As tourists are increasingly putting off their air travel due to the COVID-19 pandemic that has tremendously affected the travel and tourism industry, this study examined the role of negative affect, ...perceived health risk, perceived uncertainty, and mental wellbeing in forming travel attitudes and temporal avoidance behaviour to global destinations seriously-hit by the COVID-19 pandemic from a U.S. tourist perspective. The cross-sectional online survey showed that negative affect as a result of COVID-19 significantly influenced perceived health risk, which in turn induced mental wellbeing and perceived uncertainty. While mental wellbeing significantly predicted attitudes towards international travel and temporal avoidance behaviour, perceived uncertainty significantly predicted short-term avoidance behaviour. The insight obtained from this study provides a mechanism behind tourist avoidance behaviour in times of global health crises and implications for tourism reliant destinations to develop recovery strategies in coping with the impact of the pandemic.
The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates ...over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.
We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.
Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs 95% UI 111·2 million to 137·0 million), high systolic blood pressure (122·2 million DALYs 110·3 million to 133·3 million, and low birthweight and short gestation (83·0 million DALYs 78·3 million to 87·7 million), and for women, were high systolic blood pressure (89·9 million DALYs 80·9 million to 98·2 million), high body-mass index (64·8 million DALYs 44·4 million to 87·6 million), and high fasting plasma glucose (63·8 million DALYs 53·2 million to 76·3 million). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7–17·5) of deaths and 6·2% (3·9–8·7) of DALYs, and population growth for 12·4% (10·1–14·9) of deaths and 12·4% (10·1–14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9–29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.
Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.
The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
Facing pressure to train for victory, warfighters and athletes (hereafter, “athletes”) face numerous health risks that are directly related to their regular physical training. The concept of ...universal training precautions (UTP) signifies universal processes designed to prevent unnecessary bodily harm, to include injury, illness, and death, during such physical training programs. Although no formal guidelines exist for collective implementation of a defined set of precautionary UTP strategies against a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to prevention of sudden death during high school sports and collegiate conditioning sessions. A long list of critical issues must be considered as UTP, to include physical fitness factors, appropriate recovery, use of medications and dietary supplements, hydration, transition period accommodation, environmental factors and acclimatization, and importantly leadership. In this article we outline in detail, along with a corresponding strength of recommendation taxonomy, what should be considered a “universal recommendation” to minimize risk of athletes coming to harm when participating in group physical activities.
Colorectal cancer Dekker, Evelien; Tanis, Pieter J; Vleugels, Jasper L A ...
The Lancet (British edition),
10/2019, Volume:
394, Issue:
10207
Journal Article
Peer reviewed
Several decades ago, colorectal cancer was infrequently diagnosed. Nowadays, it is the world's fourth most deadly cancer with almost 900 000 deaths annually. Besides an ageing population and dietary ...habits of high-income countries, unfavourable risk factors such as obesity, lack of physical exercise, and smoking increase the risk of colorectal cancer. Advancements in pathophysiological understanding have increased the array of treatment options for local and advanced disease leading to individual treatment plans. Treatments include endoscopic and surgical local excision, downstaging preoperative radiotherapy and systemic therapy, extensive surgery for locoregional and metastatic disease, local ablative therapies for metastases, and palliative chemotherapy, targeted therapy, and immunotherapy. Although these new treatment options have doubled overall survival for advanced disease to 3 years, survival is still best for those with non-metastasised disease. As the disease only becomes symptomatic at an advanced stage, worldwide organised screening programmes are being implemented, which aim to increase early detection and reduce morbidity and mortality from colorectal cancer.
Cervical cancer is one of the most common cancers threatening women's health, and the persistent infection of high-risk human papillomavirus (HPV) is closely related to the pathogenesis of cervical ...cancer and many other cancers. The carcinogenesis is a complex process from precancerous lesion to cancer, which provides an excellent window for clinical prevention, diagnosis, and treatment. However, despite the various preventions and treatments such as HPV screening, prophylactic HPV vaccines, surgery, radiotherapy, and chemotherapy, the disease burden remains heavy worldwide. Currently, three types of prophylactic vaccines, quadrivalent HPV vaccine, bivalent HPV vaccine, and a new nonavalent HPV vaccine, are commercially available. Although these vaccines are effective in protecting against 90% of HPV infection, they provide limited benefits to eliminate pre-existing infections. Therefore, new progress has been made in the development of therapeutic vaccines. Therapeutic vaccines differ from prophylactic vaccines in that they aim to stimulate cell-mediated immunity and kill the infected cells rather than neutralizing antibodies. This review aims at systematically covering the progress, current status and future prospects of various vaccines in development for the prevention and treatment of HPV-associated lesions and cancers and laying foundations for the development of the new original vaccine.
•Recent advances in HPV-related cancer biology and the viral action in carcinogenesis.•Development, current status, limitations, and prospects of prophylactic HPV vaccines.•Characteristics of several vaccine platform technologies that are being applied to the therapeutics for HPV diseases.•Research advances and further exploration of HPV vaccines.
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