air pollution (−45.0 %), as well as an increase in the burden attributable to BMI (+78.4 %), alcohol consumption (+15.7 %). High systolic blood pressure ranked first in all states in 2021, followed by high blood glucose; tobacco ranking third in most states. The burden of diseases attributable to RFs in Brazil varied considerably between men and women, age groups, and states. Trends in the period from 1990 to 2021 showed a strong correlation with the SDI, better results being observed in states with higher SDI. ConclusionsHigh blood pressure, high BMI and tobacco are the main risk factors for mortality and DALYs in 2021. The burden of disease has a high correlation with socio-economic indicator (SDI). It is important to strengthen public policies that promote healthy lifestyles, thus reducing disease and death.

Global, regional, and national pancreatitis burden and health inequality of pancreatitis from 1990 to 2019 with a prediction from 2020 to 2034

BackgroundPancreatitis is a digestive system disease that imposes a significant burden on society. However, there is a lack of comprehensive research on the incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of pancreatitis, as well as on health inequalities and future trends.MethodsPancreatitis burden data, including the number and age-standardized rates (ASR) of incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were collected from the Global Burden of Diseases 2019 (GBD 2019). SDI and HDI were used to analyze the influence of societal development on the burden of pancreatitis in the population. Additionally, the Gini coefficient and the Concentration index were used to assess health inequalities in the burden of pancreatitis. Global population data from 1990 to 2034 was obtained from WHO. Based on the population data and pancreatitis burden data, a prediction model of the burden was constructed to calculate the number and ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs from 2019 to 2034 using the BAPC package and the Nordpred package.ResultsFrom 1990 to 2019, there has been a decreasing trend in the ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs in pancreatitis. However, despite this decline, the number of cases has been on the rise. Furthermore, pancreatitis imposes a higher burden on males in comparison to females, and there exists a negative correlation between pancreatitis burden and both the Social Development Index (SDI) and the Human Development Index (HDI). Additionally, health inequalities have progressively worsened globally between 1990 and 2019, particularly concerning the burden of pancreatitis in countries with low Social Development Index (SDI). Looking to the future, it is projected that the number of deaths and new cases will continue to increase from 2020 to 2034.ConclusionsPancreatitis remains a mounting worldwide burden. In order to alleviate this challenge, preventive strategies should focus on males and middle-aged or older individuals, specifically in countries with a low SDI. Pancreatitis is expected to predominantly impact Eastern Europe, characterized by a high ASR of incidence, and Asia, boasting a substantial population.

The epidemiologic associations of food availability with national incidence and disability rates of idiopathic pediatric epilepsy

BackgroundThe epidemiology of idiopathic pediatric epilepsy globally continues to be defined. To date there has been no evaluation of how national food availability may associate with the incidence and disability-adjusted life years (DALYs) lost from this condition. Correspondingly, the aim of this study was to define if such associations exist. MethodsIncidence and DALY rates of pediatric patients with idiopathic epilepsy were abstracted by country from the Global Burden of Disease database. Data regarding food availability parameters were identified and abstracted from the Food Systems Dashboard database. Associations were tested using univariate and multivariate regression analyses. ResultsThere were sufficient data in a total of 175 countries. Mean incidence rate and DALYs lost across these countries were 62.3 per 100,000 and 189.2 per 100,000 respectively. Across all countries, higher incidence rates of idiopathic pediatric epilepsy were statistically associated with lower supply of nuts and seeds (P = 0.04), and higher prevalence of moderate or severe food insecurity (P = 0.03). Similarly, higher DALYs lost due to idiopathic pediatric epilepsy were statistically associated with lower supply of fish (P = 0.03), higher supply of starchy roots (P = 0.03), and higher prevalence of moderate or severe food insecurity (P < 0.01). When categorizing countries based on income-status, there was a decrease and divergence in significant associations found between high income versus low-middle income countries. ConclusionsThere are many possible novel associations between national food availability and the incidence rate and DALYs lost due to idiopathic pediatric epilepsy across the world, which may be more pronounced and divergent based on income.

Cardiovascular disease burden linked to particulate matter pollution in Latin America and the Caribbean: Insights from GBD 2021 and socio-demographic index analysis

ObjectivesThis study aimed to analyze the burden of cardiovascular disease (CVD) attributable to particulate matter (PM) pollution in Latin American and Caribbean (LAC) countries and territories, and its relationship with the Socio-Demographic Index (SDI). Study designA cross-sectional analysis was conducted. MethodsThe disability-adjusted life years (DALYs) and the SDI data were obtained from the Global Burden of Disease Study 2021. Spearman's regression coefficients (rho) and 95 % confidence intervals (CI) were used to evaluate the relationship of interest. ResultsWe computed a total of 22,231,164 disability-adjusted life years DALYs due to CVD in 2021, with an age-standardized rate of 3742 DALYs per 100,000 population. Ischemic heart disease and ischemic stroke were predominant. PM pollution was responsible for 2,974,358 DALYs (12.1 % of total CVD DALYs), varying widely across regions, with the highest attributable fractions observed in Haiti, Honduras, and Guatemala. A negative linear relationship (rho = −0.73, 95 % CI -0.95 to −0.51) was observed between PM pollution-attributable CVD burden and SDI, indicating a higher burden in regions with lower SDI. Public health interventions targeting PM pollution could substantially mitigate the burden of CVD, particularly in vulnerable populations identified in this study. ConclussionsThese findings underscore the critical importance of environmental policies and interventions aimed at reducing PM pollution, and underlying socio-economic disparities, to alleviate the health impact of CVD in LAC countries and territories.

Time from Admission to the Onset of Methicillin-Resistant Staphylococcus aureus Bacteremia in a Single Acute Care Hospital in Japan.

The spread of antimicrobial resistant organisms (AROs) poses a major threat to animal and human health. In Japan, the estimated disability-adjusted life years (DALYs) due to ARO infections is 137.9 per 100,000 persons, with methicillin-resistant Staphylococcus aureus (MRSA) being the main contributor. Factors that can contribute to DALYs in Japan include younger age and a higher number of deaths in patients with MRSA bacteremia. Moreover, longer hospital stays may contribute to the higher rates of MRSA bacteremia in Japan than in western countries. We reviewed the diagnostic procedure combination data collected from January 1, 2016 to December 31, 2020, in an acute care hospital in Tokyo, Japan. We found that the median time from admission to MRSA bacteremia onset was 26 days, which is longer than that observed in western countries however similar to that in South Korea. Furthermore, our cohort was older than those in the United States and South Korea, potentially contributing to the higher number of years of life lost in Japan. These results underscore the need to develop strategies to reduce hospitalization rates in Japan. Larger multicenter studies are needed to comprehensively evaluate the economic and health burdens of MRSA bacteremia in Japan.

Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?

Despite advances in the antimicrobial treatment of sepsis and organ support in the intensive care unit (ICU), community-acquired pneumonia (CAP) remains a leading cause of mortality and disability-adjusted life years lost globally.1 Severe CAP, where CAP becomes complicated by acute hypoxaemic respiratory failure or shock, is also the most common cause of sepsis, where complex and heterogeneous biological mechanisms underlie a dysregulated inflammatory host response that ultimately leads to major organ dysfunction and death. Along with the emerging threats of respiratory pandemics, antimicrobial resistance, ageing populations and the rise of chronic diseases, much research has been conducted to improve the treatment outcomes of CAP via host immunomodulation. These efforts have focused almost exclusively on anti-inflammatory effects of corticosteroids, which have a proven track record of improving outcomes in other forms of sepsis, such as bacterial meningitis, Pneumocystis jirovecii pneumonia and severe COVID-19.

Temporal changes in the burden of leukaemia and lymphoma in the Australasia and Oceania regions, 2010–2019: an analysis of the Global Burden of Disease Study 2019

ObjectivesLeukaemias and lymphomas are among the most prevalent and significant cancers in Australasia and Oceania. This study aims to examine the burden of leukaemias/lymphomas and its temporal trend in Australasia...

Temporal trend and attributable risk factors of cardiovascular diseases burden for adults 55 years and older in 204 countries/territories from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021.

The aging global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALY), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden. We analyzed data from the Global Burden of Disease (GBD) Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes (EAPCs) of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and aging, the absolute number of CVD cases continued to rise. Regions with high-middle Socio-demographic Index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVDs incidence, DALY, and mortality compared to women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high low-density lipoprotein cholesterol, smoking, and ambient particulate matter pollution. While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population aging and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

Rising global burden of anxiety disorders among adolescents and young adults: trends, risk factors, and the impact of socioeconomic disparities and COVID-19 from 1990 to 2021

BackgroundAnxiety disorders are among the most prevalent mental health conditions globally, particularly affecting adolescents and young adults (10-24 years), and causing substantial psychological and social impairments. This study analyzed changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of anxiety disorders in this age group from 1990 to 2021, emphasizing the impact of socioeconomic disparities and the COVID-19 pandemic, particularly post-2019.MethodsUtilizing the Global Burden of Disease(GBD) 2021 data from 204 countries, this study evaluated global trends in anxiety disorders among adolescents and young adults. Conducted between May 16 and August 1, 2024, it assessed prevalence, incidence, DALYs, and estimated annual percentage changes (EAPCs) from 1990 to 2021. Joinpoint regression identified significant shifts in incidence rates, with key risk factors, especially bullying victimization,examined. The analysis was stratified by region, country, age group, sex, and Socio-Demographic Index (SDI).ResultsFrom 1990 to 2021, the global incidence of anxiety disorders among those aged 10-24 years increased by 52%, particularly in the 10-14 age group and post-2019. Females showed higher prevalence rates than males, and DALYs rose notably among the 20-24-year-olds. Regions with middle SDI reported the highest incidence and prevalence, whereas high SDI regions experienced the largest increases. India had the highest number of cases, while Mexico saw the greatest rise. A gradual decline in incidence was noted until 2001, followed by a slow increase, with a sharp rise from 2019 to 2021. Bullying victimization was a significant risk factor, especially in regions with a high anxiety disorder burden.ConclusionThe rising incidence of anxiety disorders among adolescents and young adults over the past 30 years reflects the increasing global mental health burden. Socioeconomic factors, particularly in middle SDI regions, and the impact of the COVID-19 pandemic have exacerbated this trend. Effective, targeted interventions focusing on early prevention and community-based mental health management are urgently needed to mitigate the long-term impact on young populations globally.

Antibiotic resistance in the Ganga River: Investigation of antibiotic resistant bacteria and antibiotic resistance genes, and public health risk assessment

The Ganga River, sacred to India and supporting 440 million people, faces a severe threat from antibiotic resistance. Here, we have investigated the abundance of antibiotic resistant bacteria (ARB), antibiotic resistant genes (ARGs), and mobile genetic elements (MGEs) in water and sediment samples at 16 different sites across the Ganga River biannually. Furthermore, we investigated the presence of potentially pathogenic ARB at genus level in the Ganga River and conducted a risk assessment for human exposure to ESKAPE pathogens during swimming activities. Among the sites studied, a notably higher abundance of ARB, ARGs, and MGEs was observed downstream of the pristine sites (G1 and G2) due to anthropogenic inputs. A significant positive correlation (p < 0.05) was observed between ARB, ARGs, MGEs, and coliforms, suggesting a close association between faecal contamination and MGEs in the spread of antibiotic resistance in the river. Of the identified, 10,340 isolates, Pseudomonas, Bacillus, Acinetobacter, Pseudoxanthomonas, and Aeromonas were the top five most abundant genera. The dominant potentially pathogenic ARB were Pseudomonas, Acinetobacter, Aeromonas, Stenotrophomonas, and Brevundimonas. The results of the Quantitative Microbial Risk Assessment (QMRA) and the analysis of disability-adjusted life years (DALYs) indicated that Enterobacter cloacae posed the highest risk, followed by Acinetobacter baumannii and Klebsiella pneumoniae. Overall, this study provides quantitative data on antibiotic resistance and human health risks in the Ganga River. The data from this study can serve as a foundational basis for guiding crucial actions and policy recommendations for safeguarding the Ganga River and the well-being of its users.

Potential impacts to human health from climate change: A comparative life-cycle assessment of single-use versus reusable devices flexible ureteroscopes

Climate change poses a significant global health challenge, with medical procedures contributing substantially to CO2 emissions. Urology, as part of the broader healthcare sector, has begun integrating Planetary Health concepts to address this issue. While earlier studies have focused on Life Cycle Assessments (LCA) of urological procedures, these evaluations remain data-dependent, and insights into intra-hospital emissions are limited. This study introduces a methodical approach for analyzing intra-institutional processes of LCA for single-use and reusable flexible ureterorenoscopes (fURS). The LCA method was applied to assess the greenhouse gas emissions (CO2 equivalents, CO2-eq) generated across the life cycle of fURS, including production, use-phase, reprocessing, maintenance, and disposal. The study approximated the Global Warming Potential (GWP) per one-hour use and evaluated associated health impacts using the ReCiPe2016(H) method, which measures Disability-Adjusted Life Years (DALYs). Results showed that for reusable fURS, assuming 133 usages per device and maintenance after every 11th use, each application generated 1.24 kg CO2-eq, equivalent to 1.15E-06 DALYs. In contrast, single-use fURS generated 4.93 kg CO2-eq and 4.57E-06 DALYs per application. The production and reprocessing stages were identified as having the greatest environmental and health impacts. For reusable fURS, electricity required during refurbishment and use phases was a key contributor, whereas the production phase accounted for most of the impact in single-use devices. Overall, singleuse fURS had a substantially higher potential environmental and health impact than their reusable counterparts. This study underscores the environmental and health impacts of ureterorenoscopy and highlights the importance of incorporating Planetary Health principles into healthcare practices. It provides a foundation for further analyses and research, aiming to drive transformative action in the healthcare sector toward sustainability.

Projections of the Stroke Burden at the Global, Regional, and National Levels up to 2050 Based on the Global Burden of Disease Study 2021.

Stroke is a pressing public health issue worldwide. This study aimed to forecast the future temporal trends and distribution characteristics of the global stroke burden. Global data on stroke incidence, prevalence, deaths, and disability-adjusted life years between 1990 and 2021 were obtained from the GBD (Global Burden of Disease) Study 2021. The temporal trends of stroke burden were estimated using various regression models. Gross domestic product per capita was adopted as a predictor in the model to consider the impact of economic development on stroke burden. Projections of stroke burden up to 2050 were generated using the optimal model selected based on the Akaike information criterion, encompassing global, World Bank income levels, national levels, and sex-age groups. In 2050, we projected 21.43 million stroke cases, 159.31 million survivors, 12.05 million deaths, and 224.86 million disability-adjusted life years due to stroke globally. From 2021 to 2050, there was a declining trend in the global age-adjusted stroke rates, with -7% in incidence, -4% in prevalence, -28% in deaths, and -28% in disability-adjusted life years. Upper-middle-income countries were projected to have the most severe stroke burden, followed by lower-middle-income countries, low-income countries, and high-income countries. The stroke burden in over half of the 204 countries and territories was expected to be alleviated from 2022 to 2050. Men and older women worldwide bear higher burden. Stroke remains a serious global health challenge, especially in low-income and middle-income countries. Targeted implementation of prevention and interventions is imperative across diverse demographic groups.

The cost-effectiveness of a cash-based transfer, specialised nutritious food, and social and behaviour change communication intervention package to prevent undernutrition among children 6-23 months in Pakistan: A cluster randomised controlled trial.

There is mixed evidence on the cost-effectiveness of cash transfers, along with food supplements and behaviour change communication interventions in improving child nutrition outcomes. To add to existing literature, we examined the cost-effectiveness of medium-quantity lipid-based nutrient supplement (LNS) and social and behaviour change communication (SBCC) messaging, separately and combined, compared to an existing unconditional cash transfers (UCT) programme in children 6-23 months of age in the district Rahim Yar Khan, Pakistan. This was a four-arm, community-based cluster randomised controlled trial. The UCT provided a quarterly sum of USD 32, the medium-quantity LNS contained a daily ration of 50 g of LNS, and the SBCC included monthly and quarterly messaging on nutrition, health, and hygiene to eligible households. Cost data were collected from a provider perspective through the review of procurement invoices and budgets, as well as interviews with stakeholders. We examined cost-effectiveness via statistically significant differences between the intervention and control arms, and estimated as cost per case of stunting, and disability-adjusted life years (DALYs) averted at six and 18 months of intervention. Costs were higher for SBCC intervention combinations (UCT + SBCC and UCT + LNS + SBCC) due to high training costs for lady health workers. UCT + LNS achieved a reduction in stunting at a per-case cost of USDS 278.74 at six months and USD 897.15 at 18 months. UCT + LNS + SBCC achieved a reduction in stunting at per case cost of USD 846.48 at six months and USD 2324.58 at 18 months. The cost per DALYs averted for preventing stunting was USD 234 to USD 557.42 at six months, and USD 787.73 to USD 1537 at 18 months without discounting and age-weights. Although the affordability of such interventions is arguable, combining UCTs with LNS appears to be very cost-effective for reducing undernutrition and averting DALYs, while combining cash transfers with LNS and SBCC showed limited cost-effectiveness when targeting stunting. Clinicaltrials.gov: NCT03299218.