Years Lost Due To Disability Research Articles

Acute Lymphoblastic Leukaemia’s Burden Of Disease In Portugal

Acute lymphoblastic leukaemia (ALL) is a haematological malignancy with a rapid progression, affecting both children and adults. Although rare, it is the most common leukaemia in childhood. The main objective of this study was to estimate the burden of disease impact of ALL measured by Disability Adjusted Life Years (DALY) in Portugal, for 2015. DALY combines Years Lost due to Disability (YLD), and Years of Life Lost (YLL) due to premature death. Deaths due to ALL were estimated based on lymphoblastic leukaemia (LL) mortality data from national statistics. The disability weights used to estimate YLD were based on the 2015 Global Burden of Disease (GBD 2015). Four disease states were considered: 1) diagnosis and primary therapy; 2) controlled disease; 3) relapsed/refractory disease; and 4) terminal phase. The incidence of states 1) and 4) was based on national registries and statistics for LL, and on international registries for ALL. The incidence of states 2) and 3) was estimated for children and adults separately through partitioned survival models based on clinical trials in ALL patients. State 1) was assumed to last 2 years (experts’ opinion), and other states durations were based on GBD 2015. In 2015, 130 new ALL cases and 58 ALL deaths were estimated to have occurred in Portugal. The total disease burden attributable to ALL was estimated at 1,039 DALY, with 89% due to YLL and the remaining due to YLD. Per average ALL patient, a burden of 1.78 DALY was estimated. Children and adults share YLD equally, but 69% of YLL took place in adults. ALL is an important cause of disease burden, both in children and adults, with a higher impact on YLL in Portuguese adults. ALL is therefore an important target for health policy interventions due to its burden by average patient.

Estimation of lung cancer burden in Australia, the Philippines, and Singapore: an evaluation of disability adjusted life years.

Objective:Lung cancer is one of the leading cancers and major causes of cancer mortality worldwide. The economic burden associated with the high mortality of lung cancer is high, which accounts for nearly $180 billion on a global scale in 2008. This paper aims to understand the economic burden of lung cancer in terms of disability adjusted life years (DALY) in Australia, the Philippines, and Singapore.Methods:The years of life lost (YLL) and years lost due to disability (YLD) were calculated using the formula developed by Murray and Lopez in 1996 as part of a comprehensive assessment of mortality and disability for diseases, injuries and risk factors in 1990 and projected to 2020. The same formula is represented in the Global Burden of Disease template provided by the World Health Organization. Appropriate assumptions were made when data were unavailable and projections were performed using regression analysis to obtain data for 2015.Results:The total DALYs due to lung cancer in Australia, the Philippines, and Singapore were 91,695, 38,584, and 12,435, respectively, and the corresponding DALY rates per a population of 1,000 were 4.0, 0.4, and 2.2, respectively, with a discount rate of 3%. When researchers calculated DALYs without the discount rate, the burden of disease increased substantially; the DALYs were 117,438 in Australia, 50,977 in the Philippines, and 16,379 in Singapore. Overall, YLL or premature death accounted for more than 95% of DALYs in these countries.Conclusions:Strategies for prevention, early diagnosis, and prompt treatment must be devised for diseases where the major burden is due to mortality.

Quantifying the Burden of Multiple Myeloma Across Europe

Background: In recent years there has been an increasing focus on the costs of managing patients with Multiple Myeloma (MM). Novel agents such as immunomodulators and proteasome inhibitors have been added into the treatment pathway alongside conventional management options including intensive chemotherapy, stem cell transplantation, and supportive care. Commissioners of healthcare have evaluated these additional costs in the context of clinical outcomes such as response rates, progression free survival and overall survival. However, relatively little attention has been paid to disease burden which we argue is an important dimension alongside costs and outcomes.Objective:To estimate the burden of disease associated with MM in the European Union.Methods: A literature review was undertaken to identify assessments of disease burden in MM. A de novo analysis was undertaken to quantify disease burden across the European Union, using Disability Adjusted Life Years (DALYs). DALYs represent the sum of Years of Life Lost (YLL) due to premature mortality and the Years Lost due to Disability (YLD) for a condition. We use long-term projections for incidence, mortality, and life expectancy to estimate DALYs in 5 year intervals out to 2030. Finally, we ran a hypothetical scenario to explore the impact of potential improvements in treatment outcomes.Results: Across the European Union we estimate a total of over 175,000 DALYs for 2015 attributable to MM; which is equivalent to more than 34.5 DALYs per 100,000 population. Disease burden appears to vary considerably by country, partly as a function of incidence rates. For the EU as a whole, MM incidence is projected to increase from approximately 35k new cases to over 43k by 2030. Over the same time period, deaths due to MM are projected to increase from 21.5k to over 27k. Using data from Eurostat and Globocan, we estimate that DALYs for MM in the EU will increase from 175k to approaching 290k by 2030. In terms of DALYs per 100,000 population, this represents a more than 60% projected increase from 34.4 to 55.6 DALYs per 100,000. In our hypothetical scenario, a 1-year increase in overall survival reduced the number of DALYs in the EU by 16,000 for 2020 and by 19,000 for 2030.Discussion: Incorporation of new treatments in the management of myeloma in the last decade has helped improve the median survival of patients. However, as population life expectancy increases, incidence of MM and associated disability is expected to increase substantially. New treatments represent a significant opportunity to reduce this burden. We estimate that a 1-year increase in life expectancy for MM patients would be associated with a 7% reduction in DALYs. Further research is required to confirm DALY estimates in MM but we argue that DALYs provide a useful metric for healthcare commissioners. DisclosuresSchey:Celgene, Takeda: Honoraria; Celgene, Johnson & Johnson: Speakers Bureau; Celgene: Consultancy. Morris:Cogentia UK: Research Funding. Maguire:Cogentia UK: Research Funding. Dhanasiri:Celgene: Employment, Equity Ownership.

New century, new challenges: changes in the burden of disease profile in Brazil, 1990-2010

to describe the burden of disease in Brazil from 1990 to 2010. analysis of the estimates of the Global Burden of Disease Study 2010 - Years of Life Lost due to premature mortality (YLL), Years Lost due to Disability (YLD), Disability-Adjusted Life Year (DALY=YLL+YLD) and risk factors. there was a decrease in deaths due to diarrhea and an increase in deaths due to diabetes and kidney disease, whilst deaths due to homicides and traffic accidents remained stable; cardiovascular diseases continued to be the leading cause of death despite a 30% reduction; the largest increases in DALY were due to diabetes and musculoskeletal diseases in women and alcohol abuse and low back pain in men; the main risk factors were poor diet and high blood pressure; smoking, domestic pollution and insufficient breastfeeding were found to have reduced. the rapid epidemiological transition highlights the need to control infectious diseases and invest in reducing violence and non-communicable diseases.

The burden of road traffic injuries in Kermanshah Province, Iran, in 2010–2011: GBD 2010 method

Deaths, injuries and disabilities resulting from road traffic injuries (RTIs) are a public health major concern. This study aims to calculate the burden of RTIs in Kermanshah Province in Iran. In this study to determine the years of life lost (YLL) related to RTIs, the National Death Registration and Forensics Medicine census data were employed. We use forensic medicine data to calculate the incidence of non-fatal injuries and years lost due to disability (YLD). The cause of death and non-fatal injuries was classified using ICD-10 codes and 23 groupes of global burden of diseases (GBD) 2010. The disability-adjusted life year (DALY) estimated on the guidelines of the GBD 2010 and age and sex structure was taken from the National Statistic Center for the year 2010. Overall, 70.8% of the subjects were males. The fatal and non-fatal injury rates of RTI were 51.3 and 283.6 per 100,000 persons, respectively. YLLs and YLDs were 46613 (24.5 per 1000) and 3405 (1.8 per 1000) in both sexes, respectively. The disability adjusted life years were 40711 in males, 9306 in females and 50018 in both sexes (42.5, 9.8 and 26.3 per 1000, respectively). More than 93% of DALY was from YLL (24.5 per 1000), with a small proportion for YLD (1.8 per 1000). Accounting for more than 50,000 DALY attributed to RTIs, traffic injuries is a major public health and socioeconomic problem in Kermanshah. Designing cost-effective interventions based on comprehensive and multi-sectoral programmes at the national and provincial levels can save many lives and resources that are lost every year. Undoubtedly, establishing a surveillance system at the sub-national level and measuring the burden of injuries, as in this study, can help policy-makers and planners in lessening the burden of RTIs.

Burden of diabetes mellitus attributable to demographic levels in Qatar: An emerging public health problem

BackgroundDiabetes is one of the main contributors to ill health and premature mortality worldwide and its prevalence has been rising during the last decades. AimThe aim of the present study was to quantify the burden of disease in terms of deaths and loss of healthy life years (DALYs) attributed to diabetes by its demographic levels in the State of Qatar. Materials and methodsThe methods were largely based on the established Global Burden of Disease methodology and use the burden of disease in terms of disability adjusted life years (DALYs) and the years lost due to disability (YLD) as the outcome measure. We calculated years lost due to disability (YLD) and years life lost (YLL) attributable to diabetes. The study was conducted during the period from June 2013 to January 2014. ResultsThe study findings revealed that disability adjusted life years (DALYs) has been increasing across the years and reached to 4.35 in 2011 from 2.58 in 2007. DALYs for men was remarkably higher than women during the period (2007–2011). Diabetes mellitus was the 6th leading cause of disease burden in Qatar (3.8%). The YLD showed a sharp increase in men (2.52 in 2011 from 1.34 in 2007) and women (1.05 in 2011 from 0.33 in 2007) during the year 2011. YLL portion of women enlarged considerably in 2011 (0.10) compared to 2010 (0.04). YLL for men and women was fluctuating across the years with a decrease in 2011 (18%) from 2007 (35%). Men and women in the age group 30–44 years had the highest peak across the years. ConclusionThe study findings revealed that diabetes disease burden was considerably high in Qatar, particularly in the working age group. DALYs has been increasing across the years.

Non-Small Cell Lung Cancer'S Burden of Disease in Portugal

ABSTRACT Aim: To estimate the Disability Adjusted Life-Years (DALY) associated with Non-Small Cell Lung Cancer (NSCLC) during 2012 in Portugal. Methods: DALY combines Years of Life Lost (YLL) due to premature mortality and Years Lost due to Disability (YLD). The YLL correspond to the number of deaths multiplied by the present valued socially weighted life expectancy at the age at which death occurs using a standardized life table. For the distribution of lung cancer mortality by age and gender the WHO European mortality database was used. To estimate the proportion of these deaths that is due to NSCLC we applied a ratio (85.7%) based on data from the Diagnosis-Related Groups database. To estimate YLD in a particular time period, the number of incident cases in that period is multiplied by the average duration of the disease on a scale ranging from 0 (perfect health) to 1 (death). NSCLC incidence was estimated from Portuguese National and Regional Cancer Registry. The average duration of the disease was derived from the survival curves published by the International Association for the Study of Lung Cancer. Disability weights were taken from the Disability Weights for Diseases in the Netherlands Study. Results: A total of 3,180 deaths in Portugal in 2012 were caused by NSCLC, which corresponds to 2.0% of the total deaths in Portugal. The DALYs resulting from premature deaths caused by NSCLC in 2012 totaled 25,071 representing 4.5% of years lost generated by all deaths in the country. For 2012 it is estimated that 3,236 life years were lost due to disability. The total disease burden attributable to NSCLC is thus estimated at 28,307 DALY. Conclusions: NSCLC is an important cause of disease burden in Portugal and should receive adequate attention from policy makers. Disclosure: M.F. Borges: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; M. Gouveia: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; J. Alarcao: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; R. Sousa: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; F. Barata: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; E. Laranjeira: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; F. Lopes: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; B. Parente: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; L. Pinheiro: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; M.E. Teixeira: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; A. Vaz-Carneiro: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; J. Costa: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study.

Disability-adjusted life years (DALYs) in general population with pelvic organ prolapse: a study based on the prolapse quality-of-life questionnaire (P-QOL)

ObjectiveTo evaluate the impact of pelvic organ prolapse (POP) on quality of life in symptomatic and asymptomatic women. Study designThis is a cross-sectional study in a general population of adult women. Symptomatic and asymptomatic women with POP were studied. Symptomatic women were defined as those who reported the presence/feeling of lump/bulge/pressure in the vagina and on vaginal examination had the sign of POP defined as the leading edge of the vagina wall/cervix presenting at or beyond the hymeneal remnants. All women were asked to self-complete the Prolapse Quality of life questionnaire (P-QOL) to estimate the disability-adjusted life-years (DALYs) lost due to symptomatic POP. DALYs for a symptomatic POP were calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD). To determinate the optimal threshold of each P-QOL domain in relationship to the symptomatic POP population a receiver operating curve (ROC) and area under curve (AUC) analysis were used. ResultsA total of 785 were recruited. Only 539 (68.7%) consented to participate in the study. The mean age was 47 years (range 18–82 years). The total scores for each of the P-QOL domains were found to be significantly higher in symptomatic prolapse subjects compared to asymptomatic subjects (p<0.05). Estimated DALY lost per year per 1000 women obtained were 217.0 vs 324.8, lost years of 14.5 vs 10.3 in 50 vs 60-year old women. ConclusionIn this group of women with POP the quality of life is severely affected. The DALYs revealed lost years due to symptomatic POP.

Mortality, Morbidity, Survival, and Burden of Top 9 Cancers in a Developing Country

Background: Cancer is one of the most important leading causes of morbidity and mortality worldwide. Objectives: This study aimed to calculate the burden of 9 common cancers in the population covered by Mashhad University of Medical Sciences in Iran in 2010-2011. Patients and Methods: We calculated disability adjusted life years (DALYs ) for each of nine cancers according to the sex and age groups of (0-4, 5-14, 15-29, 30-44, 45-59, 60-69, 70-79, and ≥ 80 years) using disease modeling (DisMod) version II software. The population-based data used in this study is mostly from cancer registries. The final estimates for the survival time were derived by combining several information sources. We applied r = 0.03 discounting and β = 0.04 age weighting. In our study, the standard life expectancy considered 80 years for men and 82.5 for women. Results: This study shows that the most years life lost (YLL) related to gastric, leukemia and lung cancers are 10116, 9564 and 7061 respectively. Cancers with the most years lost due to disability (YLD) were breast, brain and esophageal cancers (594, 506 and 460). The most DALY related to gastric, leukemia and lung cancers (10516, 9803 and 722). The maximum DALY was for breast cancer (1550) seen in women aged 30-44 years old. Conclusions: It can be concluded that the YLL (93%) has a major role in the burden of diseases in developing countries. Better strategies for improving the prevention and screening program are really needed in developing countries.

Burden of illness attributable to subclinical hypothyroidism in the Spanish population

Abstract Introduction Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Patients and methods Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), years of life lost (YLL) and years lost due to disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic set data [MBSD], inpatient mortality records, etc.). Results In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9 mIU/L (70.5%), 538,988 with levels between 7 and 9.9 mIU/L (19.5%), and 278,317 between 10 and 19.9 mIU/L (10%). These subjects suffer approximately 12,608 cardiac events and 1388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. Conclusion SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective.

Development of Methodology for Disability-Adjusted Life Years (DALYs) Calculation Based on Real-Life Data

BackgroundDisability-Adjusted Life Years (DALYs) have the advantage that effects on total health instead of on a specific disease incidence or mortality can be estimated. Our aim was to address several methodological points related to the computation of DALYs at an individual level in a follow-up study.MethodsDALYs were computed for 33,507 men and women aged 20–70 years when participating in the EPIC-NL study in 1993–7. DALYs are the sum of the Years Lost due to Disability (YLD) and the Years of Life Lost (YLL) due to premature mortality. Premature mortality was defined as death before the estimated date of individual Life Expectancy (LE). Different methods to compute LE were compared as well as the effect of different follow-up periods using a two-part model estimating the effect of smoking status on health as an example.ResultsDuring a mean follow-up of 12.4 years, there were 69,245 DALYs due to years lived with a disease or premature death. Current-smokers had lost 1.28 healthy years of their life (1.28 DALYs 95%CI 1.10; 1.46) compared to never-smokers. The outcome varied depending on the method used for estimating LE, completeness of disease and mortality ascertainment and notably the percentage of extinction (duration of follow-up) of the cohort.ConclusionWe conclude that the use of DALYs in a cohort study is an appropriate way to assess total disease burden in relation to a determinant. The outcome is sensitive to the LE calculation method and the follow-up duration of the cohort.

Carga de la enfermedad atribuible al hipotiroidismo subclínico en la población española

IntroductionSubclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Patients and methodsBased on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. ResultsIn Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. ConclusionSH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective.

The non-fatal disease burden caused by type 2 diabetes in South Africa, 2009

Background: Increasing urbanisation and rising unhealthy lifestyle risk factors are contributing to a growing diabetes epidemic in South Africa. In 2000, a study estimated diabetes prevalence to be 5.5% in those aged over 30. Accurate, up-to-date information on the epidemiology and burden of disease due to diabetes and its sequelae is essential in the planning of health services for diabetes management.Objective: To calculate the non-fatal burden of disease in Years Lost due to Disability (YLD) due to diabetes and selected sequelae in South Africa in 2009. YLD measures the equivalent loss of life due to ill-health.Methods: A series of systematic literature reviews identified data on the epidemiology of diabetes and its sequelae in South Africa. The data identified were then applied to Global Burden of Disease (GBD) methodology to calculate the burden attributable to diabetes.Results: Prevalence of type 2 diabetes in South Africa in 2009 is estimated at 9.0% in people aged 30 and older, representing approximately 2 million cases of diabetes. We modelled 8,000 new cases of blindness and 2,000 new amputations annually caused by diabetes. There are 78,900 YLD attributed to diabetes, with 64% coming from diabetes alone, 24% from retinopathy, 6% from amputations, 9% from attributable stroke disability, and 7% from attributable ischemic heart disease disability.Conclusions: We estimate that the prevalence of diabetes is increasing in South Africa. Significant disability associated with diabetes is demonstrated. Some of the attributed burden can be prevented through early detection and treatment.Appendices available online under Reading Tools.

Surgery as a Global health issue

Over the past decade, the concept of surgical care as a population-based, affordable, and globally relevant issue has gradually begun to emerge.[24,28,34,37] The facts are startling: more people die each year due to the inability to access surgical care than from human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), tuberculosis, and malaria combined.[6] The highest incidence results from (in descending order) accidental trauma (bone and soft-tissue injuries), tumors, obstetrical complications (including obstetrical fistula), cataracts and glaucoma, perinatal conditions and congenital anomalies, male circumcision (prevention of HIV transmission) and a large group (19%) under the heading of “Other,” which include a variety of diagnoses such as hernia, gall bladder disease, infections requiring surgical care, etc.[4,6] However, the global burden of disease (GBD) associated with surgical and obstetrical care has yet to be adequately defined; current numbers are likely to be artificially low.[27,36] While the total volume of actual surgical cases can be tallied, the unmet surgical need is only beginning to be measured.[29] It is not without reason that surgery has been termed the “neglected stepchild” of global public health and the “neglected specialty in the current global health arena.”[7,8] Historically, the primary barrier to developing surgical services has been the (mis)perception that surgery is overly expensive for the majority of lower and middle income countries (LMICs).[3] However, the World Bank published the 2nd edition of Disease Control Priorities in Developing Countries (DCP, 2006), which provided the first clear economic evidence that surgical care could be a cost-effective strategy under certain circumstances when compared with other types of care, such as antiretroviral medications, vaccinations, and other primary treatments. This economic impact was calculated on the basis of Disability Adjusted Life Years (DALYs), which is the sum of Years of Life Lost (YLL) plus the Years Lost due to Disability (YLDs) or simply: DALY = YLL + YLD. The purpose of surgery, however, is to alleviate or mitigate against certain physical conditions and the resultant “DALYs averted” reflects the reduction in calculated DALY as a consequence of the timely institution of appropriate surgical care. Surgical conditions account for 11% of global DALYs lost each year, with LMICs carrying the greatest burden; Southeast Asia plus Africa alone, accounted for 54% of DALYs in 2004.[6,9] Emergency and essential surgical care is increasingly recognized as a critical element to improving primary health care delivery. In the World Health Report 2008—Primary Health Care (Now more than Ever), the World Health Organization (WHO) included Surgery for the first time within the Primary Healthcare Sphere of Care.[22,35] This report emphasized the creation of primary care teams responsible for defined populations with access to all aspects of care, which was not splintered by economic concerns or differences. While inserting one word on an organizational chart appears to be a small step, it was a huge leap forward that required years of continual effort. Additionally, WHO has made surgical care a priority.[1,20] The Emergency and Essential Surgical care (EESC) of the WHO, has been active in the Global Initiative for Emergency and Essential Surgical Care (GIEESC), a forum of surgical experts. EESC has published the volume Surgical Care at the District Hospital (SCDH) in seven languages and produced the Integrated Management of Emergency and Essential Surgical Care (IMEESC) toolkit, a Compact Disc that contains the SCDH, a long list of best-practice protocols (including disaster management), multiple point-of-contact posters, and a number of instructional videos. Ongoing research within EESC includes a large database of surgical hospital capacity throughout the developing world (>700), capacity building through educational programs, and periodic follow-up of existing programs. Within the WHO, other areas of relating to surgery include Violence and Injury Prevention, Maternal and Child Health, HIV/AIDS (male circumcision), and transplantation. Surgery is credited with providing a critical role in achieving the United Nations Millennium Development Goals (MDGs) and is most closely involved with numbers 4, 5, and 6.[23] Although most directly linked to these MDGs, surgical care also indirectly, but significantly contributes to MDG 1: The eradication of poverty and hunger. This is due to the fact that restoring health to the man who is a primary provider (such as repairing an inguinal hernia so that he can return to work) and/or the woman who provides for the home and children (such as relieving obstructed labor or repairing a vesico-vaginal fistula), greatly reduces economic loss and/or emotional hardship.

Global Burden of Visual Impairment and Blindness

Vision loss and age-related eye diseases are major global public health problems. The Global Burden of Diseases, Injuries, and Risk Factors Study (hereafter referred to as the GBD Study) was commissioned by the World Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and injuries, and 10 selected risk factors, for the world, specifically including data from 8 major regions. The methods of the original GBD Study (hereafter referred to as the GBD 1990 Study) created a common metric, the disability-adjusted life-year,1 which extends the concept of potential years of life lost due to premature death to include equivalent years of “healthy” life lost by virtue of being in poor health or disability. The number of disability-adjusted life-years caused by a disease or injury are calculated as the sum of the years of life lost due to premature mortality in the population and the years lost due to disability (YLD) for incident cases of the disease or injury.

Days lost due to disability of diclofenac-induced adverse drug reactions

Disability Adjusted Life Years (DALY) is a widely used measure to quantify the burden of diseases or illness. DALYs for a disease is calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the equivalent healthy Years Lost due to Disability (YLD). The only difference from the YLD and Days Lost due to Disability (DLD) calculation is that instead of considering the duration of Adverse Drug Reaction (ADR) in years, it is calculated in days. DLD was measured for diclofenac tablets to prepare the ADR profile. The study was done on the patients (18-65 years old) attending the community pharmacy at Kasaragod district, South India, with prescription of diclofenac tablets. Patients reported ADRs on their next visit to the pharmacy or they had called to the provided phone number and reported it. Disability Weight (DW) was calculated in an analogue scale from 0-1. Zero represent complete health and 1 represent death or equivalent condition. DW was multiplied with occurrence and duration of ADRs in days. About 943 patients received diclofenac tablets in 1000 prescriptions were successfully followed up for possible, probable and definite ADRs. A total of 561 reactions reported in 2010 for diclofenac tablet in the study population. There were 34 different types of ADRs under 12 physiological systems/organs. Most common reactions were on gastrointestinal (GI) system (48%), followed by skin (14%), Central Nervous System (10%), renal (7%), and cardiovascular (7%). Abdominal pain, cramps or flatulence was the highest occurring GI ADR (107), followed by 43 rashes, 42 nausea/vomiting, 37 indigestion, 34 peptic ulcers, 31 edema etc. DLD for peptic ulcer was considerably high (0.078) per 1000 of the study population on diclofenac. The most damaging ADR were peptic ulcer with or without perforation, followed by rash 0.036 DLD and edema 0.027 DLD. There was considerable DLD by acute renal failure (0.012) Steven-Johnson syndrome (0.013) even though few cases were reported. Diclofenac has a complex adverse drug profile. Around 34 types of reactions were reported. Diclofenac was widely prescribed because of the experiential belief of comparative safety with other NSAIDs. The study shows the importance of pharmacovigilance even on the most prescribed medicine. Most disabling ADR for the study population was peptic ulcer with or without perforation. YLD or DLD are useful measures of calculating disability caused by ADRs. Future studies could focus on improving the usefulness & precision of DLD.

The disease burden of childhood adversities in adults: A population-based study

Objectives There is much evidence showing that childhood adversities have considerable effects on the mental and physical health of adults. It could be assumed therefore, that the disease burden of childhood adversities is high. It has not yet been examined, however, whether this is true. Method We used data of a large representative sample ( N = 7,076) of the general population in the Netherlands. We calculated the disability weight (DW) for each respondent. The DW is a weight factor that reflects the severity of a disease or condition on a scale from 0 (perfect health) to 1 (equivalent to death). We used an algorithm based on the SF-6D to estimate DW. Because the DW indicates the proportion of a healthy life year that is reduced by the specific health state of the individual, it also possible to calculate the total number of years lost due to disability (YLD) in the population. We calculated the years lived with disability (YLD) for 9 different childhood adversities (in the areas of parental psychopathology; abuse and neglect; major life events), as well as for major categories of mental disorders and general medical disorders. Results All 9 adversities resulted in a significantly increased DW, except death of a parent before the age of 16. Adversities in the category of abuse and neglect are associated with the highest DWs (0.057), followed by parental psychopathology (0.031) and life events during childhood (0.012). All adversities (46.4% of the population reports one or more adversity) are associated with 20.7 YLD/1,000, which is more than all mental disorders together (12.9 YLD/1,000). The category of abuse/neglect has the highest YLD/1,000 (15.8), which is also higher than all mental disorders together. Adjustment for the presence of mental and general medical disorders resulted in comparable outcomes. Conclusions Childhood adversities are more important from a public health point of view than all common mental disorders together, and should be a priority for public health interventions.

Stratified Active Screening: Where Neurotechnology Meets Public Health

Nearly one quarter of the global burden of disease stems from neurological, psychiatric and neurodevelopmental disorders due to malformations or dysfunctions of the central nervous system.[1] Such neuropsychiatric conditions influence quality of life worldwide, causing one third of years lost due to disability (YDL).[2] Ranging from congenital conditions to dementias of the elderly, these disorders appear throughout the life cycle and also account for a substantial proportion of mortality. Recent advances in neuroimaging and neuroinformatics have opened the way for early identification of dysfunctional brain networks, providing essential information for the early detection, proper diagnosis, treatment selection, and follow-up of people with disabilities due to brain disorders.

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

BackgroundThe epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years.MethodsDescriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed.ResultsAmongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.ConclusionA higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.

Projected Burden of Bacillary Dysentery Due to Climate Change in a Temperate City in China

ISEE-211 Objective: This study aims to project the morbidity burden of bacillary dysentery due to climate change, measured in terms of years lost due to disability (YLDs), in a temperate city of China, to provide scientific evidence for policy makers to reduce the impact of climate change on food-borne diseases in the future. Material and Methods: Notified age- and sex-specified incidence cases of bacillary dysentery and demographic data of the study city were collected from relevant local authorities. The calculation of the YLDs was based on the methodologic framework in the Global Burden of Disease study. The quantitative relationship between climatic variables and the number of cases were based on our previous studies. Various scenarios of increasing temperatures (and demographic change) were applied in this estimate. The YLDs of bacillary dysentery in 2000 were estimated first and then the projection for 2020 and 2050 was conducted. Results: The total YLDs of bacillary dysentery in 2000 in the temperate city were more than 600 and the YLDs were slightly higher in men than women. Considering the temperature scenarios alone, the YLDs of bacillary dysentery may increase up to 80% by 2020 and 174% by 2050, compared with 2000. With the consideration of both climate scenarios and demographic change, the YLDs of bacillary dysentery may double by 2020 and triple by 2050, compared with 2000, if other influencing factors remain unchanged. Conclusions: Despite the uncertainties and limitations in the burden of diseases study, our results suggest that global warming may cause a serious increase in the morbidity burden of bacillary dysentery in the temperate city of China. Sustainable policies should be developed and implemented at an early stage for better mitigation and adaptation to the future risk of climate change.