Summary Background The Global Burden of Disease (GBD) study assesses health losses from diseases, injuries, and risk factors using disability-adjusted life-years, which need a set of disability ...weights to quantify health levels associated with non-fatal outcomes. The objective of this study was to estimate disability weights for the GBD 2013 study. Methods We analysed data from new web-based surveys of participants aged 18–65 years, completed in four European countries (Hungary, Italy, the Netherlands, and Sweden) between Sept 23, 2013, and Nov 11, 2013, combined with data previously collected in the GBD 2010 disability weights measurement study. Surveys used paired comparison questions for which respondents considered two hypothetical individuals with different health states and specified which person they deemed healthier than the other. These surveys covered 183 health states pertinent to GBD 2013; of these states, 30 were presented with descriptions revised from previous versions and 18 were new to GBD 2013. We analysed paired comparison data using probit regression analysis and rescaled results to disability weight units between 0 (no loss of health) and 1 (loss equivalent to death). We compared results with previous estimates, and an additional analysis examined sensitivity of paired comparison responses to duration of hypothetical health states. Findings The total analysis sample consisted of 30 230 respondents from the GBD 2010 surveys and 30 660 from the new European surveys. For health states common to GBD 2010 and GBD 2013, results were highly correlated overall (Pearson's r 0·992 95% uncertainty interval 0·989–0·994). For health state descriptions that were revised for this study, resulting disability weights were substantially different for a subset of these weights, including those related to hearing loss (eg, complete hearing loss: GBD 2010 0·033 0·020–0·052; GBD 2013 0·215 0·144–0·307) and treated spinal cord lesions (below the neck: GBD 2010 0·047 0·028–0·072; GBD 2013 0·296 0·198–0·414; neck level: GBD 2010 0·369 0·243–0·513; GBD 2013 0·589 0·415–0·748). Survey responses to paired comparison questions were insensitive to whether the comparisons were framed in terms of temporary or chronic outcomes (Pearson's r 0·981 0·973–0·987). Interpretation This study substantially expands the empirical basis for assessment of non-fatal outcomes in the GBD study. Findings from this study substantiate the notion that disability weights are sensitive to particular details in descriptions of health states, but robust to duration of outcomes. Funding European Centre for Disease Prevention and Control , Bill and Melinda Gates Foundation.
Summary Background Listeriosis, caused by Listeria monocytogenes , is an important foodborne disease that can be difficult to control and commonly results in severe clinical outcomes. We aimed to ...provide the first estimates of global numbers of illnesses, deaths, and disability-adjusted life-years (DALYs) due to listeriosis, by synthesising information and knowledge through a systematic review. Methods We retrieved data on listeriosis through a systematic review of peer-reviewed and grey literature (published in 1990–2012). We excluded incidence data from before 1990 from the analysis. We reviewed national surveillance data where available. We did a multilevel meta-analysis to impute missing country-specific listeriosis incidence rates. We used a meta-regression to calculate the proportions of health states, and a Monte Carlo simulation to generate DALYs by WHO subregion. Findings We screened 11 722 references and identified 87 eligible studies containing listeriosis data for inclusion in the meta-analyses. We estimated that, in 2010, listeriosis resulted in 23 150 illnesses (95% credible interval 6061–91 247), 5463 deaths (1401–21 497), and 172 823 DALYs (44 079–676 465). The proportion of perinatal cases was 20·7% (SD 1·7). Interpretation Our quantification of the global burden of listeriosis will enable international prioritisation exercises. The number of DALYs due to listeriosis was lower than those due to congenital toxoplasmosis but accords with those due to echinococcosis. Urgent efforts are needed to fill the missing data in developing countries. We were unable to identify incidence data for the AFRO, EMRO, and SEARO WHO regions. Funding WHO Foodborne Diseases Epidemiology Reference Group and the Université catholique de Louvain.
Recently the World Health Organization, Foodborne Disease Burden Epidemiology Reference Group (FERG) estimated that 31 foodborne diseases (FBDs) resulted in over 600 million illnesses and 420,000 ...deaths worldwide in 2010. Knowing the relative role importance of different foods as exposure routes for key hazards is critical to preventing illness. This study reports the findings of a structured expert elicitation providing globally comparable food source attribution estimates for 11 major FBDs in each of 14 world subregions.
We used Cooke's Classical Model to elicit and aggregate judgments of 73 international experts. Judgments were elicited from each expert individually and aggregated using both equal and performance weights. Performance weighted results are reported as they increased the informativeness of estimates, while retaining accuracy. We report measures of central tendency and uncertainty bounds on food source attribution estimate. For some pathogens we see relatively consistent food source attribution estimates across subregions of the world; for others there is substantial regional variation. For example, for non-typhoidal salmonellosis, pork was of minor importance compared to eggs and poultry meat in the American and African subregions, whereas in the European and Western Pacific subregions the importance of these three food sources were quite similar. Our regional results broadly agree with estimates from earlier European and North American food source attribution research. As in prior food source attribution research, we find relatively wide uncertainty bounds around our median estimates.
We present the first worldwide estimates of the proportion of specific foodborne diseases attributable to specific food exposure routes. While we find substantial uncertainty around central tendency estimates, we believe these estimates provide the best currently available basis on which to link FBDs and specific foods in many parts of the world, providing guidance for policy actions to control FBDs.
Foodborne diseases are globally important, resulting in considerable morbidity and mortality. Parasitic diseases often result in high burdens of disease in low and middle income countries and are ...frequently transmitted to humans via contaminated food. This study presents the first estimates of the global and regional human disease burden of 10 helminth diseases and toxoplasmosis that may be attributed to contaminated food.
Data were abstracted from 16 systematic reviews or similar studies published between 2010 and 2015; from 5 disease data bases accessed in 2015; and from 79 reports, 73 of which have been published since 2000, 4 published between 1995 and 2000 and 2 published in 1986 and 1981. These included reports from national surveillance systems, journal articles, and national estimates of foodborne diseases. These data were used to estimate the number of infections, sequelae, deaths, and Disability Adjusted Life Years (DALYs), by age and region for 2010. These parasitic diseases, resulted in 48.4 million cases (95% Uncertainty intervals UI of 43.4-79.0 million) and 59,724 (95% UI 48,017-83,616) deaths annually resulting in 8.78 million (95% UI 7.62-12.51 million) DALYs. We estimated that 48% (95% UI 38%-56%) of cases of these parasitic diseases were foodborne, resulting in 76% (95% UI 65%-81%) of the DALYs attributable to these diseases. Overall, foodborne parasitic disease, excluding enteric protozoa, caused an estimated 23.2 million (95% UI 18.2-38.1 million) cases and 45,927 (95% UI 34,763-59,933) deaths annually resulting in an estimated 6.64 million (95% UI 5.61-8.41 million) DALYs. Foodborne Ascaris infection (12.3 million cases, 95% UI 8.29-22.0 million) and foodborne toxoplasmosis (10.3 million cases, 95% UI 7.40-14.9 million) were the most common foodborne parasitic diseases. Human cysticercosis with 2.78 million DALYs (95% UI 2.14-3.61 million), foodborne trematodosis with 2.02 million DALYs (95% UI 1.65-2.48 million) and foodborne toxoplasmosis with 825,000 DALYs (95% UI 561,000-1.26 million) resulted in the highest burdens in terms of DALYs, mainly due to years lived with disability. Foodborne enteric protozoa, reported elsewhere, resulted in an additional 67.2 million illnesses or 492,000 DALYs. Major limitations of our study include often substantial data gaps that had to be filled by imputation and suffer from the uncertainties that surround such models. Due to resource limitations it was also not possible to consider all potentially foodborne parasites (for example Trypanosoma cruzi).
Parasites are frequently transmitted to humans through contaminated food. These estimates represent an important step forward in understanding the impact of foodborne diseases globally and regionally. The disease burden due to most foodborne parasites is highly focal and results in significant morbidity and mortality among vulnerable populations.
In sub-Saharan Africa, socioeconomic factors such as place of residence, mother's educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such ...as health behavior or exposure to diseases and injuries. The aim of the study was to assess the relative contribution of four known socioeconomic factors to the variability in U5M in sub-Saharan countries.
The study was based on birth histories from the Demographic and Health Surveys conducted in 32 sub-Saharan countries in 2010-2016. The relative contribution of sex of the child, place of residence, mother's educational level, and household wealth to the variability in U5M was assessed using a regression-based decomposition of a Gini-type index.
The Gini index - measuring the variability in U5M related to the four socioeconomic factors - varied from 0.006 (95%CI: 0.001-0.010) in Liberia 2013 to 0.034 (95%CI: 0.029-0.039) in Côte d'Ivoire 2011/12. The main contributors to the Gini index (with a relative contribution higher than 25%) were different across countries: mother's educational level in 13 countries, sex of the child in 12 countries, household wealth in 11 countries, and place of residence in 8 countries (in some countries, more than one main contributor was identified).
Factors related to socioeconomic status exert varied effects on the variability in U5M in sub-Saharan African countries. The findings provide evidence in support of prioritizing intersectoral interventions aiming at improving child survival in all subgroups of a population.
The slope (SII) and relative (RII) indices of inequality are commonly recommended to monitor health inequality policies. As an upwards shift of the educational level distribution (ELD) can be part of ...those policies, we examine how such a shift affects the SII, the RII and the population attributable fraction (PAF).
We simulated 632 distributions of 4 educational levels (ELs) by varying the share (p1 to p4) of each EL, with constant mortality rates (MR) and calculated the corresponding RII, SII and PAF. Second, we decomposed the effect on the three indices of a change affecting both the ELD and the MRs, into the contributions of each component.
RIIs and SIIs sharply increase with p4 at fixed p1 values and evolve as reversed U-curves for p1 changing in complement to p4. The RII reaches a maximum, at much higher p4 values than the SII. PAFs monotonically decrease when p4 increases.
If improving the educational attainment is part of a policy, an upwards shift of EL should be assessed as a progress; however the RII, and to a lesser extent the SII, frequently translate an increased EL4 share as a worsening. We warn against the use of SII and RII for monitoring inequality-tackling policies at changing socio-economic structures. Rather, we recommend to complement the assessment of changes in absolute and relative pairwise differentials, with changes in PAF and in the socio-economic group shares.
The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This ...estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food.
We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region.
For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives.
Abstract
Background
When conducting COVID-19 contact tracing, pre-defined criteria allow differentiating high-risk contacts (HRC) from low-risk contacts (LRC). Our study aimed to evaluate whether ...contact tracers in Belgium followed these criteria in practice and whether their deviations improved the infection risk assessment.
Method
We conducted a retrospective cohort study in Belgium, through an anonymous online survey, sent to 111,763 workers by email. First, we evaluated the concordance between the guideline-based classification of HRC or LRC and the tracer’s classification. We computed positive and negative agreements between both. Second, we used a multivariate Poisson regression to calculate the risk ratio (RR) of testing positive depending on the risk classification by the contact tracer and by the guideline-based risk classification.
Results
For our first research question, we included 1105 participants. The positive agreement between the guideline-based classification in HRC or LRC and the tracer’s classification was 0.53 (95% CI 0.49–0.57) and the negative agreement 0.70 (95% CI: 0.67–0.72). The type of contact tracer (occupational doctors, internal tracer, general practitioner, other) did not significantly influence the results. For the second research question, we included 589 participants. The RR of testing positive after an HRC compared to an LRC was 3.10 (95% CI: 2.71–3.56) when classified by the contact tracer and 2.24 (95% CI: 1.94–2.60) when classified by the guideline-based criteria.
Conclusion
Our study indicates that contact tracers did not apply pre-defined criteria for classifying high and low risk contacts. Risk stratification by contact tracers predicts who is at risk of infection better than guidelines only. This result indicates that a knowledgeable tracer can target testing better than a general guideline, asking for a debate on how to adapt the guidelines.
To estimate the prevalence of childhood wasting and to investigate the effects of drought and conflict on wasting in crisis-affected areas within Ethiopia.
We searched the Complex Emergency Database ...for nutrition surveys carried out in Ethiopia over the period 2000-2013. We extracted data on the prevalence of wasting (weight-for-height
-scores below -2) among children aged 6-59 months for areas of Ethiopia that had sufficient data available. Data on any conflict events (irrespective of magnitude or impact) and episodes of seasonal drought affecting the survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesize the evidence from 231 small-scale surveys.
From the total sample of 175 607 children analysed, the pooled number of children wasted was 21 709. The posterior median prevalence of wasting was 11.0% (95% credible interval, CrI: 10.3-11.7) over the 14-year period. Compared with areas unaffected by drought, the estimated prevalence of wasting was higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05-1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68-1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82-1.26).
Despite an overall declining trend, a wasting problem persists among children in Ethiopia. Conflict events did not have a major impact on childhood wasting. Nutrition interventions should go beyond severe drought-prone areas to incorporate areas where moderate droughts occur.
Over the last few years, the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria have been increasingly used to evaluate the ...prevalence of inappropriate prescribing. However, very few studies have evaluated the link between these criteria and clinical outcomes.
The objectives of this study were to evaluate the prevalence of inappropriate prescribing according to STOPP and START in a population of frail elderly persons admitted acutely to hospital; to evaluate whether these inappropriate prescribing events contributed to hospital admissions; and to identify determinants of hospital admissions potentially related to inappropriate prescribing.
This was a cross-sectional study including all frail older patients admitted to a 975-bed teaching hospital over a 12-month period. A pharmacist and a geriatrician independently detected events of prescribing of potentially inappropriate medication (PIM) and potential prescribing omission (PPO), using the STOPP and START criteria, respectively, in all patients included in the study. They determined whether the inappropriate prescribing event was the main cause or a contributory cause of hospital admission. Demographic, clinical and geriatric clinical syndromes (i.e. cognitive impairment, falls) were evaluated as potential determinants of hospital admissions related to inappropriate prescribing, using multivariate methods (i.e. logistic regression and a classification tree).
302 frail older persons (median age 84 years) were included in the study. PIMs (prevalence 48%) mainly involved overuse and/or misuse of benzodiazepines, aspirin and opiates. PPOs (prevalence 63%) were mainly related to underuse of calcium and vitamin D supplementation, aspirin and statins. Overall, inappropriate prescribing according to STOPP (54 PIMs) and/or START (38 PPOs) led or contributed to hospital admission in 82 persons (27%). The multivariate analyses indicated a relation between PIM-related admissions and a history of previous falls (p < 0.001), while the PPO-related admissions were associated with a history of osteoporotic fracture (p < 0.001) and atrial fibrillation (p = 0.004).
Using the STOPP and START criteria, it was found that inappropriate prescribing events (both PIMs and PPOs) were frequent and were associated with a substantial number of acute hospital admissions in frail older persons. Fall-induced osteoporotic fracture was the most important cause of hospital admission related to inappropriate prescribing and should be a priority for pharmacological optimization approaches.
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