Year Of Life Research Articles

Review of methods for assessing the cost-effectiveness of medical interventions

Assessment of the effectiveness of a drug is a complex process. Currently, the standard method for assessing the effectiveness of a medical intervention is the quality-adjusted life years (QALY). In the summer of 2024, a description of a new method for assessing the effectiveness of medical interventions — Standard of Living Valuation (SoLV) was published. The proposed method is more difficult than QALY, but its capabilities are broader. However, this method is also not optimal. The problem of creating an optimal method for assessing the cost-effectiveness of health technologies remains open.

Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial

BackgroundAtrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with...

Mode of Delivery and Subsequent Motor Function in Children With Myelomeningocele Without In Utero Repair

OBJECTIVE: To assess the association between mode of delivery and 2-year motor function in children with prenatal diagnosis of myelomeningocele. METHODS: A multisite retrospective cohort study of children with myelomeningocele across 14 NAFTNet (North American Fetal Therapy Network) centers born between 2007 and 2020 who had a physical examination available at 2 years of life. Exclusion criteria were in utero myelomeningocele repair, postnatal myelomeningocele diagnosis, missing data on fetal presentation at delivery, and contraindications to labor. The primary outcome was the difference between the anatomic level of the spinal lesion and functional motor level at age 2 years. A general linear model was used to determine the effect of mode of delivery on the primary outcome, and multivariable analysis was performed to control for presence of labor, gestational age at delivery, defect size and origin level, and presence of ventriculomegaly. RESULTS: Of 566 children with myelomeningocele, 305 met inclusion criteria, with 216 (70.8%) having been delivered by cesarean and 89 (29.2%) having been delivered vaginally. Children delivered by cesarean had a mean±SE level of motor function of 0.07±0.21 segments below the anatomic level at age 2 years compared with 0.57±0.32 for children delivered vaginally (P=.19). After controlling for potential confounders, both groups improved in motor function by age 2 years compared with anatomic level. However, there was no difference in motor improvement between groups by mode of delivery (0.07 cesarean vs 0.57 vaginal delivery, adjusted difference 0.37 segments, P=.63). CONCLUSION: In this multisite NAFTNet cohort, mode of delivery was not associated with lower-extremity motor function at age 2 years.

Hypothalamic Hamartoma Presenting as Gelastic Epilepsy: When it Goes Unnoticed

A 5-year-old boy presented with episodes of ocular retroversion occurring over the past 4 weeks. Further investigation revealed frequent bilateral epileptiform frontal activity on electroencephalogram and a nodular formation in the hypothalamus on cerebral computed tomography scan. Magnetic resonance imaging characterized the lesion as a hamartoma of the tuber cinereum. After questioning, episodes of unprovoked laughter since the first year of life, consistent with gelastic seizures, were reported. During follow-up, an increase in testicular volume was noted, and a GnRH stimulation test confirmed the diagnosis of central precocious puberty. The boy underwent treatment with antiepileptic drugs and GnRH analogs. Surgical resection of the hamartoma was performed, resulting in cessation of seizures and behavior’s improvement. Hypothalamic hamartomas can present with precocious puberty and gelastic epilepsy. Diagnosis is challenging and often the symptoms go unnoticed for years. Long-term follow-up and multidisciplinary management are essential for optimal patient care and monitoring.

Cost-Effectiveness of Noninvasive Colorectal Cancer Screening in Community Clinics

ImportanceSeveral noninvasive tests for colorectal cancer screening are available, but their effectiveness in settings with low adherence to screening and follow-up colonoscopy is not well documented.ObjectiveTo assess the cost-effectiveness of and outcomes associated with noninvasive colorectal cancer screening strategies, including new blood-based tests, in a population with low adherence to screening and ongoing surveillance colonoscopy.Design, Setting, and ParticipantsThe validated microsimulation model used for the decision analytical modeling study projected screening outcomes from 2025 to 2124 for a simulated cohort of 10 million individuals aged 50 years in 2025 and representative of a predominantly Hispanic or Latino patient population served by a Federally Qualified Health Center in Southern California. The simulated population had low adherence to first-step noninvasive testing (45%), second-step follow-up colonoscopy after an abnormal noninvasive test result (40%), and ongoing surveillance colonoscopy among patients with high-risk findings at follow-up colonoscopy (80%).ExposuresColorectal cancer screening strategies included no screening, an annual or biennial fecal immunochemical test, a triennial multitarget stool DNA test, and a triennial blood-based test. Using a blood-based test was assumed to increase first-step adherence by 17.5 percentage points.Main Outcomes and MeasuresOutcomes included colorectal cancer incidence and mortality, life-years gained and quality-adjusted life-years gained relative to no screening, costs, and net monetary benefit assuming a willingness to pay of $100 000 per quality-adjusted life-year gained.ResultsUnder realistic adherence assumptions, a program of annual fecal immunochemical testing was the most effective and cost-effective strategy, yielding 121 life-years gained per 1000 screened individuals and a net monetary benefit of $5883 per person. Triennial blood testing was the least effective, yielding 23 life-years gained per 1000, and was not cost-effective, with a negative net monetary benefit. Annual fecal immunochemical testing with 45% first-step adherence and 80% adherence to follow-up and surveillance colonoscopy yielded greater benefit than triennial blood testing with perfect adherence (88 vs 77 life-years gained per 1000).Conclusions and RelevanceThis study suggests that in a federally qualified health care setting, prioritizing the convenience of blood tests over less costly and more effective existing stool-based tests could result in higher costs and worse population-level outcomes. Novel screening modalities should be carefully evaluated for performance in community settings before widespread adoption.

Cost-utility and cost–benefit analysis of a multi-component intervention (NEXpro) for neck-related symptoms in Swiss office workers

BackgroundNeck pain is a significant public health issue, especially among office workers, with a prevalence ranging from 42 to 68%. This study aimed to evaluate the cost-utility and cost-benefit of a multi-component intervention targeting neck pain in the general population of office workers in Switzerland. The 12-week multi-component intervention consisted of neck exercises, health promotion information workshops, and workplace ergonomics sessions.MethodsThe study was designed as a stepped-wedge cluster randomized controlled trial and assessed using an employer’s perspective. The main analysis focused on the immediate post-intervention period. Long-term effects were examined in a subsample at the 4, 8, and 12-month follow-ups. The intervention effects on costs and quality-adjusted life years (QALYs) were estimated using generalized linear mixed-effects models, controlling for confounding factors. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were presented, along with calculations of the break-even point and the return on investment. Various sensitivity analyses were performed.ResultsA total of 120 office workers participated in the trial, with 100 completing the intervention period and 94 completing the entire study. The main analysis included 392 observations. The intervention had a significant positive effect on QALYs and a nonsignificant effect on costs. The ICER was estimated at -25,325 per QALY gain, and the probability of the intervention being cost saving was estimated at 88%. The break-even point was reached one week after the end of the intervention.ConclusionThe multi-component intervention is likely to reduce company costs and simultaneously improve the quality of life of employees. However, the implementation of such interventions critically depends on evidence of their cost-effectiveness. As there is still a large research gap in this area, future studies are needed.Trial registrationClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered.Trial protocolAegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, et al. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):391. https://doi.org/10.1186/s12891-020-03388-x.

Gestural Iconicity and Alignment as Steps in the Evolution of Language

AbstractStudies of the evolution of language rely heavily on comparisons to nonhuman primates, particularly the gestural communication of nonhuman apes. Differences between human and ape gestures are largely ones of degree rather than kind. For example, while human gestures are more flexible, ape gestures are not inflexible. In this piece, I closely consider two features of the gestural communication of apes and humans that might display differences in kind: iconicity and temporal alignment. Iconicity has long played a privileged role in theories of gestural language origins, the proposal being that it provided a steppingstone into language through a stage of pantomime. However, iconicity is not as easy as it seems. Evidence from co‐speech gestures of hearing children and from homesign suggests that iconic reference is both cognitively complex and slow to develop in humans. There is no conclusive evidence that nonhuman apes understand or produce iconic gestures; some gestures may appear iconic to human observers but the apes themselves may not understand the similarity between form and meaning. Far from providing an easy pathway into the emergence of symbolic communication, iconicity relies on sophisticated capacities for analogy and abstraction, ones often lacking in apes and young children. Temporal alignment between gesture and vocalization is another area that may show sharp contrasts between adult humans and apes, though data here is sparser. I discuss the tight synchronization of gesture and speech that emerges over the first year of life in human children and contrast it with gesture and vocalization in apes, which typically are described as overlapping but not simultaneous. Human ancestors probably communicated in ways similar to other apes, but the dual emergence of the ability to use iconic reference and the alignment of hand and mouth may have set our ancestors down a unique evolutionary road toward language.

Adding capivasertib to fulvestrant in patients with hormone receptor-positive advanced breast cancer: a cost-effectiveness analysis

ObjectiveCapivasertib, a novel pan-AKT inhibitor, shows significant antitumor activity against hormone receptor-positive advanced breast cancer. However, its cost-effectiveness of this treatment remains uncertain. This study aimed to evaluate the cost-effectiveness of capivasertib plus fulvestrant versus fulvestrant alone for advanced breast cancer treatment from the perspectives of healthcare payers in the United States. Meanwhile, a experimental analysis from the perspective of China, incorporating specific assumptions, was also conducted in this study.MethodsA partitioned survival model was constructed to project the progression of breast cancer. Overall survival (OS) and progression-free survival (PFS) data were obtained from the CAPItello-291 trial and extrapolated for long-term survival estimates. Direct medical costs and utility data were gathered. The primary outcome measure was incremental cost-utility ratio (ICUR) to evaluate the cost-effectiveness of treatment regimen. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of the results.ResultsThe base-case analysis estimated the ICUR for capivasertib plus fulvestrant versus fulvestrant alone to be $709,647 per quality-adjusted life-year (QALY) in the US. OWSA revealed that the results were sensitive to hazard ratio of OS and the cost of capivasertib. PSA demonstrated that capivasertib plus fulvestrant exhibited a 0% probability of cost-effectiveness in the US.ConclusionOur finding suggests that, at its current price, capivasertib plus fulvestrant regimen is unlikely to be a cost-effective option compared to fulvestrant alone for HR-positive advanced breast cancer patients from the perspective of healthcare system in the US. For the experimental analysis based on specific assumptions from Chinese perspective, the therapy regimen was also found to lack cost-effectiveness.

Optimal allocation of antenatal and young child nutrition interventions: an individual-based global burden of disease calibrated microsimulation

BackgroundUndernutrition remains a global crisis and is a focus of Sustainable Development Goals. While there are multiple known, effective interventions, complex interactions between prevention and treatment and resource constraints can lead to difficulties in allocating funding. Simulation studies that use in silico simulation can help illuminate the interactions between interventions and provide insight into the cost-effectiveness of alternative packages of options.MethodsWe developed an individual-based microsimulation model based on the Global Burden of Disease (GBD) 2021 study data to test a range of nutrition interventions, including antenatal interventions (iron and folic acid, multiple micronutrients, and balanced energy protein supplementation) and child interventions (treatment for severe acute malnutrition, treatment for moderate acute malnutrition, and wasting prevention with small-quantity lipid-based nutrient supplements). We also developed an analytic approach to process the results of the microsimulation and identify the optimal intervention funding allocation for a given budget size. We use Ethiopia as an example in this paper.ResultsIn our illustrative example of Ethiopia, the reallocation of the baseline budget to minimize disability-adjusted life years (DALYs) resulted in first funding the antenatal multiple micronutrients to their maximum coverage and then funding treatment for severe child acute malnutrition. Relative to the baseline allocation, the reallocation optimized to minimizing DALYs resulted in 592,000 fewer annual DALYs, constituting an 8.3% reduction in total DALYs in Ethiopia.For budgets larger than the baseline, our model recommended funding first targeted moderate acute malnutrition treatment, second universal moderate acute malnutrition treatment, third wasting prevention with small-quantity lipid-based nutrient supplements, and fourth balanced energy protein supplementation.ConclusionsOur simulation is a novel model for estimating optimal allocation of spending on antenatal and child health nutrition interventions which accounts for the interaction between preventive and therapeutic approaches. Our illustrative results show that an optimized reallocation of current spending can substantially improve pregnancy-related and child health without additional funding. We hope this model can add validity and confidence to prior results to aid stakeholders in funding decisions.

The burden of chronic kidney disease attributable to high sodium intake: a longitudinal study in 1990–2019 in China

ObjectiveElevated sodium consumption is associated with increased risk for chronic kidney disease (CKD) and data for this disease burden attributable to high sodium intake in China from 1990 to 2019 are scarce in China. Our study aims to estimate and present the national burden of CKD attributable to high sodium intake, as well as its profile.MethodsThe regional disease burden data from the China Center for Food Safety Risk Assessment (CFSA) from 1990 to 2019 were compiled based on the methodology of GBD 2019. CKD burden [deaths and disability-adjusted life years (DALYs)] was quantified according to population group (age, gender) and regions categories (province, SDI). The estimated annual percentage change (EAPC) in age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were calculated to describe long-term trends.ResultsTotally, the number of deaths of CKD attributable to high sodium intake reached 95,000, with DALYs amounting to 2.59 million person-years in 2019, while the trends of ASMR (EAPC: -0.31, 95%CI: −0.46, −0.17%) and ASDR (−0.33, 95%CI: −0.48, −0.18%) were down during the observation period. The age-specific numbers and rates of deaths, as well as DALYs increase with age are higher in males than in females. Significant disparities in CKD burden attributable to high sodium intake were observed across provinces and SDI regions. In both 1990 and 2019, the number of deaths and DALYs were higher in middle SDI regions, while low-middle SDI regions had highest ASMR and ASDR. The EAPC of ASDR was found to be significantly negatively correlated with the 1990 ASDR (ρ = −0.393, p = 0.024), and the EAPC of ASMR and ASDR were also significantly negatively correlated with the 2019 SDI (ASMR:ρ = −0.571, p < 0.001; ASDR:ρ = −0.368, p = 0.035).ConclusionHigh sodium intake accounted for a sizeable burden of disease from 1990 to 2019 in China, also presents sexual and geographic variations. Despite a slight decreasing trend exists, the absolute number increased as much as twofold, particularly among males and seniors. Targeting to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation, particularly in middle SDI regions that are experiencing rising trends and low-middle SDI regions being susceptible to approaches.

Deep learning reveals diverging effects of altitude on aging

Abstract Aging is influenced by a complex interplay of multifarious factors, including an individual’s genetics, environment, and lifestyle. Notably, high altitude may impact aging and age-related diseases through exposures such as hypoxia and ultraviolet (UV) radiation. To investigate this, we mined risk exposure data (summary exposure value), disease burden data (disability-adjusted life years (DALYs)), and death rates and life expectancy from the Global Health Data Exchange (GHDx) and National Data Management Center for Health of Ethiopia for each subnational region of Ethiopia, a country with considerable differences in the living altitude. We conducted a cross-sectional clinical trial involving 227 highland and 202 lowland dwellers from the Tigray region in Northern Ethiopia to gain a general insight into the biological aging at high altitudes. Notably, we observed significantly lower risk exposure rates and a reduced disease burden as well as increased life expectancy by lower mortality rates in higher-altitude regions of Ethiopia. When assessing biological aging using facial photographs, we found a faster rate of aging with increasing elevation, likely due to greater UV exposure. Conversely, analysis of nuclear morphologies of peripheral blood mononuclear cells (PBMCs) in blood smears with five different senescence predictors revealed a significant decrease in DNA damage-induced senescence in both monocytes and lymphocytes with increasing elevation. Overall, our findings suggest that disease and DNA damage-induced senescence decreases with altitude in agreement with the idea that oxidative stress may drive aging.

Global burden of cardiovascular diseases attributable to diet low in vegetables from 1990 to 2021 and forecasting the future trends: a population-based study

BackgroundThis investigation examines the worldwide impact of cardiovascular diseases (CVD) resulting from inadequate vegetable consumption, based on the 2021 Global Burden of Disease Study data.MethodThe study assessed the global, regional, and national repercussions of low vegetable intake on CVD, with a focus on variations among different age and gender demographics. It further analyzed the correlation between disease burden and the Socio-Demographic Index (SDI), and employed an ARIMA model to predict future trends in CVD associated with insufficient vegetable consumption up to 2050.ResultIn 2021, a diet lacking in vegetables was responsible for roughly 682,400 deaths and 16 million disability-adjusted life years (DALYs) attributed to CVD, indicating a declining pattern over recent year. Individuals aged 75 and older were predominantly affected. Future projections indicate an expected rise in CVD incidence in lower-middle SDI regions, with African nations potentially experiencing increased challenges related to low vegetable consumption by 2030 and 2050.ConclusionThe findings underscore the critical necessity for preventive measures against CVD and emphasize the significance of improving dietary habits, particularly vegetable intake.

Global burden of chronic kidney disease due to dietary factors

BackgroundWe aimed to assess the global impact of chronic kidney disease (CKD) attributable to dietary risk factors.MethodsThe research utilized data from the Global Burden of Disease Study 2021 to evaluate age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) linked to CKD resulting from dietary risk factors.ResultsFrom 1990 to 2021, both the ASMR and age-standardized DALY rate (ASDR) for CKD attributable to dietary risk factors exhibited an overall increasing trend globally. The mortality EAPC was 0.65, while the EAPC for DALYs stood at 0.39. Among dietary risk factors examined, a diet high in sugar-sweetened beverages was associated with the most substantial increase in CKD burden. Notably, Central sub-Saharan Africa bore the highest burden of CKD due to dietary risk factors, with an ASMR of 10.24 and an ASDR of 229.23. The increases in ASMR and ASDR were more pronounced in high-income regions, particularly in Latin America and the Caribbean, where the EAPC values for ASMR were 1.45 and 1.05, respectively, and for ASDR were 1.08 and 0.96. Furthermore, the burden of CKD was notably higher among middle-aged and elderly individuals, especially men aged 65 and above.ConclusionThe global disease burden attributed to dietary risk factors for CKD is increasing. A diet high in sugar-sweetened beverages exerted the most significant impact on CKD. There is a high incidence in Central sub-Saharan Africa, as well as in high-income regions and Latin America and the Caribbean.

Analysis of study Global Burden of Disease in 2021: global, regional, and national burden of nutritional deficiency from 1990 to 2021

BackgroundNutrient deficiency disorders (NDs) harm growth, causing economic losses. Addressing NDs is a global priority, yet recent data is limited. This study examines latest NDs data across 204 countries and 21 regions from 1990 to 2021.MethodsData from the 2021 Global Burden of Disease (GBD) study were used to analyze NDs-related incidence, prevalence, deaths, and disability-adjusted life years (DALYs) at global, national, and regional levels. Joinpoint regression analysis was applied to evaluate temporal trends, with Estimated Annual Percentage Change (EAPC) assessing long-term patterns.ResultsIn 2021, the global burden of NDs remained substantial, with a total of 1,845,246,558 cases with an ASPR of 23,858.99 cases per 100,000 individuals (95% UI: 23,445.77–24,320.82). The ASIR was 7,725.1 per 100,000 people (95% UI: 7,404.01–8,109.01), while the ASMR was 3.03 per 100,000 persons (95% UI: 2.69–3.4). Additionally, age-standardized DALYs rate was 657.62 per 100,000 individuals (95% UI: 489.93–869.58). Regionally, areas with low SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALYs rates, whereas high SDI regions had the lowest rates.ConclusionsAlthough global NDs burden has declined from 1990 to 2021, regional and demographic disparities remain. Enhanced healthcare access in high-risk SDI regions is essential to further mitigate NDs's global impact.

Global, regional and national burden of depressive disorders and attributable risk factors, from 1990 to 2021: results from the 2021 Global Burden of Disease study.

Depressive disorders pose a significant global public health challenge, yet evidence on their burden remains insufficient. To report the global, regional and national burden of depressive disorders and their attributable risk factors from 1990 to 2021. Data from the Global Burden of Disease 2021 were analyzed for 204 countries and territories from 1990 to 2021. We explored the age-standardised incidence, prevalence and disability-adjusted life years (DALYs) of depressive disorders by age, gender and sociodemographic index. In 2021, there were 357.44 million incident cases, 332.41 million prevalent cases and 56.33 million DALYs. Age-standardised rates for incidence, prevalence and DALYs were 4333.62, 4006.82 and 681.14 per 100 000 persons, with annual declines of 0.06%, 0.03% and 0.04%. Uganda, Greenland and Lesotho had the highest prevalence, while Spain, Mexico and Uruguay showed the largest increases. Greenland and Brunei Darussalam had the highest and lowest age-standardised DALYs rates, respectively. DALYs peaked in the 55-59 age group for men and 60-64 for women, with higher rates in women. Regionally, a U-shaped association was found between the sociodemographic index and DALYs rates. Population growth was the main driver for the increase in DALYs cases. Childhood maltreatment was the leading risk factor, with intimate partner violence affecting more females and childhood sexual abuse more males. Despite decreasing trends in incidence, prevalence and DALYs rates, absolute case numbers and age-standardised rates continue to increase for depressive disorders. Tackling childhood abuse and improving depressive disorder management are crucial to reducing future burdens.

Global, regional, and national burden inequality of chronic kidney disease, 1990–2021: a systematic analysis for the global burden of disease study 2021

BackgroundChronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations.MethodsData were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period.ResultsIn 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs—up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities.ConclusionThe study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.

Assessing and projecting the global impacts of Alzheimer’s disease

BackgroundThis study aims to assess the global burden of Alzheimer’s disease (AD) from 1990 to 2030, with a focus on incidence, mortality, and disability-adjusted life years (DALY).MethodsData on the incidence rates, DALY rates, and death rates of AD across various geographic populations from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Generalized Additive Models (GAMs) were employed to forecast the disease burden from 2022 to 2030.ResultsThe projected global burden of Alzheimer’s disease from 2022 to 2030 indicates a decrease in DALYs, with an Estimated Annual Percentage Change (EAPC) of −1.44 (95% CI: −1.45, −1.42). Similarly, death rates and incidence rates also show a decline, with EAPCs of −1.80 (95% CI: −1.83, −1.77) and −1.27 (95% CI: −1.29, −1.26) respectively. Gender-specific analysis reveals that the projected global incidence EAPC from 2022 to 2030 is estimated at −1.73 (95% CI: −1.75, −1.70) for males and −1.03 (95% CI: −1.04, −1.02) for females. Regionally, Andean Latin America and the Caribbean exhibit the highest positive EAPCs for DALYs at 0.94 (95% CI: 0.93, 0.94) and 0.59 (95% CI: 0.59, 0.60) respectively, while Eastern Europe shows the lowest EAPC at −16.31 (95% CI: −18.60, −13.95). Country-specific projections highlight Cyprus and Serbia with the highest positive EAPCs for DALYs at 12.55 (95% CI: 11.21, 13.91) and 9.6416 (95% CI: 8.86, 10.4333) respectively. On the other hand, Bahrain and Armenia exhibit significant negative EAPCs at −87.28 (95% CI: −94.66, −69.70) and −85.41 (95% CI: −92.80, −70.41). An analysis based on the Socio-Demographic Index (SDI) reveals that regions with higher SDI values have greater burdens of AD, with countries having SDI ≥ 0.8 showing significantly higher age-standardized Incidence Rates (ASIR), age-standardized Death Rates (ASDR), and age-standardized DALY rates compared to those with SDI < 0.8.ConclusionFrom 1990 to 2030, global burden of AD is projected to decrease, with significant gender and regional disparities. Regions with higher SDI show higher disease burdens, underscoring the necessity for targeted interventions and customized public health strategies to effectively address AD in varied socio-economic settings.

Years of life lost attributable to air pollution, a health risk-based air quality index approach in Ningbo, China.

Air pollution remains a significant threat to human health and economic development. Most previous studies have examined the health effects of individual pollutants, which often overlook the combined impacts of multiple pollutants. The traditional composite indicator air quality index (AQI) only focuses on the major pollutants, whereas the health risk-based air quality index (HAQI) could offer a more comprehensive evaluation of the health effects of various pollutants on populations. Currently, research on HAQI to evaluate the influence of multiple air pollutants on life expectancy losses is limited. In this study, we employed HAQIto estimate years of life lost (YLL) caused by exposure to air pollution for total deaths and sub-groups by sex, age, and cause-specific disease in Ningbo from 2014 to 2018. Results reveal that significant improvement in air quality during the study period. Based on the AQI-classified air quality risk category, the HAQI estimated a more severe level, which suggests that the commonly used AQI significantly underestimates the hazards of multiple air pollutants. The YLL attributable to exposure above threshold concentrations of the Chinese Ambient Air Quality Standards (CAAQS) 24-hour Grade II standards was 1.375 years (95% CI, 1.044-1.707) per death based on the HAQI, while the YLL estimated using AQI was 1.047 years (95% CI, 0.809-1.286) per death. Females and elderly people over 65 years were vulnerable subgroups, with YLL of 1.232 and 1.480 years per death, respectively. Among deaths of cause-specific disease, the YLL attributed to polluted air was highest for patients with respiratory diseases (0.866 years, 95% CI: 0.668-1.064), followed by patients with circulatory diseases (0.490 years) and endocrine diseases (0.478 years), respectively. Improving the standards of air quality could promote the management of air quality and reduce the disease burden and economic losses caused by polluted air to populations, especially for vulnerable populations. Our study provides a basis for the formulation of policies and upgrade of air quality standards.

Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge.

To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge. Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves. A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls. While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.

A community-based intervention (the Omama Project) improves neurodevelopment in impoverished 2-year-old Roma children: a quasi-experimental observational study

High rates of childhood neurodisability are reported among the Roma, Europe’s largest ethnic minority community. Interventions targeting early child development (ECD) during the first 2 years of life can improve neurodevelopmental outcomes in vulnerable children; however, evidence from Roma preschoolers is scarce. In a quasi-experimental observational study, we compared neurodevelopmental outcomes at age 2 years, measured on the INTERGROWTH-21st Project Neurodevelopmental Assessment (INTER-NDA), between Roma children receiving a community-based ECD intervention (RI, n = 98), and age- and sex-matched Roma and non-Roma children (RC, n = 99 and NRC, n = 54, respectively) who did not receive the intervention in Eastern Slovakia. The intervention was delivered between 3 weeks and 20 months in weekly home-based sessions by trained Roma women from matched settlements to RIs. Compared with RC, RI had higher 2-year cognitive (B = 0.15; 95% CI, 0.04, 0.25), language (B = 0.25; 95% CI, 0.11, 0.38) and fine motor (B = 0.08; 95% CI, 0.01, 0.16) scores. After adjustment for covariates, cognitive delay decreased by 88% in RI compared with RC (aOR, 0.12; 95% CI, 0.03, 0.53). Linear growth at 24 months was a key predictor of developmental scores for both groups (range, B = 0.04–0.14; 95% CI, 0.01, 0.07 and 0.09, 0.20).Conclusions: Our results highlight that, without directly intervening on nutritional and poverty status, a community-based ECD intervention, delivered by trained Roma women to Roma children, can significantly improve neurodevelopmental outcomes at age 2 years.What is Known:• The Roma are Europe’s largest ethnic minority. High rates of neurodisability, malnutrition and poverty are reported in Roma preschoolers.• Optimal early child development (ECD) is foundational to lifecourse health and wellbeing. Early interventions improve ECD outcomes in vulnerable children; however, evidence from Roma communities is limited.What is New:• The Omama project is a community-based ECD intervention, delivered by trained Roma women to Roma children aged 3 weeks to 20 months living in impoverished settlements in Eastern Slovakia.• Roma children receiving the intervention had (i) higher cognitive, language and fine motor scores and (ii) lower rates of cognitive delay compared with controls.