Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://link.springer.com/article/10.1007%2Fs00038-017-1006-1 ; Este artículo forma parte del suplemento titulado "The state of health in the Eastern Mediterranean Region, 1990-2015". ; Objectives. Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7–5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.
Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://link.springer.com/article/10.1007%2Fs00038-017-1006-1 ; Este artículo forma parte del suplemento titulado "The state of health in the Eastern Mediterranean Region, 1990-2015". ; Objectives. Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7–5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.
1. Do no harm : a social science approach to medical errors and hospital-acquired infections : a systemic approach to the epidemic / William Charney -- ch. 2. For-profit care : its effect on medical errors / Joseph Schirmer -- ch. 3. Medical errors / John H. Lange, Luca Cegolon, and Giuseppe Mastrangelo -- ch. 4. Nosocomial diseases : a discussion of issues and prevention / John H. Lange, Luca Cegolon, and Giuseppe Mastrangelo -- ch. 5. No more preventable deaths : hospital-acquired infections in Canada and one union's campaign to stop them / Jonah Gindin and Michael Hurley -- ch. 6. Hospital epidemiology / John H. Lange, Giuseppe Mastrangelo, and Luca Cegolon -- ch. 7. Staffing and medical errors / Beth Piknick -- ch. 8. Working conditions and patient safety : impacts on medical errors / Steven Hecker -- ch. 9. Shift work and its impact on medical error / Christine Pontus and Susan Farist Butler -- ch. 10. Bullying and medical errors / Kathleen Bartholomew -- ch. 11. The relationship between lateral and horizontal violence and bullying : nurses and patient safety / Christine Pontus and Pamela M. Ortner -- ch. 12. Special populations : medical error and infection / Susan Gallagher -- ch. 13. Personal protective equipment : patient and worker safety / Thomas P. Fuller -- ch. 14. Legal issues / Barbara Machin -- ch. 15. Technology and medical errors / Shannon Gallagher -- ch. 16. Nursing injury rates and negative patient outcomes : connecting the dots / William Charney and Joseph Schirmer -- ch. 17. Industrial hygiene for health-care workers : exposures causing injuries / John H. Lange, Giuseppe Mastrangelo, and Luca Cegolon -- ch. 18. Perspectives of a frontline nurse / Maggie Flanagan -- ch. 19. Medical error : a personal story / Daniel Gilmore.
Participation in physical and sports activities 'PSA' is a health factor. Sport is a form of physical activity 'PA' that helps to reach the recommended amount of PA per day. PSA promotions plans are launched by European states. However, sport participation also involves significant risks. Some sports injuries provoke long-term health negative outcomes. Promotion of sport participation faces a paradox. As a mean of healthy state, it implies some risks linked to the modalities of participation. To know the extent of these effects, epidemiological studies are needed. They help to determine adolescents' subgroups that play sports, and among them, those at greater risk of injury. In France, previous studies are representative of the national population. However, no study estimated sport participation and injury risks factors while focusing on adolescent. Moreover, international findings showed that variation of results exists as function of the life environment of participants. We performed epidemiological retrospectives studies among the adolescent population of a specific French locality: the Bouches-du-Rhône. This one is characterized by a high-level of poverty and inequalities. We made the hypothesis, that results differ compared to those obtained at the national level. In addition of objectives measures of participation and injuries, we asked adolescents about the experiences that they like to live in their favorite sport. This knowledge could be useful to the development of promotion initiatives that are adapted to the tastes of this population. The questioning was inspired by the theory of experience, that suggest the importance of pleasure to understand people's futures behaviors. We measured retrospective reports of pleasure in three characteristics forms of modern sports: risk-taking, progress and competition. Studies were conducted in schools and followed a sample design that respected the proportion of schools in priority education networks, and outside. Three analysis axes were performed. The first have had the purpose to measure the trends in sport participation between 2001 and 2015. The second have had the purpose to identify adolescents the most at risk of injuries while adding a variable never used in population-studies, the level of competition. The third axe attempted to validate our retrospective reports of pleasure scale and to identify different profiles of participants. Results shows a decline in sport participation, a greater risk of injury from the regional level of competition and an important variation of reported pleasure in experiences of competition and risk-taking. This thesis pointed out the need to develop studies with a narrower geographical scale that the national one. Results differs and could help to the development of local sports policies. In terms of promotion, girls with low socioeconomic status must be a priority. About prevention, an additional effort should be done from the regional level of competition, regardless sports activities. ; La pratique d'activité physique sportive 'APS' est un facteur de santé. Le sport est une forme d'activité physique 'AP' qui aide à atteindre les taux recommandés journaliers. Des plans de promotion des APS sont adoptés par les Etats Européens. Mais la pratique sportive recèle aussi des risques. Certaines blessures sportives génèrent des troubles de santé à long terme. La promotion de l'activité sportive est face à un paradoxe. Moyen d'être en bonne santé, elle comporte des risques liés aux modalités de pratique. Pour connaître l'ampleur de ces effets, des études épidémiologiques sont nécessaires. Elles aideront à déterminer les sous-groupes d'adolescents sportifs, et parmi eux, ceux qui sont à risque de blessure. En France, les études menées sont représentatives de la population nationale. En revanche, aucune n'a estimé la participation et les facteurs de risque en se focalisant sur la population adolescente. Aussi, la littérature internationale fait ressortir des variations de résultats en fonction de l'environnement de vie des participants. Nous avons donc réalisé des enquêtes épidémiologiques auprès de la population adolescente d'un département français spécifique : les Bouches-du-Rhône. Celui-ci se caractérise par un haut-niveau de pauvreté et d'inégalité. Par hypothèse, les résultats différent de ceux obtenus à l'échelon national. En plus des mesures objectives de participation et de blessures, nous avons questionné les adolescents sur les expériences qu'ils aimaient vivre dans leur sport préféré. Cette connaissance vise le développement d'initiatives de promotion de l'activité sportive adaptées aux goûts de cette population. Le questionnement, inspiré des théories de l'expérience, suggère l'importance du plaisir vécu pour comprendre les actes futurs des individus. Nous avons mesuré les plaisirs rapportés par référence à trois formes d'expériences caractéristiques du sport moderne : le risque, le progrès et la compétition. Les études, réalisées en établissement scolaire, ont suivi un protocole d'échantillonnage respectant les proportions d'établissements en zone d'éducation prioritaire et en dehors. Trois axes d'analyses ont été développés. Le premier avait pour objectif de mesurer l'évolution de la participation sportive de 2001 à 2015. Le deuxième avait pour but d'identifier les adolescents les plus à risque de blessure en utilisant une variable jamais utilisée dans les études de population, le niveau de compétition. Le troisième axe tentait de valider notre échelle de mesure des plaisirs éprouvés dans la pratique et de mettre en évidence des profils de participants. Les résultats obtenus montrent une baisse de la participation sportive, une surexposition au risque de blessure à partir du niveau régional de compétition et une appréciation très variée des expériences du risque et de la compétition. En revanche, l'expérience du progrès est valorisée par tous. Cette thèse met en évidence l'importance de développer des études dont l'échelle géographique est plus restreinte que le niveau national. Les résultats diffèrent et peuvent aider au développement de politiques sportives locales. En terme de promotion, les populations de filles défavorisées doivent être prioritaires. A propos de la prévention, un effort accru doit être concentré sur le niveau régional de compétition et au-delà, et cela quels que soient les sports.
Background The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI). Findings In 2017, there were 6.8 million (95% UI 6.4-7.3) cases of IBD globally. The age-standardised prevalence rate increased from 79.5 (75.9-83.5) per 100 000 population in 1990 to 84.3 (79.2-89.9) per 100 000 population in 2017. The age-standardised death rate decreased from 0.61 (0.55-0.69) per 100 000 population in 1990 to 0.51 (0.42-0.54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422.0 [398.7-446.1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6.7 [6.3-7.2] per 100 000 population). High Sociodemographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464.5 [438.6-490.9] per 100 000 population), followed by the UK (449.6 [420.6-481.6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1.8 [0.8-3.2] per 100 000 population) and Singapore had the lowest (0.08 [0.06-0.14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0.56 million (0.39-0.77) in 1990 to 1.02 million (0.71-1.38) in 2017. The age-standardised rate of DALYs decreased from 26.5 (21.0-33.0) per 100 000 population in 1990 to 23.2 (19.1-27.8) per 100 000 population in 2017. Interpretation The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. ; Peer reviewed
Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme – Implementation Plan II (NHSP-IP 2) 2010–2015; the National Health Policy 2014; the National Health Sector Strategy 2015–2020 and its implementation plan (2016–2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016–2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.
Background. The epidemiology of traumatic spinal cord injury (TSCI) is poorly understood in developing countries. In South Africa (SA) specifically, two healthcare systems (private v. government funded) exist, and it is therefore important to assess patient characteristics in order to plan appropriately.Objectives. To determine epidemiological characteristics of TSCI in the private healthcare system in Cape Town, SA, and compare findings with previously published data from the government sector.Methods. A regional, population-based design was used, including all private and government-funded hospitals in the catchment area (Cape Town Metropolitan Municipality). All eligible survivors of TSCI in the private sector were retrospectively identified from admission records for a 1-year period. The International Spinal Cord Injury Core Data Set was systematically completed using patient medical records. Epidemiological data from the government cohort were secondarily analysed; however, socioeconomic variables were primarily analysed in this study. Inferential statistics were used to assess differences between the two healthcare systems.Results. The annual crude incidence of 20.0 per million in the private sector was significantly lower than the 75.6 per million in the government sector (p<0.001). In addition, the two cohorts differed significantly with regard to age at injury, pre-injury employment and aetiology, highlighting that individuals in the private sector were older than those in the government sector, that most were employed prior to the injury, and that their injuries were chiefly transport related, as opposed to assault in the government sector.Conclusions. Two cohorts with TSCI from the sampling population differed with regard to incidence, aetiology and sociodemographic characteristics. The findings suggest the need for more than one high-priority primary prevention programme, stratified by healthcare system. These programmes should inclusively emphasise road safety and the consequences of interpersonal violence among men.
Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993: PROBLEM/CONDITION: Although chronic fatigue syndrome (CFS) has been recognized as a cause of morbidity in the United States, the etiology of CFS is unknown. In addition, information is incomplete concerning the clinical spectrum and prevalence of CFS in the United States. REPORTING PERIOD COVERED: This report summarizes CFS surveillance data collected in four U.S. cities from September 1989 through August 1993. DESCRIPTION OF SYSTEM: A physician-based surveillance system for CFS was established in four U.S. metropolitan areas: Atlanta, Georgia; Wichita, Kansas; Grand Rapids, Michigan; and Reno, Nevada. The objectives of this surveillance system were to collect descriptive epidemiologic information from patients who had unexplained chronic fatigue, estimate the prevalence and incidence of CFS in defined populations, and describe the clinical course of CFS. Patients aged > or = 18 years who had had unexplained, debilitating fatigue or chronic unwellness for at least 6 months were referred by their physicians to a designated health professional(s) in their area. Those patients who participated in the surveillance system a) were interviewed by the health professional(s); b) completed a self-administered questionnaire that included their demographic information, medical history, and responses to the Beck Depression Inventory, the Diagnostic Interview Schedule, and the Sickness Impact Profile; c) submitted blood and urine samples for laboratory testing; and d) agreed to a review of their medical records. On the basis of this information, patients were assigned to one of four groups: those whose illnesses met the criteria of the 1988 CFS case definition (Group I); those whose fatigue or symptoms did not meet the criteria for CFS (Group II); those who had had an identifiable psychological disorder before onset of fatigue (Group III); and those who had evidence of other medical conditions that could have caused fatigue (Group IV). Patients assigned to Group III were further evaluated to determine the group to which they would have been assigned had psychological illness not been present, the epidemiologic characteristics of the illness and the frequency of symptoms among patients were evaluated, and the prevalence and incidence of CFS were estimated for each of the areas. RESULTS: Of the 648 patients referred to the CFS surveillance system, 565 (87%) agreed to participate. Of these, 130 (23%) were assigned to Group I; 99 (18%), Group II; 235 (42%), Group III; and 101 (18%), Group IV. Of the 130 CFS patients, 125 (96%) were white and 111 (85%) were women. The mean age of CFS patients at the onset of illness was 30 years, and the mean duration of illness at the time of the interview was 6.7 years. Most (96%) CFS patients had completed high school, and 38% had graduated from college. The median annual household income/for CFS patients was $40,000. In the four cities, the age-, sex-, and race-adjusted prevalences of CFS for the 4-year surveillance period ranged from 4.0 to 8.7 per 100,000 population. The age-adjusted 4-year prevalences of CFS among white women ranged from 8.8 to 19.5 per 100,000 population. INTERPRETATION: The results of this surveillance system were similar to those in previously published reports of CFS. Additional studies should be directed toward determining whether the data collected in this surveillance system were subject to selection bias (e.g., education and income levels might have influenced usage of the health-care system, and the populations of these four surveillance sites might not be representative of the U.S. population). ACTIONS TAKEN: In February 1997, CDC began a large-scale, cross-sectional study at one surveillance site (Wichita) to describe more completely the magnitude and epidemiology of unexplained chronic fatigue and CFS. ; Malaria surveillance : United States, 1993: PROBLEM/CONDITION: Malaria is caused by infection with one of four species of Plasmodium (P. falciparum, P. vivax, P. ovale, and P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria cases in the United States occur among persons who have traveled to areas (i.e., other countries) in which disease transmission is ongoing. However, cases are transmitted occasionally through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations. REPORTING PERIOD COVERED: Cases with onset of illness during 1993. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and/or state health departments by health-care providers and/or laboratories. Case investigations are conducted by local and/or state health departments, and the reports are transmitted to CDC. RESULTS: CDC received reports of 1,275 cases of malaria in persons in the United States and its territories who had onset of symptoms during 1993; this number represented a 40% increase over the 910 malaria cases reported for 1992. P. vivax, P. falciparum, P. ovale, and P. malariae were identified in 52%, 36%, 4%, and 3% of cases, respectively. The species was not determined in the remaining 5% of cases. The 278 malaria cases in U.S. military personnel represented the largest number of such cases since 1972; 234 of these cases were diagnosed in persons returning from deployment in Somalia during Operation Restore Hope. In New York City, the number of reported cases increased from one in 1992 to 130 in 1993. The number of malaria cases acquired in Africa by U.S. civilians increased by 45% from 1992; of these, 34% had been acquired in Nigeria. The 45% increase primarily reflected cases reported by New York City. Of U.S. civilians who acquired malaria during travel, 75% had not used a chemoprophylactic regimen recommended by CDC for the area in which they had traveled. Eleven cases of malaria had been acquired in the United States: of these cases, five were congenital; three were induced; and three were cryptic, including two cases that were probably locally acquired mosquito-borne infections. Eight deaths were associated with malarial infection. INTERPRETATION: The increase in the reported number of malaria cases was attributed to a) the number of infections acquired during military deployment in Somalia and b) complete reporting for the first time of cases from New York City. ACTIONS TAKEN: Investigations were conducted to collect detailed information concerning the eight fatal cases and the 11 cases acquired in the United States. Malaria prevention guidelines were updated and disseminated to health-care providers. Persons who have a fever or influenza-like illness after returning from a malarious area should seek medical care, regardless of whether they took antimalarial chemoprophylaxis during their stay. The medical evaluation should include a blood smear examination for malaria. Malaria can be fatal if not diagnosed and treated rapidly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC. ; Tetanus surveillance : United States, 1991-1994: PROBLEM/CONDITION: Despite the widespread availability of a safe and effective vaccine against tetanus, 201 cases of the disease were reported during 1991-1994. Of patients with known illness outcome, the case-fatality rate was 25%. REPORTING PERIOD COVERED: 1991-1994. DESCRIPTION OF SYSTEM: Physician-diagnosed cases of tetanus are reported to local and state health departments, the latter of which reports these cases on a weekly basis to CDC's National Notifiable Disease Surveillance System. Since 1965, state health departments also have submitted supplemental clinical and epidemiologic information to CDC's National Immunization Program. RESULTS: During 1991-1994, 201 cases of tetanus were reported from 40 states, for an average annual incidence of 0.02 cases per 100,000 population. Of the 188 patients for whom age was known, 101 (54%) were aged > or = 60 years and 10 (5%) were aged or = 80 years was more than 10 times greater than the risk for persons aged 20-29 years. All deaths occurred among persons aged > or = 30 years. The case-fatality rate (overall: 25%) increased with age, from 11% in persons aged 30-49 years to 54% in persons aged > or = 80 years. Only 12% of all patients were reported to have received a primary series of tetanus toxoid before onset of illness. For 77% of patients, tetanus occurred after an acute injury was sustained. Of patients who obtained medical care for their injury, only 43% received tetanus toxoid as part of wound prophylaxis. INTERPRETATION: The epidemiology of reported tetanus in the United States during 1991-1994 was similar to that during the 1980s. Tetanus continued to be a severe disease primarily of older adults who were unvaccinated or inadequately vaccinated. Most tetanus cases occurred after an acute injury was sustained, emphasizing the need for appropriate wound management. ACTIONS TAKEN: In addition to decennial booster doses of tetanus-diphtheria toxoid during adult life, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination visits for adolescents at age 11-12 years and for adults at age 50 years to enable health-care providers to review vaccination histories and administer any needed vaccine. Full implementation of the ACIP recommendations should virtually eliminate the remaining tetanus burden in the United States. ; Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993 / Michele Reyes, Howard E. Gary, Jr., James G. Dobbins, Bonnie Randall, Lea Steele, Keiji Fukuda, MGary P. Holmes, David G. Connell, Alison C. Mawle, D. Scott Schmid, John A. Stewart, Lawrence B. Schonberger, Walter J. Gunn, William C. Reeves -- Tetanus surveillance : United States, 1991-1994 / Hector S. Izurieta, Roland W. Sutter, Peter M. Strebel, Barbara Bardenheier, D. Rebecca Prevots, Melinda Wharton, Stephen C. Hadler, Epidemiology and Surveillance Division. National Immunization Program; Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases -- Malaria surveillance : United States, 1993 / Lawrence M. Barat, Jane R. Zucker, Ann M. Barbe,r Monica E. Parise, Lynn A. Paxton, Jacqueline M. Roberts, Carlos C. Campbell, Division of Parasitic Diseases National Center for Infectious Diseases. ; February 21, 1997 ; Includes bibliographical references.
Background. The burden of sexual violence has been well described in children of both sexes and in women, but there is minimal literature on adult male rape victims. Studies of adult male rape victims have mainly been conducted among incarcerated males or military personnel, and in high-income countries.Objectives. To describe the epidemiology, occurrence and reporting of rape cases involving male victims, both child (<18 years old) and adult, in South Africa (SA).Methods. The study consisted of a nationally representative sample of case dockets maintained by the SA Police Service of rape incidents reported in 2012. A retrospective review of the dockets provided sociodemographic information on the victim and suspect, the circumstances of the rape and the medicolegal services provided to the victim. Data on male victims were analysed using Stata 13 to test for significant differences between child and adult male victims.Results. The study comprised 209 male victims, including 120 (57.4%) children and 89 (42.6%) adults. The findings showed that there were significant differences in the occurrence and reporting of rape of male victims by age. Adult males experienced more violent rapes, perpetrators were more likely to be armed and often humiliated the victim, and rapes were more likely to occur in institutional settings. Adult males reported incidents of rape earlier and therefore had visible non-genital injuries during the medical examination. In contrast, more child rapes involved known perpetrators, occurred in a home and perpetrators were more likely to act kindly to the victim after the incident. This parallels the patterns in rape circumstances seen in female adult and child victims.Conclusions. While there is political commitment to understanding sexual violence against women as a societal problem, work on such violence against men lags behind and is little understood. Rape of males needs to be acknowledged, and their vulnerabilities to sexual abuse and rape need to be addressed. Prevention efforts to end violence against women and girls, especially in relation to children, can be used to address violence against men and boys.
Hand-arm vibration dose and work-related requirements for occupational disease no. 2103 – An epidemiological case-control study Background: An epidemiological case-control study of dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders of occupational disease no. 2103 (BK 2103) was carried out in order to provide evidence-based recommendations for the recognition of BK 2103. Methods: Male cases and controls were recruited and standardised personal interviews were conducted between 1 January 2010 and 30 November 2021. In addition to leisure activities and comorbidities, work histories regarding the use of hand-operated and hand-held technical tools that can induce hand-arm vibrations were recorded in detail. To quantify the individual vibration exposure, a database of industrial hygiene measurements of vibration values of over 700 technical power tools was established (vibration register). The vibration measurements recorded in the database allows quantification of the daily dose and lifetime dose of the vibration exposure. The dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders as defined by BK 2103 were quantified for the various dose models using conditional logistic regression analyses. Results: In total, 209 cases and 614 controls were recruited. Compared to controls, cases suffered more frequently from gout, arm fractures, hip osteoarthritis, knee osteoarthritis, spinal osteoarthritis and trauma injuries or inflammatory conditions of the finger, elbow and shoulder joints. After adjusting for relevant confounders, the study analyses demonstrate consistent and statistically significant dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders as defined by BK 2103. A vibration dose of Dhv = 142.331 m2/s4 x day or Dhw = 38.724 m2/s4 x day is associated with a doubling of the risk of musculoskeletal disorders of the upper extremities as defined by BK 2103. Conclusions: These dose values serve as a guide and could also be applied in an assessment of the work-related requirements for the recognition of BK 2103. Sensitivity analyses indicate that an exposure duration with a defined threshold daily dose is not suitable for guiding the recognition of BK 2103. Keywords: hand-arm vibration – musculoskeletal disorders – dose-effect relationship – epidemiology – risk-doubling dose
INTRODUCTION: Pakistan has a population exceeding 160 million. Communicable diseases remain the most important health problem in Pakistan, with non-communicable diseases and injuries comprising a quarter of all deaths. NATIONAL POLICY AND HEALTH SERVICE MODEL: The government provides a multi-tiered healthcare system, from the Basic Health Unit at the village level, ranging up to the tertiary care teaching hospitals in the larger cities. These facilities are accessible to all, and are usually free or highly subsidised. Patients have the choice to see a private or government GP, a specialist, or an alternative medicine healer. The current National Health Policy focusses mainly on prevention of communicable diseases, as well as improving primary and secondary health care services. EPIDEMIOLOGY: Only 6% of 13 to 14 year olds are medically diagnosed as having asthma, and more than half report symptoms of rhinitis. The prevalence of chronic bronchitis in patients over 65 is 14% and 6% in rural females and males, respectively, and 9% (with no sex difference) in urban areas. The higher rates of chronic bronchitis observed in females in rural areas may be attributed to high levels of indoor air pollution due to cooking over smoking fires. It is estimated that 36% of adult males, and 9% of females, smoke, and the cigarette consumption per person per year in Pakistan is among the highest in South Asia. Pakistan is ranked 7th among the 22 highest tuberculosis disease burden countries in the world. In 2006 the number of all TB cases was 76,668 compared to 97,245 in 2004. It is estimated that 70–80,000 people are infected with HIV, but only 3,000 AIDS cases have been reported so far. The incidence of acute respiratory infections in children varies, and is a common cause of morbidity. In adults, it is estimated that pneumonia may affect as many as 2.8 million Pakistanis. ACCESS TO CARE: Patients usually can access their local GPs or alternative medical practitioners with relative ease. In villages in remote areas, access to ...
The present study addresses abused Vietnamese women's experience of health, as well as other health problems and family conflicts, while also taking into consideration professional dealings with family violence. Women's health in everyday life is largely affected when they are exposed to violence by their male partners. Such violence exists in most societies around the world, also in the Vietnamese context, where the official policies focus on gender equality, together with a strong family concept. Thus, the present study aims to contribute to an empirical understanding of the relation between women's health and violence against women within the family, from three perspectives: That of the society (organisations and professionals), the neighbourhood community (family members and neighbours), and the individuals (the abused women). The thesis is based on three qualitative interview studies. To reach the official Vietnamese society, national organisations working against violence were invited to participate and eleven professionals of different positions were interviewed. The semi-structured interviews were analysed with content analysis. To include the neighbourhood community perspectives on health and conflicts in family life, twenty-two men and women of different ages and backgrounds, but without any known history of abuse, participated in sixteen semi-structured interviews. For the third study twelve abused women presented life-stories through indepth interviews. The interviews of study two and three were analysed using narrative approach. On a professional level, the discussion on violence focus on the abusive men's violent acts, on how to promote good social relations and how to make people in general recognise violence as a public health problem and value gender equality. In family everyday life, the informants consider women as the main responsible for the family well-being, but find cooperative support necessary in daily life. To adjust family life to social change, and to make everyone feel important, means to avoid boredom or distress are strategies used, since such conditions are considered to cause troubled relations, abuse and suffering. Violence within the family is seen as interpersonal problems where both partners are to blame for family dysfunction. Empathic sentiments, mutual support and communication are means to handle problems, and a harmonious and happy family is seen as protecting health. The abused women experience vulnerability, which they see as the foremost threat to their health. Injuries as well as worries cause harm. The abused women blame their husbands, for the violence, but they rarely confront them. Instead they use a number of strategies to handle their situation; through enduring, making their husband's face others judgements, or divorce. They see violence as part of an everyday life of hardship, and consider that bearing too many troubles harms their health. A coherent approach between the different perspectives is needed if the abused women and their families will have a possibility to experience health. The professionals need to consider both public equality policies and the individuals' experience of vulnerability. The abused women, and abusive men, would benefit from a neighbourhood community that is open to individual failure but still supportive and encouraging. To experience health this study found that it matters what position a person has, what expectations and judgement a person face, how well a person can manage her obligations, and what room for action she possesses. ; Studien fokuserar på vietnamesiska kvinnors hälsa, om de utsatts för våld i hemmet, samt närliggande hälsoproblem och familjekonflikter. Studien behandlar också professionellas hanterande av våld i familjen. Kvinnors hälsa och vardagsliv försämras av att de utsätts för våld från sina manliga partner. Detta våld återfinns i de flesta av världens länder, så också i Vietnam, som dock är ett land med starkt politiskt och officiellt fokus på jämställdhet, samtidigt som man värnar om familjen som enhet och begrepp. Därför är syftet för denna studie att bidra till en empirisk förståelse av relationen mellan kvinnors hälsa och våld mot kvinnor inom familjen, från tre perspektiv: samhällets (professionella organisationer), grannskapets (familjemedlemmar och grannar) samt individernas (de våldsutsatta kvinnorna). Studien baseras på tre kvalitativa delstudier. För att söka förstå det vietnamesiska samhället, inbjöds nationella organisationer som arbetar mot våld att delta, och elva professionella på olika positioner intervjuades. De semi-strukturerade intervjuerna analyserades med innehållsanalys. För att nå grannskapets perspektiv på hälsa och konflikter i familjelivet, intervjuades 22 män och kvinnor av olika åldrar och bakgrunder, utan känd våldshistorik inom familjen. De deltog i 16 semistrukturerade intervjuer. I den tredje delstudien intervjuades 12 våldsutsatta kvinnor genom att de presenterade sina livshistorier. Studie två och tre analyserades narrativt. På den professionella nivån rör diskussionen om våld de våldsutövande männens handlingar, hur man ska främja goda sociala relationer och hur man ska få allmänheten att förstå våld som en folkhälsofråga och värdera jämställdhet. I familjernas vardagsliv ser informanterna kvinnan som ansvarig för familjens välbefinnande, men samarbete och stöd som nödvändigt i familjelivet. För att anpassa familjelivet efter sociala förändringar, och att få alla att känna sig betydelsefulla i familjen, anses det nödvändigt att undvika tristess och leda. Anpassning till samhällets förändring och att främja familjens välbefinnande ses som strategier för att hantera problematiska relationer, konflikter, våld och lidande. Våld inom familjen anses vara ett interpersonellt problem, där båda parter bär skulden för familjens dysfunktion. Empati, ömsesidigt stöd och kommunikation är verktyg för att hantera problem, och en harmonisk och lycklig familj anses främja hälsan. De våldsutsatta kvinnorna upplever sårbarhet, vilket de ser som det främsta hotet mot sin hälsa. Såväl kroppsskador som oro försämrar kvinnornas situation. De våldsutsatta kvinnorna lägger skulden på sina män för våldet, men de konfronterar dem sällan. Istället använder de sig av strategier för att hantera sin situation: genom att uthärda, få maken att möta andras fördömanden, eller skilsmässa. De ser våldet som en del av ett vardagsliv fyllt av svårigheter, och anser att bördan av för många problem är det som skadar deras hälsa. Ett samordnat tillvägagångssätt mellan de olika samhällsnivåernas perspektiv behövs om de våldsutsatta kvinnorna och deras familjer ska ha en möjlighet att uppleva hälsa. De professionella behöver beakta såväl jämställdhetspolicyer som individers upplevelse av sårbarhet. De våldsutsatta kvinnorna, och våldsutövande männen, skulle gagnas av en grannskapsgemenskap som är öppen för individuella misslyckanden, men ändå stödjande och uppmuntrande. Denna studie visar att för att uppleva hälsa är det av betydelse vilken social position personen har, vilka förväntningar och bedömningar en person möter, hur väl hon kan hantera sina åtaganden, och vilket handlingsutrymme hon besitter.
Funding This project was funded as an Applied Health Research Question (AHRQ), a process by which government-funded research organisations are funded to answer questions from relevant knowledge users. The Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC), was funded to carry out this AHRQ research question on behalf of Public Health Ontario, Ontario's expert technical and scientific public health organisation. ; Background: Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning. Our objective was to analyse contemporary sex differences over a 20-year period. Methods: We analysed data from a population-based death registry, the Ontario Registrar's General Death file, which includes all deaths recorded in Canada's most populous province, from 1992 to 2012 (N=1 710 080 deaths). We calculated absolute and relative mortality sex differences for all-cause and cause-specific mortality, age-adjusted and age-specific, including the following causes: circulatory, cancers, respiratory and injuries. We used negative-binomial regression of mortality on socioeconomic status with direct age adjustment for the overall population. Results: In the 20-year period, age-adjusted mortality dropped 39.2% and 29.8%, respectively, among men and women. The age-adjusted male-to-female mortality ratio dropped 41.4%, falling from 1.47 to 1.28. From 2000 onwards, all-cause mortality rates of high-income men were lower than those seen among low-income women. Relative mortality declines were greater among men than women for cancer, respiratory and injury-related deaths. The absolute decline in circulatory deaths was greater among men, although relative deciles were similar to women. The largest absolute mortality gains were seen among men over the age of 85 years. Conclusions: The large decline in mortality sex ratios in a Canadian province with universal healthcare over two decades signals an important population shift. These narrowing trends varied according to cause of death and age. In addition, persistent social inequalities in mortality exist and differentially affect men and women. The observed change in sex ratios has implications for healthcare and social systems. ; Publisher PDF ; Peer reviewed
Publisher´s version (útgefin grein). ; Background Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. ; ROA is funded by the National Institutes of Health (U01HG010273). SMA acknowledges the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. AAw acknowledges funding support from Department of Science and Technology, Government of India, New Delhi, through INSPIRE Faculty scheme. TBA acknowledges partial funding from the Institute of Medical Research and Medicinal Plant Studies. ABa is supported by the Public Health Agency of Canada. TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor Award, funded by the Federal Ministry of Education and Research. MSBS acknowledges support from the Australian Government Research and Training Program scholarship for a PhD degree at the Australian National University, Australia. JJC is supported by the Swedish Heart and Lung Foundation. FCar is supported by the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundacao para a Ciencia e a Tecnologia and Ministerio da Educacao e Ciencia) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020UID/QUI/50006/2013. EC is supported by an Australian Research Council Future Fellowship (FT3 140100085). KD is supported by a Wellcome Trust [Grant Number 201900] as part of his International Intermediate Fellowship. EF is supported by the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundacao para a Ciencia e a Tecnologia and Ministerio da Educacao e Ciencia) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020UID/QUI/50006/2013. SMSI is funded by the Institute for Physical Activity and Nutrition (IPAN), Deakin University and received funding from High Blood Pressure Research Council of Australia. YKa is a DBT/Wellcome Trust India Alliance Fellow in Public Health. YJK is supported by the Office of Research and Innovation at Xiamen University Malaysia. BL acknowledges funding from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. WDL is supported in part by U10NS086484 NINDS. SLo is funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1411A). RML is supported by a National Health and Medical Research Council (NHMRC) of Australia Senior Research Fellowship. AMa and the Imperial College London are grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research and Care. JJM is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the John Cade Fellowship (APP1056929) from NHMRC. TMei acknowledges additional institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena-Halle-Leipzig. IMV is supported by the Sistema Nacional de Investigacion (Panama). MOO is supported by SIREN U54 U54HG007479 and SIBS Genomics R01NS107900 grants. AMS was supported by a fellowship from the Egyptian Fulbright Mission Program. MMSM acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (contract no 175087). AShe is supported by Health Data Research UK. MBS' work on traumatic brain injury is supported by grants NIH U01 NS086090 (PI G Manley) from the National Institutes of Health (NIH) and DoD W81XWH-14-2-0176 (PI G Manley) from the United States Department of Defense. RTS is supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIIIFEDER. AGT was supported by a Fellowship from the NHMRC (Australia; 1042600. KBT acknowledges funding supports from the Maurice Wilkins Centre for Biodiscovery, Cancer Society of New Zealand, Health Research Council, Gut Cancer Foundation, and the University of Auckland. CY acknowledges support from the National Natural Science Foundation of China (grant number 81773552) and the Chinese NSFC International Cooperation and Exchange Program (grant number 71661167007). ; "Peer Reviewed"
Correction in: LANCET Volume: 390 Issue: 10103 Pages: 1644-1644 Published: OCT 7 2017 . ; Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years. ; Bill & Melinda Gates Foundation and Bloomberg Philanthropies. ; Peer Reviewed
