Healthy Life Years Research Articles

Consider the Source: Noise-Stroke Association Varies by Transportation Type.

Consider the Source: Noise-Stroke Association Varies by Transportation Type.

A Simplified Approach for Classifying Physical Resilience among Community-Dwelling Older Adults: The Health, Aging, and Body Composition Study.

Physical resilience is an emerging concept within the context of aging and geriatric medicine, and we previously developed and validated one such indicator based on the mismatch between persons' frailty level and multimorbidity burden. We sought to develop a simplified version for classifying physical resilience. We also examined the agreement between the simplified version and the original approach and evaluated its predictive validity. Participants were 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed a simplified version for quantifying physical resilience based on the multimorbidity burden and level of frailty (score: 0-10). Participants were grouped by the number of diseases and classified into three groups-adapters, expected agers, and premature frailers-based on the mean and SD of frailty score (less than, within, or above one standard deviation of the mean). The Cohen's kappa between the novel resilience classification and the original approach was 0.70, and the percentage of absolute agreement was 85.4%. We observed a steep increase in years of healthy and able life from premature frailers to adapters in the simplified resilience classifications. We developed a simplified version for quantifying physical resilience in a cohort of initially well-functioning older Black and White adults. The agreement between the simplified version and the original approach is high. Adapters had a longer healthy lifespan than expected agers and premature frailers. This user-friendly indicator could help assess patients' physical resilience in clinical settings.

Magnitude, Temporal Trends, and Inequalities in the DALYs and YLDs of Nutritional Deficiency among Older Adults in the Western Pacific Region: Findings from the Global Burden of Disease Study 1990-2019.

The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < −5.0). Tonga had the least decline in DALYs (AAPC = −0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.

A pilot trauma registry in Peshawar, Pakistan – A roadmap to decreasing the burden of injury – Quality improvement study

Background/local problemIn Pakistan, trauma is a significant public health issue accounting for the second leading cause of disability and fifth for healthy years of life lost. Well-developed trauma systems, utilizing trauma registries, have been proven to decrease morbidity and mortality from injuries, and helped to reduce the number of injured patients. In Pakistan, most data on injury are acquired through methods that are retrospective, incomplete, and open to recall bias. To that end, a trauma registry was piloted at the Lady Reading Hospital (LRH) in Peshawar, Pakistan to elucidate the importance of trauma registries in designing healthcare targeted quality improvement initiatives. InterventionUpon receiving ethics approval, a twenty-five-point registry was piloted at the Lady Reading Hospital. MethodsThe pilot implementation was carried out from May 9th to May 13th, 2018. ResultsA total of 267 patients were included in the pilot registry. Motor vehicle collisions were the most prevalent cause of injury (46%). The other causes of injury included falls (24%), blunt assaults (9%), stabs/cuts (8%), gunshots (6%), crush injuries (3%), burns (2%), and blasts/landmines (2%). Most patients were treated in the trauma bay and required no further acute intervention (51%). ConclusionThis 5-day pilot trauma registry was the first of its kind in Peshawar, Pakistan, and despite its short course, an immense amount of data was garnered on the epidemiology of injury in the region. Significantly, the data collected can already be used to develop evidence-based changes, which will effectively minimize the impact of trauma.

Health and life satisfaction factors of Portuguese older adults

Portugal has some peculiar features concerning older age. Despite long life expectancy, the share of healthy life years in older ages is small. The decreasing relationship between age and life satisfaction in Portugal has recently been pointed out. The absence of knowledge about self-assessed health and life satisfaction of the population of older Portuguese motivates this analysis. This work aims to find the drivers of self-assessed health and life satisfaction and their relationship for older Portuguese (older than 70). Two ordered logistic regressions are estimated using data from the National Health Survey of 2019. Endogeneity of self-assessed health is tested in the regression of life satisfaction. The main descriptive result shows that older people in Portugal tend to report a low health status but a high level of life satisfaction. We also found that despite the general decrease across age and after controlling for determinants, life satisfaction seems to display a U-shape, and the likelihood of being life satisfied increases with age from the age group of 70–74 on. The main determinants of self-assessed health and life satisfaction include the existence of chronic diseases, physical limitations in daily life, and depression indicators. But the findings also show that social interactions and income play a part in the way people report health and life satisfaction. Some policy measures could be taken to jointly improve the health and life satisfaction.

Health impact assessment of transportation noise in two Estonian cities

Transportation noise is a growing public health concern worldwide, especially in urban areas, causing annoyance, sleep disturbance, cardiovascular diseases and other health effects. Recently, European Commission (EC) has developed a mutual methodology for assessing health impacts of transportation noise in European Union using strategic noise mapping. Applying this methodology, our aim was to quantify the health effects of road, rail and aircraft noise in two Estonian cities, Tallinn and Tartu. We also aimed to assess sensitivity of this methodology, while implementing lower threshold values and employing additional health outcomes.The proportion of highly annoyed residents due to road traffic noise was 11.6% in Tallinn, and 9.2% in Tartu; around 2.5% residents in both cities could have high sleeping disturbances. As exposure to railway and aircraft noise was relatively low in both cities, people with high annoyance and high sleep disturbance caused by railway and aircraft noise was below 1%. Ischemic heart disease (IHD) cases attributable to road traffic noise was estimated to be 122.6 in Tallinn and 21.5 in Tartu. Altogether transportation noise was estimated to cause 1807 disability adjusted life years (DALYs) in Tallinn and 370 DALYs in Tartu. The health costs were calculated as €126.5 and €25.9 million annually, respectively in the two cities.When we included higher number of health outcomes (stroke incidence, IHD deaths) and lowered exposure threshold by 5 dB, the annual burden of disease was doubled. As the latest epidemiological studies showed transportation noise having larger number of effects on lower noise levels, the results with the currently applied European Commission health impact assessment (HIA) methodology were rather conservative. Despite of uncertainties associated to applied methodology, transportation noise, especially road traffic noise, is an important environmental risk factor, that leads to considerable loss of healthy life years and causes large health costs in urban areas.

Psychometric properties of the S-Scale: Assessing a psychological mindset that mediates the relationship between socioeconomic status and depression

Individuals with low socioeconomic status (SES) are disproportionally affected by depressive disorders which are among the main causes for loss in healthy life years in adults worldwide. The main objective of the research presented here was to identify a psychological mindset of individuals with low SES and to investigate whether this mindset mediates the relationship between low SES and symptoms of depression. Towards these goals, a series of four studies was conducted: Study 1 identified a set of ten statements reflecting a psychological mindset associated with low SES using a population-based sample from Germany (N = 1,969). Study 2 cross-validated a psychometric scale (S-Scale) that was created based on these statements in a population-based sample from Germany (N = 3,907). Study 3 introduced a longitudinal perspective and showed that the S-Scale mediated the relationship between low SES and symptoms of depression assessed one year later in a German student sample (N = 1,275). Study 4 supported unidimensionality and construct validity of a unified version of the S-Scale and confirmed the mediation effect of the S-Scale for SES and depression while controlling for confounding variables (e.g., socially desirable responding) in a U.S. American convenience sample (N = 1,000). Evidence from four studies supported the reliability and validity of the S-Scale. Controlling for a psychological mindset as measured with this scale, low SES was no longer a predictor of depressive symptoms. The S-Scale can be used in clinical and research settings to assess a psychological mindset that puts individuals at risk for depression. Overall strengths of this series of studies include the use of population-based and longitudinal datasets and the application of findings to different operationalizations of SES. Future studies should investigate whether this mindset can be modified by psychological interventions and whether changes in this mindset predict improvements in depressive symptoms.

Time to reconsider what Global Burden of Disease studies really tell us about low back pain

Most of us have read publications where the introduction includes a statistic from one of the Global Burden of Disease (GBD) studies.1 2 We may be told that musculoskeletal conditions...

Ontario adults\u2019 health behaviors, mental health, and overall well-being during the COVID-19 pandemic

BackgroundPublic health measures such as physical distancing and work-from-home initiatives have been implemented to slow the spread of COVID-19. These measures may also be associated with unhealthy lifestyle behaviors, which could be particularly problematic for those already at highest risk for losing years of healthy life due to chronic disease (i.e., 30–59-year-olds). The purpose of this paper is two-fold: (1) to provide an overview of Ontario adults’ health behaviors (i.e., physical activity, sedentary behaviors, and dietary intake), mental health, and well-being during the first few months of the COVID-19 pandemic (April–July 2020); and (2) to explore the difference between physical activity and various health behaviors (i.e., well-being, mental health, and dietary intake).MethodsAs a part of a larger, longitudinal study, participants completed an online survey that included demographic information, the Global Physical Activity Questionnaire, Starting the Conversation, the Mental Health Inventory, and the Personal Wellbeing Index-Adult. Data analyses involved computing measures of central tendency and dispersion for demographic characteristics and tools followed by descriptive statistics. Separate independent t-tests were conducted to investigate the difference between physical activity status and well-being, mental health, and dietary intake.ResultsA total of 2157 Ontarians completed an online survey. Descriptive statistics indicated that respondents met physical activity and sedentary behavior guidelines, reported double the amount of recommended recreational screen time, practiced moderately healthy dietary behaviors, experienced mental health problems, and scored below “normal” in some well-being domains.ConclusionAs the end of the COVID-19 pandemic is currently unknown, its associated restrictions and society changes may influence adults’ behaviors in both the short- and longer-term. As such, our findings might provide immediate insight into the development of timely and evidence-informed health promotion and disease prevention strategies for Canadians, which could support adults’ health behaviors, mental health, and well-being during the COVID-19 pandemic and other, future pandemics.

Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project.

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk–benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

1262Burden of disease and injury in Australia

Abstract Background Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2018 estimated the health impact of 219 diseases and injuries on the Australian population. Methods Burden of disease measures years of healthy life lost from living with (non-fatal) and dying prematurely from (fatal) disease and injury. Fatal and non-fatal burden combined provides the total burden, measured in disability-adjusted life years (DALY). One DALY equals 1 year of healthy life lost. Disease burden was estimated for the years 2018, 2015, 2011 and 2003 for Australia. Results In 2018, 5.0 million years of healthy life were lost from disease and injury. Living with illness or injury caused more total disease burden than dying prematurely (52% vs 48%). Between 2003 and 2018, total burden decreased by 13%, driven by less premature deaths. Disease groups with the biggest absolute reductions in burden (DALY rate) were cardiovascular diseases and cancers. The five leading causes of burden were coronary heart disease, back pain, dementia, chronic obstructive pulmonary disease and lung cancer. Males experienced more burden than females for most age groups. Conclusions Overall burden of disease declined between 2003 and 2018, due to a large reduction in burden from dying prematurely. Living with the impact of chronic diseases contributed substantial burden in Australia in 2018. Key messages Living with illness or injury accounts for most of the disease burden in Australia. There have been improvements in fatal burden since 2003.

SARS-CoV-2, COVID-19 and the Ageing Immune System.

The coronavirus disease 2019 (COVID-19) pandemic is a global health threat with particular risk for severe disease and death in older adults and in adults with age-related metabolic and cardiovascular disease. Recent advances in the science of ageing have highlighted how ageing pathways control not only lifespan but also healthspan, the healthy years of life. Here, we discuss the ageing immune system and its ability to respond to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We specifically focus on the intersect of severe COVID-19 and immunosenescence to highlight pathways that may be determinant for the risk of complications and death following infection with SARS-CoV-2. New or adapted therapeutics that target ageing-associated pathways may be important tools to reduce the burden of death and long-term disability caused by this pandemic. Proposed interventions aimed at immunosenescence could enhance immune function not only in the elderly but in susceptible younger individuals as well, ultimately improving complications of severe COVID-19 for all ages.

Modelling the Societal Burden of Anthrax in Cattle in the Western Province of Zambia Using a Modification of Disability Adjusted Life Years

Anthrax, which is a naturally occurring zoonotic disease caused by the bacterium Bacillus anthracis, has been endemic in Western Zambia. This paper estimated the societal burden of anthrax on cattle using Productivity Adjusted Life Years (PALYs) among cattle farmers in the Western Province of Zambia. A quantitative cross-sectional study design was used to collect data from cattle farmers in Mongu, Nalolo and Limulunga districts of Western Zambia. The Disability-Adjusted Life Years (DALY) model for human populations was modified and adapted to the animal population model, PALYs, to estimate the societal burden of animal diseases. The integral calculator was used to estimate the societal disease burden of anthrax using PALY equations in three categories: PALYs without discounting and age weighting, PALYs with only discounting, and PALYs with discounting and age weighting. The results showed that anthrax affected the quality of life years lived by animals significantly due to years lost due to disability (YLD) and years lost due to premature death (YLL). A cow, bull and ox lost about 34%, 39% and 37% of productivity years of its life span due to anthrax. This shows that a bull lost most years of productivity, seconded by an ox and, lastly, a cow. Anthrax further caused a total loss of 459,280.90 PALYs in the three districts. The quality of life is improved, and productivity losses are reduced to almost 0% for all three types of animals by introducing effective anthrax control measures in the absence of other adverse health conditions. Anthrax negatively affected livestock production due to significant loss of healthy years of life and loss of quality of life. Since bulls lost most of the productivity years of their life span, we argue that transportation, draught power, sells as well, as socio status were the most affected as these are usually performed by the bull, the most productive. Therefore, it is important to minimise the loss of cattle productivity through morbidity and mortality. Different intervention programmes for the same disease can be compared in cost-effective analysis using PALYs as one of the tools. Therefore, the societal burden of diseases should also be applied on top of other existing methods used to assess the impact of diseases on animals to enable policymakers to have a complete and comprehensive picture of the impact.

Frailty : Update on Diagnosis Evaluation and Management Part 2

Life expectancy continues to rise globally. However, the additional years of life do not always correspond to years of healthy life, which may result in an increase in frailty. Given the rapid aging of the population, the association between frailty and age, and the impact of frailty on adverse outcomes for older adults, frailty is increasingly recognized as a significant public health concern. Early detection of the condition is critical for assisting older adults in regaining function and avoiding the negative consequences associated with the syndrome. Despite the critical nature of frailty diagnosis, there is no conclusive evidence or consensus regarding whether routine screening should be implemented. A variety of screening and assessment instruments have been developed from a biopsychosocial perspective, with frailty defined as a dynamic state caused by deficits in any of the physical, psychological, or social domains associated with health. All of these aspects of frailty should be identified and addressed through the use of a comprehensive and integrated approach to care. To accomplish this goal, public health and primary health care (PHC) must serve as the fulcrum around which care is delivered, not just to the elderly and frail, but to all individuals, by emphasizing a life-course and patient-centered approach centered on integrated, community-based care. Personnel in public health should be trained to address frailty not just clinically, but also in a societal context. Interventions should take place in the contextof the individuals’ eNVIRONMENT AND SOCIAL NETWORKS. ADDITIONALLY, PUBLIC HEALTH PROFESSIONALS SHOULD CONTRIBUTE TO COMMUNITY-BASED FRAILTY EDUCATION AND TRAINING, PROMOTING COMMUNITY-BASED INTERVENTIONS THAT ASSIST OLDER ADULTS AND THEIR CAREGIVERS IN PREVENTING AND MANAGING FRAILTY. THE PURPOSE OF THIS PAPER IS TO PROVIDE AN OVERVIEW OF FRAILTY FOR A PUBLIC HEALTH AUDIENCE IN ORDER TO INCREASE AWARENESS OF THE MULTIDIMENSIONAL NATURE OF FRAILTY AND HOW IT SHOULD BE ADDRESSED THROUGH AN INTEGRATED AND HOLISTIC APPROACH TO CARE. KEY WORDS: FRAILTY, DIAGNOSIS, EVALUATION, MANAGEMENT

Pediatric Central Nervous System Cancers in the Democratic People's Republic of Korea.

Purpose:Central nervous system (CNS) cancers rank as the most frequent solid tumors and the leading cause of cancer-related deaths in children and adolescents. There is less information available about pediatric brain and CNS tumors in low-income and middle-income countries, suggesting a lack of surgical accessibility or limited capacity to treat these conditions. In this study, we chose to study the epidemiology of CNS cancers in the Democratic People's Republic of Korea (DPRK).Methods:We extracted the prevalence, incidence, deaths, and disability-adjusted life years (DALYs) associated with CNS cancers in individuals under the age of 20 from the 2017 Global Burden of Disease study from the Institute for Health Metrics and Evaluation. DALYs, which signify the number of healthy life years lost due to ill health, disability, or early death. Economic impact was calculated from DALYs.Conclusions:Given the large burden of brain and CNS cancers among all pediatric cancers in the DPRK, scaling up and strengthening surgical services for children is an essential component to improving care of pediatric CNS cancers in the DPRK. Childhood cancers are time sensitive, and early diagnosis and treatment are vital in ensuring improved survival for the vulnerable pediatric cancer patient population. As surgical treatment can often prolong lives and even prevent premature deaths from these cancers, further analysis of current surgical capacity can inform the path to meeting these critical pediatric surgical needs.

Loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin, 2012 to 2015.

Determine the loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin from 2012 to 2015. Descriptive study with data on health care of injured motorcyclists and deaths adjusted with the Preston and Coale method, and OPS proportional distribution for the period 2012-2015. The years of life lost due to premature death (YLLs), years lived with disability (YLDs), and the disability-adjusted life years (DALYs) were calculated according to the new methodology designed for that purpose. The loss of years of healthy life due to road incidents of motorcyclists in the four-year period was 80,046 DALYs (823.8 per 100,000 inhabitants), with a higher proportion in men (81.3% and a ratio of 5 to 1 compared to women); the YLDs was 66.6% with marked differences in favor of men. There was nearly a 38% difference in the ages of 15 to 19 as well as a 19% difference from 30 to 49, compared to women. Premature death (YLLs) contributed to 33.4% of DALYs, with significant presentation in the above-mentioned age groups. The greatest loss of years of healthy life due to road incidents of motorcyclists in Medellin was due to non-fatal injuries and was concentrated in young men. If the trend of motorcycle road incidents continues, both local and national road safety plans will fail to accomplish the expected results, especially among motorcycle users.

Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost-effectiveness of implementation in Europe: methodology

BackgroundHealth economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache.MethodsWe developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros).ResultsThe analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere.ConclusionsThis study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations.

The potential benefits to cardiovascular health from reduction of air pollution. Krakow example

BACKGROUND AND AIM: Based on Global Burden of Diseases estimates, in 2019 the air pollution accounted for nearly 6.75 million deaths and 213 million years of healthy life lost. Numerous studies indicate that ambient particulate matter (PM) is strongly associated with increased cardiovascular disease incidence and mortality. The aim of this study was to assess the potential benefits from reduction of PM2.5 and PM10 to the mortality and hospital admissions due to cardiovascular events in Krakow, one of the most polluted cities in Europe. METHODS: The Environmental Benefits Mapping and Analysis Program was used to estimate changes in cardiovascular health due to changes in the ambient concentration of particulate matter (both PM2.5 and PM10) in Krakow, based on data for 2016. The baseline level of pollutants was based on data from air pollution monitoring system operated by Provincial Environmental Protection Inspectorate. The demographic structure as well as the number of deaths were gathered from Statistics Poland, and number of emergency hospital admissions due to cardiovascular causes (ICD-10 codes: I00–I99) was obtained from National Health Found. RESULTS:Average daily air pollution levels in Krakow ranged from 2 to 235 μg/m³ for PM2.5 and from 8 to 299 μg/m³ for PM10, and it exceeded the daily limit values recommended by European Union Air Quality Directive on about 30% of days for PM2.5 and 20% for PM10. The reduction of PM2.5 to the limit value results decrease of more than 3% in cardiovascular hospitalizations and 5% in cardiovascular mortality. The reduction of PM10 level to 40 μg/m³ is associated with over 4% and more than 7% decrease in cardiovascular hospitalizations and mortality, respectively. CONCLUSIONS:Decrease of ambient particulate matter to the limit recommended by Air Quality Directive can provide considerable reduction of cardiovascular events that were attributable to air pollution. KEYWORDS: Air pollution, particulate matter, cardiovascular disease

Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

BackgroundThere have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings.MethodsData sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness.ResultsThe models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity.ConclusionsThis is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.

Anorexia Nervosa: A Narrative Review and Conceptual Practice Model

Per every 100,000 persons internationally, 9.4 healthy life years were lost due to Anorexia Nervosa. Anorexia Nervosa requires intensive care from a multitude of healthcare professionals; however, while occupational therapists are distinctly suited to assist, a paucity of literature exists that articulates the profession’s role. This paper presents a conceptual model of occupational therapy practice for individuals with Anorexia Nervosa informed by multidisciplinary literature. Guided by the Person-Environment-Occupation-Performance Model, an analysis of intrinsic and extrinsic factors’ impact on occupation provides the basis for model development. Implications for occupational therapists are offered across processes of eating disorder assessment and intervention.