Herpes zoster is a common disease, affecting up to 30% of the population in their lifetime. We examined the burden of this disease over the period of 1997-2013 using administrative healthcare data to determine changes over time. Key medications used to treat herpes zoster and postherpetic neuralgia became generic, resulting in costs reductions, where was offset by increased drug utilization leaving drug-episode costs unchanged. Mean per-episode medical costs increased moderately. Combined, these resulted in increased outpatient costs over time. However, dramatic reduction in HZ-related hospitalizations countered these trends, resulting in no net change in overall burden. The total healthcare cost of treating HZ and PHN in Manitoba in 2011/12 was $1,997,183, slightly less than the $2,095,633 burden determined for 1997/98, the first study year. Long-term demographic projections suggest the population will continue to grow and age, likely driving the future burden upwards. / October 2016

Magister Curationis - MCur / The purpose of the study will be to explore the discharge referral pathway for patients that have been discharged from hospital to home in the Western Cape Province. A mix of quantitative and qualitative research, using a descriptive design will be undertaken. Quantitatively, following the patient paper trail from Tertiary Hospital to grassroots level. Qualitatively, to identify whether the referral pathway was user friendly. Records of discharged patients from the Tertiary Hospital will be used as the study population. Patient information will be accessed from patient files at the hospital. Interviews will be conducted with the relevant discharge liaison officers at the Tertiary Hospital, and Primary Health Care level. Relevant staff members within the non–governmental –organisations (NGOs), will also be interviewed in order to determine their perception of the discharge referral pathway. The findings of the study will be used to inform policy guidelines. Challenges encountered by staff members in referring patients for continuum of care, and the perception of consumers will also be described and documented.

No description available.

Student Number : 0310496H - MPH research report - Faculty of Health Sciences / This study compares pharmaceutical company research on new medicines in South Africa with the country’s burden of disease and describes the process and criteria that companies use to set their research priorities. A quantitative survey of pharmaceutical companies shows that company research conducted from 2000 to 2003 is moderately associated with the country’s burden of disease estimates for 2000. The degree of association is dependent on which measures of company research and burden of disease are compared, and which comparative statistic is used. A qualitative analysis of company interviews reveals that feasibility of clinical trials, market forces, and environmental factors are core criteria for company research priority setting. The burden of disease, although important, is not a sole criterion, and has considerable limitations. Furthermore, this study reveals the complex nature of health priority setting by pharmaceutical companies and thus can assist policy decision makers in identifying practical strategies to encourage research in diseases of need by pharmaceutical companies.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:51:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:52:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Made available in DSpace on 2017-09-19T15:52:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) Previous issue date: 2016 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / As infecções primárias de corrente sanguínea (IPCS) estão entre as infecções relacionadas à assistência à saúde (IRAS) mais frequentemente adquiridas no ambiente hospitalar. Essas infecções aumentam o tempo de internação, o custo e a mortalidade intra-hospitalar. No entanto, o impacto deste agravo em perda de saúde permanece desconhecido. Método: foi conduzida uma coorte de IPCS com comprovação microbiológica (IPCS-CM) com objetivo de estimar a carga de doença das IPCS-CM detectadas no Hospital Universitário Antônio Pedro (HUAP), de dezembro de 2013 a dezembro de 2014. Os anos de vida perdidos por morte prematura e os vividos sem condições plenas de saúde foram calculados conforme metodologia do Global Burden of Disease de 2010. O DALY (Disabilty-ajusted Life Year) foi calculado através de planilha da Organização Mundial de Saúde (OMS). Resultados: o DALY das IPCS-CM foi 20,44/1000 pacientes internados. Os anos de perdidos por morte prematura (YLL) contribuíram com a maior fração do DALY (YLL = 20,42/1000), comparado com os anos vividos sem condições ideais de saúde (YLD = 0,02/1000). Quando comparadas as infecções por microrganismos multirresistentes com aquelas por germes multissensíveis, as infecções por multirresistentes contribuíram mais para o DALY (multirresistentes: 13,42 DALYs/1000; multissensíveis: 7,18 DALYs/1000; DALY GAP: 6,24/1000). Conclusão: esses resultados demonstram através da elevada carga de doença o impacto em perda de saúde das IPCS-CM, principalmente naquelas infecções causadas por microrganismos multirresistentes. / Central line-associated bloodstream infections (CLABSI) are among the most often health care associated infections (HAIs) acquired in the hospital. CLABSI increase the length of stay, cost and hospital mortality. However, its impact on health loss remains unknown. This study was a cohort of CLABSI episodes in order to estimate the burden of CLABSI detected in a Brazilian public university-affiliated hospital from December 2013 to December 2014. The Disability-adjusted Life Year (DALY) was calculated based on the Global Burden of Disease methodology of 2010, through Excel spreadsheet of the World Health Organization (WHO). The DALY of CLABSI in HUAP was 20.44 / 1,000 inpatients. The Years of Life Lost due to premature death (YLL) contributed with the largest DALYs fraction (YLL=20.42/1,000), when compared with the Years Lost due to Disability (YLD) (YLD=0.02/1,000). Multiresistant infections contribute more to the DALY than those caused by non-multiresistant agents (multiresistant: 13.42 DALYs/1,000; non-multiresistant: 7.18 DALYs/1,000; DALY GAP: 6.24/1,000). These results demonstrate the great impact on loss of health due to CLABSI caused by multiresistant microorganisms.

Alzheimer's Disease is a progressive, irreversible neurodegenerative illness and the most common of the dementing disorders. Only few diseases disrupt patients and their relatives so completely or for so long a period of time as Alzheimer 's. Caring is held to be very demanding and emotionally involving. Caregiver burden has been defined as a multidimensional response to emotional, social, physical, psychological, and financial stressors associated with the caregiving experience. The objective of the 1st study was to assess the degree of burden and its possible change in family caregivers of the long-term sick family member with progressive Alzheimer's disease during eight-month monitoring. In addition to the common psychiatric examination the Mini- Mental State Examination (MMSE) was administered in patients to indicate the severity of the dementia and the Zarit Burden Interview was administered in caregivers to assessed degree of burden. The total of 60 people have been examined - 30 patients with AD and 30 their caregivers (24 females, 6 males) were recruited from the Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. At the beginning of the study there were 18 patients with mild stage of AD (60%), 11 patients suffered...

In May 2010, the United Nations (UN) General Assembly unanimously adopted a resolution on non-communicable diseases (NCDs) that called for high-level meetings to address the global burden of NCDs. This paper highlights the growing global burden of NCDs (cardiovascular diseases, cancer, chronic obstructive pulmonary diseases and diabetes), provides a brief historical background on the adoption of the UN NCDs resolution and argues that the resolution provides a remarkable new opportunity for improved international collaboration to address NCDs. Additionally, the paper argues that while the existing World Health Organisation programme on NCDs be continued and expanded, the UN can provide the expanded political leadership that is necessary for multi-sectoral collaboration and can serve as a respected forum for dealing with the issue across numerous key UN agencies.

This thesis investigates, if the exposure to conflict impacts the level of morbidity attributed to environmental risks, while addressing a gap in understanding the triple nexus between conflict, environmental hazards, and public health. Utilizing a subset of the Global Burden of Disease Study dataset, the variation of the rate of disability-adjusted life years (DALY) attributable to unsafe access to water, sanitation, and hygiene (WASH) due to conflict is examined. The findings of the country-fixed effects model – using a sample of Sub-Saharan African countries – reveal that the intensity of conflict significantly increases the rate of DALY, indicating a greater negative public health outcome in line with the hypothesis. The choice of the conflict threshold does significantly impact the results, emphasizing the importance of a robust definition of conflict. Controlling for foreign aid attributed to health and the density of health workers, the negative health outcomes associated with conflict are mitigated, suggesting that adequate healthcare provision can mitigate the impacts of conflict on public health. Overall, this thesis contributes to the understanding of the triple nexus, highlighting the need for more research and policy measures to address the long-term health impacts of conflict.

[Truncated abstract] The Disability-Adjusted Life Year index, developed by the Global Burden of Disease Study, is used extensively to compare disease burden between locations and over time. While calculation of the fatal component of this measure, Years of Life Lost, is relatively straight-forward, the non-fatal component, Years Lived with Disability, is based on parameters that are challenging to estimate. This thesis pioneers the use of the Western Australian Data Linkage System to enhance epidemiological parameters underpinning Years Lived with Disability, providing, by way of illustration, a robust quantitative profile of burden of stroke in the state of Western Australia at the turn of the 21st century. The principal methodological objective was to utilise data linkage analytic methods for the specific requirements of burden of disease estimation. The principal stroke-related objectives were: 1. To estimate the parameters underpinning the non-fatal burden of stroke (Years Lived with Disability) in Western Australia in 2000. 2. To estimate the total burden of stroke (Disability-Adjusted Life Years) in Western Australia in 2000. 3. To investigate differentials in stroke burden between different sub-populations in Western Australia. 4. To calculate projections of stroke burden for Western Australia in 2016. Years Lived with Disability from stroke were calculated for Western Australia from nonfatal stroke incidence, expected duration and disability (severity) weights. Non-fatal incidence was estimated using linked hospital and death records of first-ever hospitalised stroke 28-day survivors in 2000. This was then adjusted for out-of-hospital cases determined from the population-based Perth Community Stroke Study. iv Analysis of mortality in hospitalised 28-day survivors using linked data revealed that the excess mortality in prevalent, rather than incident cases was the main disease-specific parameter required for modelling stroke duration using DisMod II specialised software. ... Access to data linkage and population-based stroke studies in Western Australia allowed more accurate estimation of non-fatal stroke burden, with previous reports most likely underestimating disability as a contributor to total burden. Although predominantly affecting the growing aged population, stroke also affects a sizable number under the age of 65 years, the age group where differentials in stroke burden are the greatest. The findings highlight the continued need for primary prevention efforts for all ages, targeting especially younger people in disadvantaged groups. The shift to greater disability burden in the future and the needs of disadvantaged groups must be considered when planning stroke services. The multiple studies undertaken for this thesis contribute to ongoing improvement of data quality and methodological refinements underpinning estimates of Years Lived with Disability, specifically for stroke, but applicable also to other diseases. Similar linked data approaches can be used in other Australian states in the future once infrastructure is developed, thereby improving estimates of disease burden for health policy and planning in the future.

The Innovative Medicines Initiative Accelerated Development of VAccine beNefit-risk Collaboration in Europe (IMI ADVANCE) project aims to develop a framework for best practice methods on integrated rapid benefit/risk monitoring of vaccines in the European Union (EU). Burden of disease is one of the measures considered when estimating vaccine benefits. This study explores the use of notifiable infectious disease surveillance data for this purpose by estimating burden of invasive meningococcal disease in the EU/European Economic Area (EEA). We use the Burden of Communicable Diseases in Europe toolkit for computing disability-adjusted life years from incidence-based data retrieved from the European Surveillance System (TESSy) held at the European Centre for Disease Prevention and Control. Invasive meningococcal is a common cause of meningitis and septicaemia, with high case-fatality (~10%) and sequelae. We found that the median annual burden of invasive meningococcal disease in the EU/EEA, 2011-2015, was 3.87 DALYs per 100 000 total population (95% UI: 3.79-3.95). Children below one year of age and children below five years of age were at greatest risk of invasive meningococcal disease serogroup B with 89.15 DALYs per 100 000 stratum specific population (95% UI: 83.11-95.02) and 22.57 DALYs per 100 000 stratum specific population (95% UI: 21.03-24.12), respectively. We found that the distribution of burden of invasive meningococcal disease serogroup B differs widely between countries in the EU/EEA and consequently confirm that national assessment of the new infant meningococcal B vaccine is highly relevant.