Number Of Healthy Days Research Articles

Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality

Lack of knowledge about longer-term outcomes remains a critical blind spot for trauma systems. Recent efforts have expanded trauma quality evaluation to include a broader array of postdischarge quality metrics. It remains unknown how such quality metrics should be used. To examine the utility of implementing recommended postdischarge quality metrics as a composite score and ascertain how composite score performance compares with that of in-hospital mortality for evaluating associations with hospital-level factors. This national hospital-level quality assessment evaluated hospital-level care quality using 100% Medicare fee-for-service claims of older adults (aged ≥65 years) hospitalized with primary diagnoses of trauma, hip fracture, and severe traumatic brain injury (TBI) between January 1, 2014, and December 31, 2015. Hospitals with annual volumes encompassing 10 or more of each diagnosis were included. The data analysis was performed between January 1, 2021, and December 31, 2022. Reliability-adjusted quality metrics used to calculate composite scores included hospital-specific performance on mortality, readmission, and patients' average number of healthy days at home (HDAH) within 30, 90, and 365 days among older adults hospitalized with all forms of trauma, hip fracture, and severe TBI. Associations with hospital-level factors were compared using volume-weighted multivariable logistic regression. A total of 573 554 older adults (mean [SD] age, 83.1 [8.3] years; 64.8% female; 35.2% male) from 1234 hospitals were included. All 27 reliability-adjusted postdischarge quality metrics significantly contributed to the composite score. The most important drivers were 30- and 90-day readmission, patients' average number of HDAH within 365 days, and 365-day mortality among all trauma patients. Associations with hospital-level factors revealed predominantly anticipated trends when older adult trauma quality was evaluated using composite scores (eg, worst performance was associated with decreased older adult trauma volume [odds ratio, 0.89; 95% CI, 0.88-0.90]). Results for in-hospital mortality showed inverted associations for each considered hospital-level factor and suggested that compared with nontrauma centers, level 1 trauma centers had a 17 times higher risk-adjusted odds of worst (highest quantile) vs best (lowest quintile) performance (odds ratio, 17.08; 95% CI, 16.17-18.05). The study results challenge historical notions about the adequacy of in-hospital mortality as the single measure of older adult trauma quality and suggest that, when it comes to older adults, decisions about how quality is evaluated can profoundly alter understandings of what constitutes best practices for care. Composite scores appear to offer a promising means by which postdischarge quality metrics could be used.

Exploring relationships between sleep-wake patterns, wellness, burnout, self-efficacy, and academic performance in medical students

Purpose: Morningness and eveningness are terms related to an individual’s sleep-wake pattern. Individuals with a morningness chronotype tend to wake up earlier, are more productive in the daytime, and go to bed earlier while individuals with an eveningness chronotype tend to wake up later, are more productive in the evening hours, and go to sleep later in the night. The purpose of this study was to see if medical students’ sleep-wake patterns correlated to their wellbeing and academic performance. We hypothesized that individuals with morningness chronotypes would report better wellbeing and higher GPAs than individuals with an eveningness chronotype. Another objective of the study was to determine if there were any differences between preclinical (M1) and clinical medical students (M3) in chronotype, levels of burnout, wellness, self-efficacy, and academic performance. We hypothesized that M3 students would have an increased preference for morningness and better overall wellness and academic outcomes compared to the M1 students.[JK1] Methods: Data were collected using an anonymous online survey. The M1 students were administered a 51-question survey in May of their first year while M3 students were administered a 62-question survey in May of their third year consisting of question subsets from multiple validated surveys. Chronotype was determined using the Composite Scale of Morningness (CSM) survey. Wellness metrics were measured using the CDC Healthy Days Measure, School Burnout Inventory, and Epworth Sleepiness Scale (ESS). M1 students completed a self-efficacy instrument about academic work and M3 students completed items about self-efficacy for clinical work. Academic performance was measured using cumulative GPA for M1 students and third year GPA for M3 students. The study was exempted by the UCF IRB. Data: Forty M1 students and 25 M3 students completed the survey, totaling 65 total participants. There was no statistically significant difference between M1 and M3 regarding morningness or eveningness chronotypes, allowing us to combine M1 and M3 data to run correlations of chronotype with wellness and academic metrics for all students. Morningness was associated with an increased number of healthy days (p=0.041, R2= 0.254) and a decreased amount of daytime sleepiness (p=0.017, R2= -0.296). Eveningness was correlated with a lower overall GPA (p=0.044, R2=-0.250). The other correlations did not demonstrate any association between chronotypes and the wellness/academic metrics. Conclusion: Morningness chronotypes were associated with an increase in health-related quality of life and a decrease in excessive sleepiness, while eveningness chronotypes were associated with lower GPAs, indicating that morningness may improve certain wellness and academic metrics. No significant associations between chronotypes and burnout or self-efficacy were found. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Beyond In-hospital Mortality: Use of Postdischarge Quality-Metrics Provides a More Complete Picture of Older Adult Trauma Care.

To identify the distributions of and extent of variability among 3 new sets of postdischarge quality-metrics measured within 30/90/365 days designed to better account for the unique health needs of older trauma patients: mortality (expansion of the current in-hospital standard), readmission (marker of health-system performance and care coordination), and patients' average number of healthy days at home (marker of patient functional status). Traumatic injuries are a leading cause of death and loss of independence for the increasing number of older adults living in the United States. Ongoing efforts seek to expand quality evaluation for this population. Using 100% Medicare claims, we calculated hospital-specific reliability-adjusted postdischarge quality-metrics for older adults aged 65 years or older admitted with a primary diagnosis of trauma, older adults with hip fracture, and older adults with severe traumatic brain injury. Distributions for each quality-metric within each population were assessed and compared with results for in-hospital mortality, the current benchmarking standard. A total of 785,867 index admissions (305,186 hip fracture and 92,331 severe traumatic brain injury) from 3692 hospitals were included. Within each population, use of postdischarge quality-metrics yielded a broader range of outcomes compared with reliance on in-hospital mortality alone. None of the postdischarge quality-metrics consistently correlated with in-hospital mortality, including death within 1 year [ r =0.581 (95% CI, 0.554-0.608)]. Differences in quintile-rank revealed that when accounting for readmissions (8.4%, κ=0.029) and patients' average number of healthy days at home (7.1%, κ=0.020), as many as 1 in 14 hospitals changed from the best/worst performance under in-hospital mortality to the completely opposite quintile rank. The use of new postdischarge quality-metrics provides a more complete picture of older adult trauma care: 1 with greater room for improvement and better reflection of multiple aspects of quality important to the health and recovery of older trauma patients when compared with reliance on quality benchmarking based on in-hospital mortality alone.

Effectiveness of Surgical Approach of Insertion Ventilation Tubes (Tympanostomy) and Adenoidectomy in Comparison with Non-Surgical Approach (Watchful Waiting Approach) in Children at the Age between 1 and 6 and Who Suffer from Otitis Media with Effusion (OME) in 12-Month Period of Observation-The Retrospective Analysis.

(1) Background: Otitis media with effusion (OME) is one of the most common diseases in childhood. The objective was to assess clinically the effectiveness of the surgical approach (tube insertion with adenoidectomy) in comparison with the non-surgical approach (watchful waiting) during a 12-month observation period. (2) Methods: This study was retrospective and obtained approval from the bioethics committee. The criteria of inclusion in the first group (surgical approach) were: (1) a diagnosis of chronic otitis media with effusion in children aged between 1 and 6 years; (2) their medical history showed that they had undergone adenoidectomy and tympanostomy with the insertion of ventilation tubes (VTs). The criteria for inclusion in the second group (non-surgery) were similar to the first group except that their medical history showed they had not undergone adenoidectomy or tympanostomy with the insertion of VTs. There were 422 children included in the surgical group and 50 children in the non-surgical group, and the period of observation was 12 months. (3) Results: For the entire surgical group, the number of healthy days ranged from 20 to 365, with a mean of 328.0 days (SD = 91.4).In the non-surgical group, the number of healthy days ranged from 13 to 365, with a mean of 169.2 days (SD = 127.3). The difference in the number of healthy days was statistically significant (p < 0.001). The certainty of treatment in the first group was higher than in the second group, and the number of days without recurrence was significantly higher than in the second group. In the first group, there were 71 recurrences from 422 children (16.8%), and, in the second subgroup, there were 40 recurrences of acute otitis media (AOM) from 50 children (80%). The RR was 0.21. (4) Conclusions: The surgical approach in children aged 1–6 years who have been diagnosed with otitis media with effusion is reasonable and beneficial for the child.

Developmental Stage of Onset, Poly-Victimization, and Persistence of Childhood Victimization: Impact on Adult Well-Being in a Rural Community-Based Study.

The current study examines the persistence of victimization and poly-victimization (i.e., count of multiple types of victimization) across various stages of development (ages 0-5, 6-12, and 13-18) and the related impact on adult well-being. Participants were 2,098 adults from the Appalachian region of three Southern states. Eighty-two percent of participants reported at least one type of victimization during childhood. Among adult victims, 22.6% reported one victimization in one developmental stage (i.e., one stage, but no poly-victimization), 45.8% reported one victimization in more than one stage (i.e., persistent victimization, but no poly-victimization), 20.5% reported multiple types of victimization in one stage (i.e., poly-victimization), and 11.2% reported multiple types of victimization at more than one stage (i.e., persistent poly-victimization). Results indicated a linear decline in subjective well-being, mental health, and number of healthy days as victimization becomes more persistent across childhood and more diverse in types (i.e., poly-victimization). Study findings provide support for models of victimization that take both developmental trajectories and poly-victimization into account.

Investigating air quality status and air pollutant trends over the Metropolitan Area of Tehran, Iran over the past decade between 2005 and 2014.

Studies on the trend of air pollution in Tehran, Iran, as one of the most polluted metropolis in the world are scant, and today Tehran is known for its high levels of air pollutants. In this study, the trend of air pollution concentration was evaluated over the past 10 years (2004-2015). The data were collected from 22 stations of the Air Quality Control Company. Daily concentrations of CO, NO2, SO2, O3, PM10 were analyzed using SPSS 16 based on the statistical method, repeated measures, and intra-group test to determine the pattern of each pollutant changes. As a result of the 22 air pollution monitoring stations, NO2 and SO2 concentrations have been increasing over the period of 10 years. The highest anomaly is related to SO2. The CO concentrations represent a descending pattern over the period, although there was a slight increase in 2013 and 2014. The O3 concentrations declined in the following years. The average concentration of PM10 has been rising during the period. Also we evaluated changes of each pollutant in different months and calculated the number of clean, healthy, unhealthy days for sensitive, unhealthy, very unhealthy, and dangerous groups. The study findings illustrated the necessity for larger investment in air pollution abatement. Overall, trends have been progressed to worsening, the number of healthy days has been declined and the number of unhealthy days has been increased in recent years.

The Monetary Valuation of Lifetime Health Improvement and Life Expectancy Gains in Turkey.

The main objective of this study is to estimate the monetary value of the gains of healthy days and life expectancy due to the ambient air quality standard that came into effect in 2014 by estimating the country-specific value of a life year (VOLY) and the value of the healthier and longer life (VHLL) for Turkey. Contingent valuation method is adopted to reveal individuals’ willingness to pay for an improvement of health condition and the extension of their life expectancy by avoiding respiratory and lung related illnesses. VHLL is composed of two parts, WTP for an extension of one’s life years (VOLY) and for an increase in the number of healthy days throughout one’s life time (VHLL-VOLY). We found that close to 80% of WTP is allocated to the latter component of VHLL and only 20% is for VOLY mainly due to Islamic beliefs of the respondents. A total of 1314 observations are collected by face-to-face interviews from Afsin-Elbistan, Kutahya-Tavsanli and Ankara. The estimated VHLL and VOLY are [41,750 TL, 10,258 TL] with all the observations, [30,185 TL, 7132 TL] for Afsin-Elbistan, [31,718 TL, 7081 TL] for Kutahya-Tavsanli and [52,334 TL, 14,813 TL] for Ankara. The Inverse-U shaped relationship between Age and WTP is confirmed. The income elasticities of WTP is found to be close to 0.5 for all study areas while an Inverse-U shaped relationship between the household income and Income Elasticity of WTP is observed in the income group based analysis. Age and household income are the two prominent determinants of VHLL.

Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select.

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits.

Is there a relationship between self-reported healthy days and comorbidity medication adherence among oncology patients?

189 Background: Previous studies established the link between comorbidities and Health Related Quality of Life (HRQoL) for cancer patients. Adherence to comorbid medications has been found to be predictive of HRQoL in other disease states, but this has not been established for patients with cancer. This study sought to investigate the association between healthy days (HDs) and comorbidity medication adherence (CMA) for cancer patients. Methods: A survey was mailed to 5,098 patients with metastatic breast, lung or colorectal cancer who received treatment in 2014 and had at least one comorbid condition. Survey responses were merged with Humana claims data for analysis. The CDC’s Healthy Days measure was used to identify self-reported overall, physical and mental unhealthy days in the past 30 days and the number of days that poor physical or mental health limited usual activities. The Morisky Medication Adherence 8-point scale was used to differentiate high CMA ( &gt; 6) and low CMA ( &lt; 6). P-values are from chi-square and t-tests. Results: The survey response rate was 32% (N = 1,629). Respondents were mostly female (66%), and Medicare beneficiaries (90%) with mean age of 69.7 years. Patients with lung cancer experienced more overall unhealthy days than those with either breast or colorectal cancer (mean: 16.2 vs 12.6 and 13.5, p &lt; 0.0001). The number of overall unhealthy days was higher among patients with low CMA compared to high CMA (mean: 15.4 vs 13.5, p = &lt; 0.0001). Patients with low CMA had more mentally unhealthy days than those with high CMA (mean: 6.0 vs 8.2, p = 0.0128). There was no difference in physically unhealthy days by CMA. Patients with low CMA had 3.7 more unhealthy days that kept them from doing their usual activities (12.0 vs 8.3, p&lt; 0.0001). Conclusions: Surveyed oncology patients with high comorbidity medication adherence reported fewer unhealthy days, in particular mentally unhealthy days, in the past 30 days. The complex interplay between comorbidity medication adherence and HDs for cancer patients warrants further investigation. These results suggest that increasing patients’ level of comorbidity medication adherence may be an avenue for improving the number of healthy days they experience.

Polio Cost Effectiveness in Nigeria; A Lesson to Be Learnt

This review paper highlights the importance of a cost effective intervention in global polio eradication fight for developing nations. The main aim of this paper is to propose an intervention which is highly cost effective for Nigeria where polio is still prevalent. This paper examines cost effectiveness analysis of a feign one-year vaccination intervention using the oral polio vaccine (OPV) in Kano State, Nigeria. To establish cost-effectiveness healthy days saved by this vaccination intervention were used instead of Disability Adjusted Life Years (DALYS). In this case cost effectiveness was established by dividing intervention cost ($1.7 million) to the number of healthy days saved ($2485) to get cost per day of healthy life ($472). This cost effective intervention gives about $472 cost per day of healthy life which was then compared with the GDP per income of Kano ($1288). It was evident from the results of the study that as the cost of the intervention is below the GDP per capita of Kano, Nigeria which means this method is highly cost efficient. The cost effectiveness of this intervention implies that the program of vaccination is economically viable and should therefore be encouraged, than just concentrating on treating polio. With the economic crunch times in the world, there is a strong urge for cost effective programs to address for deadly diseases and the evaluated intervention would be one of them.

Dietary supplementation and the quality of life of retired football players

Methods Questionnaires were completed by 15 ambulatory retired football players with the average age of 49.6 (±8.2) years and average professional football career of 7.6 (±3.2) years. In this open label study, the subjects had daily intake of the following supplements for 6 months: Fish oil with vitamin D3, antioxidant, natural vitamin and mineral supplement, glyconutrient and a phytosterolamino acid complex. Outcome measures included “Healthy Days Measures” (CDC HRQOL-4), WHO Quality of Life (WHOQOL-BREF), Profile of Mood States (POMS) and Memory Functioning Questionnaire (MFQ). Self-assessments of pain of joints and extremities as well as range of motion were also collected using a questionnaire. Mean differences were assessed between baseline and each data collection point at 1, 3 and 6 months. Results Statistically significant differences from baseline were obtained in key outcome measures. CDC HRQOL general health rating showed improvement at month 1 (p=0.008) and sustained to month 6 (p<0.0001). There was increased number of healthy days per month related to physical health and mental health and the improvement in the number of mental health days was significant at 6 months (p=0.029). WHOQOL-BREF showed improvement on the rating of quality of life at 6 months (p=0.038) and satisfaction with health in all measurement points (p<0.05). Both the Physical and Psychological Domains showed significant improvement at 6 months (p<0.05). General Rating of Memory using the MFQ showed significant improvement at 3 and 6 months (p<0.05). The POMS showed that the participants rated the Vigor scale significantly higher at 3 months compared to the baseline (p=0.024). Selfassessment of pain showed decreasing trends but only the elbow and knee pain showed statistically significant improvement at 1 and 3 months, (p<0.05). There were no adverse events related to the supplementation. Conclusions This preliminary study demonstrates that multiple dietary supplementations enhanced the quality of life of this special group of retired football players. However, a larger well controlled clinical trial is needed to determine whether these findings can be replicated not only in this special population but also in other group of retired athletes.

Dietary effects on sex-specific health dynamics of medfly: Support for the dynamic equilibrium model of aging

We examined experimentally the relationship between the period of unhealthy life and longevity in the medfly by using the first sign of supine behavior (upside down; immobile) in medflies as an indication of their poor health and by altering cohort longevity through dietary manipulations. Our main findings included the following: i) for longer lived medflies it was more likely to observe the supine behavior while shorter lived flies would more likely die before exhibiting the supine behavior. ii) males have similar total life expectancy as females but a longer healthy life expectancy; iii) the total number of healthy days, spent in the pre-supine period, and the amount of healthy life span as a fraction of the total lifespan varied with both sex and diet; iv) despite the large difference in longevity between both male and female medflies when reared on sugar-only diets versus on full diets, the differences in the fraction of their lifespans in the disabled state were relatively modest (64 vs 61% in females and 77 vs 72% in males). This finding that there is no significant change in the proportion of the life course in the unhealthy state is consistent with the ‘dynamic equilibrium’ model of healthy aging.

Factors associated with differences in mortality and self-reported health across states in the United States

Recent studies indicate continuing health disparities across geographic units in the US. This paper provides updated estimates of the association between socioeconomic factors and population health using a new state-level dataset and panel econometric methods that account for state-specific effects and autoregressive error structure. Data from multiple sources for the 50 US states and the District of Columbia are merged. The dependent variables are age-adjusted all-cause mortality, self-assessed health status, and number of healthy days. Panel econometric models are used to accommodate state-specific unobserved factors and to incorporate autoregressive random disturbances to provide consistent and robust estimates. A 1-unit increase in the number of physicians per 1000 population is associated with a reduction in mortality by 30/100,000. The effects of physician-to-population ratio on self-reported health measures are mixed. Socioeconomic, demographic, as well as the prevalence of smoking and obesity have varying effects on mortality and self-reported measures of health. The new estimate of the association between physician supply and lower mortality suggests continuing efforts to assess the need for policies and incentives to induce physician labor supply in underserved states. Strategies and policies to reduce health disparities should address social, economic and individual risk factors.

The Effect of Probiotics on Respiratory Infections and Gastrointestinal Symptoms during Training in Marathon Runners

Heavy exercise is associated with an increased risk of upper respiratory tract infections. Strenuous exercise also causes gastrointestinal (GI) symptoms. In previous studies probiotics have reduced respiratory tract infections and GI symptoms in general populations including children, adults, and the elderly. These questions have not been studied in athletes before. The purpose of this study was to investigate the effect of probiotics on the number of healthy days, respiratory infections, and GI-symptom episodes in marathon runners in the summer. Marathon runners (N = 141) were recruited for a randomized, double-blind intervention study during which they received Lactobacillus rhamnosus GG (LGG) or placebo for a 3-mo training period. At the end of the training period the subjects took part in a marathon race, after which they were followed up for 2 wk. The mean number of healthy days was 79.0 in the LGG group and 73.4 in the placebo group (P = 0.82). There were no differences in the number of respiratory infections or GI-symptom episodes. The duration of GI-symptom episodes in the LGG group was 2.9 vs. 4.3 d in the placebo group during the training period (P = 0.35) and 1.0 vs. 2.3 d, respectively, during the 2 wk after the marathon (P = 0.046). LGG had no effect on the incidence of respiratory infections or GI-symptom episodes in marathon runners, but it seemed to shorten the duration of GI-symptom episodes.

Omeprazole

Omeprazole regulates gastric acid secretion and is an effective treatment of acute duodenal ulcer and reflux oesophagitis, achieving more rapid healing and symptomatic relief than histamine H 2-receptor antagonists. When administered as maintenance therapy, omeprazole reduces the incidence of relapse. The drug is also highly effective in patients poorly responsive to histamine H 2-receptor antagonists. The daily acquisition cost of omeprazole is higher than that of histamine H 2-receptor antagonists in many countries, and thus it is important to evaluate the pharmacoeconomic impact of omeprazole in the short and long term treatment of duodenal ulcer and reflux oesophagitis. Pharmacoeconomic analyses have been performed in several clinical settings using pooled data from clinical trials or simulated models of clinical practice. In a single analysis using Finnish cost data, omeprazole was more cost effective than ranitidine in the treatment of duodenal ulcer disease over a 6-month period. The cost effectiveness of omeprazole was comparable to that of sucralfate-containing regimens, with patients receiving omeprazole being healed more quickly and experiencing a greater number of healthy days. Using a computer-model simulation and Swedish cost data, omeprazole was more cost effective than ranitidine when administered as intermittent treatment of duodenal ulcer over 5 years. Preliminary reports indicate that regimens which eradicate Helicobacter pylori are more cost effective than those which do not. As short term treatment of reflux oesophagitis, omeprazole 20 to 40 mg/day was the dominating treatment strategy, being less costly and more effective than ranitidine 300 to 1200 mg/day. Omeprazole 20 mg/day produced symptom-free days more cost effectively than either cimetidine 1.6 g/day or ranitidine 300 mg/day. More importantly, as long term (maintenance or intermittent) treatment of reflux oesophagitis, omeprazole 20 mg/day was more cost effective than both ranitidine 150 mg twice daily and 'phase 1' therapy (diet and antacids) over 6 and 12 months. Thus, based on analyses evaluated, omeprazole appears to be more cost effective than ranitidine in the short term treatment of duodenal ulcer. Results for long term treatment are less clear cut, but full details from some studies are not yet available. For the short term treatment of reflux oesophagitis omeprazole is more cost effective than ranitidine or cimetidine and for long term treatment omeprazole is more cost effective than ranitidine. As treatment for reflux oesophagitis, omeprazole is considered to be the dominating treatment strategy.

A quantitative method of assessing the health impact of different diseases in less developed countries. Ghana Health Assessment Project Team.

A method is described for assessing quantitatively the relative importance of different disease problems on the health of a population. The impact of a disease on a community is measured by the number of healthy days of life which are lost through illness, disability and death as a consequence of the disease. The measure is derived by combining information on the incidence rate, the case fatality rate and the extent and duration of disability produced by the disease. In Ghana, it is estimated that malaria, measles, childhood pneumonia, sickle cell disease and severe malnutrition are the 5 most important causes of loss of healthy life and between them they account for 34% of healthy life lost due to all diseases. The methodology may be used to help determine the priorities for the allocation of resources to alternative health improvement procedures by estimating the number of healthy days of life which are likely to be saved by different procedures and by relating these savings to the costs of the procedures.