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1.
MMWR Morb Mortal Wkly Rep ; 69(11): 281-285, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32191687

RESUMEN

Worldwide, tuberculosis (TB) is the leading cause of death from a single infectious disease agent (1), including among persons living with human immunodeficiency virus (HIV) infection (2). A World Health Organization (WHO) initiative, The End Tuberculosis Strategy, set ambitious targets for 2020-2035, including 20% reduction in TB incidence and 35% reduction in the absolute number of TB deaths by 2020 and 90% reduction in TB incidence and 95% reduction in TB deaths by 2035, compared with 2015 (3). This report evaluated global progress toward these targets based on data reported by WHO (1). Annual TB data routinely reported to WHO by 194 member states were used to estimate TB incidence and mortality overall and among persons with HIV infection, TB-preventive treatment (TPT) initiation, and drug-resistant TB for 2018 (1). In 2018, an estimated 10 million persons had incident TB, and 1.5 million TB-related deaths occurred, representing 2% and 5% declines from 2017, respectively. The number of persons with both incident and prevalent TB remained highest in the WHO South-East Asia and African regions. Decreases in the European region were on track to meet 2020 targets. Globally, among persons living with HIV, 862,000 incident TB cases occurred, and 1.8 million persons initiated TPT. Rifampicin-resistant or multidrug-resistant TB occurred among 3.4% of persons with new TB and 18% among persons who were previously treated for TB (overall, among 4.8% of persons with TB). The modest decreases in the number of persons with TB and the number of TB-related deaths were consistent with recent trends, and new and substantial progress was observed in increased TPT initiation among persons living with HIV. However, to meet the global targets for 2035, more intensive efforts are needed by public health partners to decrease TB incidence and deaths and increase the number of persons receiving TB curative and preventive treatment. Innovative approaches to case finding, scale-up of TB preventive treatment, use of newer TB treatment regimens, and prevention and control of HIV will contribute to decreasing TB.


Asunto(s)
Salud Global/estadística & datos numéricos , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Metas , Humanos , Incidencia , Tuberculosis/mortalidad , Organización Mundial de la Salud
2.
BMJ ; 368: m108, 2020 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041707

RESUMEN

OBJECTIVE: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGN: Two stage time series analysis. SETTING: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATION: Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only). RESULTS: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONS: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.


Asunto(s)
Contaminación del Aire/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Salud Global/estadística & datos numéricos , Mortalidad , Ozono/efectos adversos , Contaminación del Aire/análisis , Ciudades/estadística & datos numéricos , Cambio Climático/mortalidad , Exposición a Riesgos Ambientales/normas , Política Ambiental , Humanos , Cooperación Internacional , Ozono/análisis , Estaciones del Año
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 165-168, 2020 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-32074704

RESUMEN

Objective: To evaluate comprehensive health status of 31 provinces in China and compare with other countries (regions). Methods: Social-demographic index, life expectancy and healthy life expectancy in 134 countries (regions) and 31 provinces in China were collected from the Global Burden of Disease Study 2015. K-means clustering method was used to classify comprehensive health status of various countries (regions) in the world. HemI 1.0.3 software was applied to draw distribution heat maps of social-demographic index, life expectancy and healthy life expectancy in different provinces of Mainland China. Discriminant analysis was used to evaluate comprehensive health status of different provinces in Mainland China. Results: Comprehensive health status of 134 countries (regions) was grouped into category 1-8 from good to poor, and Mainland China was in the category 4. The comprehensive health status of provinces in Mainland China is better in the east coast and poorer in the west inland, among which Shanghai and Beijing were grouped into the category 1, Zhejiang, Jiangsu, Guangdong and Tianjin into the category 2, Fujian, Liaoning and Shandong into the category 3, Yunnan, Guangxi, Xinjiang and Guizhou into the category 5, Qinghai and Tibet into the category 6, and the rest 16 provinces into the category 4. Conclusion: Comprehensive health status of Mainland China ranked middle to upper level in the world, and health status disparities were observed among different provinces in Mainland China.


Asunto(s)
Salud Global/estadística & datos numéricos , Estado de Salud , China , Humanos
4.
MMWR Morb Mortal Wkly Rep ; 69(8): 212-215, 2020 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-32107367

RESUMEN

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the largest bilateral funder of human immunodeficiency virus (HIV) prevention and control programs worldwide, currently supports implementation of preexposure prophylaxis (PrEP) to reduce HIV incidence among persons at substantial risk for infection, including female sex workers, men who have sex with men (MSM), and transgender women (hereafter referred to as key populations). Recent estimates suggest that 54% of all global new HIV infections in 2018 occurred among key populations and their sexual partners (1). In 2016, PEPFAR began tracking initiation of PrEP by key populations and other groups at high risk (2). The implementation and scale-up of PrEP programs across 35 PEPFAR-supported country or regional programs* was assessed by determining the number of programs reporting any new PrEP clients during each quarter from October 2016 to September 2018. As of September 2018, only 15 (43%) PEPFAR-supported country or regional programs had implemented PrEP programs; however, client volume increased by 3,351% over the assessment period in 15 country or regional programs. Scale-up of PrEP among general population clients (5,255%) was nearly three times that of key population clients (1,880%). Among key populations, the largest increase (3,518%) occurred among MSM. Factors that helped drive the success of these PrEP early adopter programs included initiation of national, regional, and multilateral stakeholder meetings; engagement of ministries of health and community advocates; revision of HIV treatment guidelines to include PrEP; training for HIV service providers; and establishment of drug procurement policies. These best practices can help facilitate PrEP implementation, particularly among key populations, in other country or regional programs to reduce global incidence of HIV infection.


Asunto(s)
Infecciones por VIH/prevención & control , Cooperación Internacional , Profilaxis Pre-Exposición/organización & administración , Desarrollo de Programa , Femenino , Salud Global/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Trabajadores Sexuales , Personas Transgénero , Estados Unidos
6.
BMJ ; 368: m234, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32075787

RESUMEN

OBJECTIVE: To describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using data from the Global Burden of Disease Study 2017. DESIGN: Systematic analysis. DATA SOURCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017. METHODS: Mortality and DALYs from chronic respiratory diseases were estimated from the Global Burden of Disease Study 2017 using DisMod-MR 2.1, a Bayesian meta-regression tool. The estimated annual percentage change of the age standardised mortality rate was calculated using a generalised linear model with a Gaussian distribution. Mortality and DALYs were stratified according to the Socio-demographic index. The strength and direction of the association between the Socio-demographic index and mortality rate were measured using the Spearman rank order correlation. Risk factors for chronic respiratory diseases were analysed from exposure data. RESULTS: Between 1990 and 2017, the total number of deaths due to chronic respiratorydiseases increased by 18.0%, from 3.32 (95% uncertainty interval 3.01 to 3.43) million in 1990 to 3.91 (3.79 to 4.04) million in 2017. The age standardised mortality rate of chronic respiratory diseases decreased by an average of 2.41% (2.28% to 2.55%) annually. During the 27 years, the annual decline in mortality rates of chronic obstructive pulmonary disease (COPD; 2.36%, uncertainty interval 2.21% to 2.50%) and pneumoconiosis (2.56%, 2.44% to 2.68%) has been slow, whereas the mortality rate for interstitial lung disease and pulmonary sarcoidosis (0.97%, 0.92% to 1.03%) has increased. Reductions in DALYs for asthma and pneumoconiosis have been seen, but DALYs due to COPD, and interstitial lung disease and pulmonary sarcoidosis have increased. Mortality and the annual change in mortality rate due to chronic respiratory diseases varied considerably across 195 countries. Assessment of the factors responsible for regional variations in mortality and DALYs and the unequal distribution of improvements during the 27 years showed negative correlations between the Socio-demographic index and the mortality rates of COPD, pneumoconiosis, and asthma. Regions with a low Socio-demographic index had the highest mortality and DALYs. Smoking remained the major risk factor for mortality due to COPD and asthma. Pollution from particulate matter was the major contributor to deaths from COPD in regions with a low Socio-demographic index. Since 2013, a high body mass index has become the principal risk factor for asthma. CONCLUSIONS: Regions with a low Socio-demographic index had the greatest burden of disease. The estimated contribution of risk factors (such as smoking, environmental pollution, and a high body mass index) to mortality and DALYs supports the need for urgent efforts to reduce exposure to them.


Asunto(s)
Salud Global/tendencias , Años de Vida Ajustados por Calidad de Vida , Trastornos Respiratorios/epidemiología , Distribución por Edad , Factores de Edad , Enfermedad Crónica , Carga Global de Enfermedades/tendencias , Salud Global/estadística & datos numéricos , Humanos , Mortalidad/tendencias , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos
10.
MMWR Morb Mortal Wkly Rep ; 68(48): 1105-1111, 2019 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-31805033

RESUMEN

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).


Asunto(s)
Erradicación de la Enfermedad , Salud Global/estadística & datos numéricos , Sarampión/prevención & control , Adolescente , Adulto , Niño , Preescolar , Humanos , Programas de Inmunización , Incidencia , Lactante , Sarampión/epidemiología , Sarampión/mortalidad , Vacuna Antisarampión/administración & dosificación , Adulto Joven
12.
MMWR Morb Mortal Wkly Rep ; 68(47): 1089, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31851652

RESUMEN

World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1).


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Epidemias , Salud Global/estadística & datos numéricos , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Aniversarios y Eventos Especiales , Humanos
13.
Presse Med ; 48(10): 1076-1084, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31706896

RESUMEN

The breast is the leading cancer site in women throughout the world. That said, breast cancer incidence varies widely, ranging from 27/100,0002 (Central-East Asia and Africa) to 85-94/100,0002 (Australia, North America and Western Europe). Its frequency in France is among the highest in Europe. While in most countries, its incidence has been increasing for more than 40 years, in a few other countries (USA, Canada, Australia, France…), it has been decreasing since 2000-2005. Possibly due to a substantial reduction of hormone-based treatments at menopause, the decrease may be transient. It is also the leading cause of female cancer deaths in almost all countries, with the exception of the most economically developed, in which it is currently second to lung cancer. That much said, for thirty years in highly industrialized countries such as France, breast cancer mortality has been declining. Taken together, early diagnosis and improved treatment explain this success. In France, 5-year survival and 10-year survival approximate 88 % and 78 % respectively; these rates are among the most elevated in Western Europe. Excess mortality due to breast cancer is consequently low (<5 %) but variable according to age, and maximal during the first two years of follow-up. Several thousand epidemiological studies on risk factors for breast cancer have been carried out worldwide; it is difficult to draw up an overall assessment, especially insofar as the identified factors interact and vary according to whether the cancers occur before or after menopause and depending on their histological, biological (receptors) or molecular characteristics. Moreover, their prevalence varies in time and from one region to another. For the majority of these factors, the level of relative risk is≤2. Genetic particularities: presence of proliferative mastopathy, a first child after 35 years of age and thoracic irradiation are the sole factors entailing relative risk from 2 to 5 (comparatively speaking, the risk levels associated with tobacco consumption reach values from 10 to 20, and in some cases even higher). However, exposure to risk factors≤2 may be relatively frequent and consequently favorable to development of a substantial number of breast cancers. Estimation (based on degree of risk and frequency of exposure) of the proportion of risk attributable to a given factor facilitates decision-making aimed at determining the most effective primary prevention actions. Taking into consideration the identified factors pertaining to post-menopausal cancers, only 35 % [23 to 45 %] of the attributable proportions could be reduced by primary prevention. In view of achieving this level of reduction, it is possible to put forward the following recommendations: for the women themselves: have a first child before the age of 30, breastfeed for several months, engage in sufficiently intense and regular physical activity, avoid or reduce excess weight after turning thirty, avoid exposure to active or passive smoking, limit alcohol consumption; for their physicians: do not prescribe pointless thoracic irradiations (unnecessary mammography in particular) or unjustified hormonal treatments. *persons/years.


Asunto(s)
Neoplasias de la Mama/epidemiología , Distribución por Edad , Factores de Edad , Neoplasias de la Mama/etiología , Neoplasias de la Mama/mortalidad , Femenino , Francia/epidemiología , Salud Global/estadística & datos numéricos , Humanos , Incidencia , Factores de Riesgo
14.
MMWR Morb Mortal Wkly Rep ; 68(43): 979-984, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31671082

RESUMEN

Dracunculiasis (also known as Guinea worm disease) is caused by the parasite Dracunculus medinensis and is acquired by drinking water containing copepods (water fleas) infected with D. medinensis larvae. The worm typically emerges through the skin on a lower limb approximately 1 year after infection, resulting in pain and disability (1). There is no vaccine or medicine to treat the disease; eradication efforts rely on case containment* to prevent water contamination and other interventions to prevent infection, including health education, water filtration, chemical treatment of unsafe water with temephos (an organophosphate larvicide to kill copepods), and provision of safe drinking water (1,2). In 1986, with an estimated 3.5 million cases† occurring each year in 20 African and Asian countries§ (3), the World Health Assembly called for dracunculiasis elimination (4). The global Guinea Worm Eradication Program (GWEP), led by The Carter Center and supported by the World Health Organization (WHO), CDC, the United Nations Children's Fund, and other partners, began assisting ministries of health in countries with dracunculiasis. This report, based on updated health ministry data, describes progress to eradicate dracunculiasis during January 2018-June 2019 and updates previous reports (2,4,5). With only five countries currently affected by dracunculiasis (Angola, Chad, Ethiopia, Mali, and South Sudan), achievement of eradication is within reach, but it is challenged by civil unrest, insecurity, and lingering epidemiologic and zoologic questions.


Asunto(s)
Erradicación de la Enfermedad , Dracunculiasis/prevención & control , Salud Global/estadística & datos numéricos , Dracunculiasis/epidemiología , Humanos
15.
J Glob Health ; 9(2): 020421, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31673337

RESUMEN

Background: Until recently, the World Health Organization (WHO) estimated the annual mortality burden of influenza to be 250 000 to 500 000 all-cause deaths globally; however, a 2017 study indicated a substantially higher mortality burden, at 290 000-650 000 influenza-associated deaths from respiratory causes alone, and a 2019 study estimated 99 000-200 000 deaths from lower respiratory tract infections directly caused by influenza. Here we revisit global and regional estimates of influenza mortality burden and explore mortality trends over time and geography. Methods: We compiled influenza-associated excess respiratory mortality estimates for 31 countries representing 5 WHO regions during 2002-2011. From these we extrapolated the influenza burden for all 193 countries of the world using a multiple imputation approach. We then used mixed linear regression models to identify factors associated with high seasonal influenza mortality burden, including influenza types and subtypes, health care and socio-demographic development indicators, and baseline mortality levels. Results: We estimated an average of 389 000 (uncertainty range 294 000-518 000) respiratory deaths were associated with influenza globally each year during the study period, corresponding to ~ 2% of all annual respiratory deaths. Of these, 67% were among people 65 years and older. Global burden estimates were robust to the choice of countries included in the extrapolation model. For people <65 years, higher baseline respiratory mortality, lower level of access to health care and seasons dominated by the A(H1N1)pdm09 subtype were associated with higher influenza-associated mortality, while lower level of socio-demographic development and A(H3N2) dominance was associated with higher influenza mortality in adults ≥65 years. Conclusions: Our global estimate of influenza-associated excess respiratory mortality is consistent with the 2017 estimate, despite a different modelling strategy, and the lower 2019 estimate which only captured deaths directly caused by influenza. Our finding that baseline respiratory mortality and access to health care are associated with influenza-related mortality in persons <65 years suggests that health care improvements in low and middle-income countries might substantially reduce seasonal influenza mortality. Our estimates add to the body of evidence on the variation in influenza burden over time and geography, and begin to address the relationship between influenza-associated mortality, health and development.


Asunto(s)
Epidemias , Salud Global/estadística & datos numéricos , Gripe Humana/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Gripe Humana/epidemiología , Modelos Lineales , Persona de Mediana Edad , Factores de Riesgo , Estaciones del Año , Adulto Joven
16.
MMWR Morb Mortal Wkly Rep ; 68(45): 1024-1028, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31725706

RESUMEN

Certification of global eradication of indigenous wild poliovirus type 2 occurred in 2015 and of type 3 in 2019. Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 and broad use of live, attenuated oral poliovirus vaccine (OPV), the number of wild poliovirus cases has declined >99.99% (1). Genetically divergent vaccine-derived poliovirus* (VDPV) strains can emerge during vaccine use and spread in underimmunized populations, becoming circulating VDPV (cVDPV) strains, and resulting in outbreaks of paralytic poliomyelitis.† In April 2016, all oral polio vaccination switched from trivalent OPV (tOPV; containing vaccine virus types 1, 2, and 3) to bivalent OPV (bOPV; containing types 1 and 3) (2). Monovalent type 2 OPV (mOPV2) is used in response campaigns to control type 2 cVDPV (cVDPV2) outbreaks. This report presents data on cVDPV outbreaks detected during January 2018-June 2019 (as of September 30, 2019). Compared with January 2017-June 2018 (3), the number of reported cVDPV outbreaks more than tripled, from nine to 29; 25 (86%) of the outbreaks were caused by cVDPV2. The increase in the number of outbreaks in 2019 resulted from VDPV2 both inside and outside of mOPV2 response areas. GPEI is planning future use of a novel type 2 OPV, stabilized to decrease the likelihood of reversion to neurovirulence. However, all countries must maintain high population immunity to decrease the risk for cVDPV emergence. Cessation of all OPV use after certification of polio eradication will eliminate the risk for VDPV emergence.


Asunto(s)
Brotes de Enfermedades , Salud Global/estadística & datos numéricos , Poliomielitis/epidemiología , Vacuna Antipolio Oral/efectos adversos , Poliovirus/aislamiento & purificación , Humanos , Poliomielitis/etiología , Poliomielitis/prevención & control , Poliovirus/clasificación , Vacuna Antipolio Oral/administración & dosificación , Serotipificación
17.
BMJ ; 367: l5873, 2019 10 31.
Artículo en Inglés | MEDLINE | ID: mdl-31672760

RESUMEN

OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS: These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.


Asunto(s)
Salud Global/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Fallo Renal Crónico/terapia , Nefrología/estadística & datos numéricos , Terapia de Reemplazo Renal/estadística & datos numéricos , Estudios Transversales , Países en Desarrollo/estadística & datos numéricos , Humanos
18.
Psychiatr Danub ; 31(4): 457-464, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31698402

RESUMEN

AIMS: National mental health policies must be grounded in accurate assessments of diseases. In the current article we used the Global Burden of Disease Study 2016 to examine burden due to mental and substance use disorders in Romania. METHODS: For each mental and substance use disorder included in the GBD 2016 we reported the yearly estimates for YLL (as a measure for non-fatal burden), YLD (fatal burden) and DALY (summing years lived with disability and years of life lost to give a measure of total burden). RESULTS: Mental and substance use disorders were the third leading cause of non-fatal burden in Romania in 2016, explaining 13.53% of total years lived with disability, the ninth leading cause for fatal burden explaining 0.84% of total years of life lost, and were the fifth leading cause of total burden, accounting for 5.52% of total disability-adjusted life years. Among MSDs, depression, anxiety and alcohol use disorders have the highest rate. Starting 1997 there has been a slow decrease of age-standardized disability-adjusted life year rates, with no significant change in the last 5 years. CONCLUSION: Global Burden of Disease Study 2016 found that mental and substance use disorders were the fifth leading contributors to disease burden in Romania, with anxiety and depressive being the most prevalent. Despite national programs and strategies in the area of mental health initiated especially after 1990, the mental health system does not fully meet the needs of the patients. Effective population-level strategic measures are still required in order to reduce the burden of disease.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Salud Global/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Personas con Discapacidad , Humanos , Prevalencia , Rumanía/epidemiología
19.
BMC Public Health ; 19(1): 1391, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660919

RESUMEN

BACKGROUND: This study assessed international variations in changes in drowning mortality rates and the quality of reporting specific information in death certificates over the past decade. METHODS: Drowning mortality data of 61 countries were extracted from the World Health Organization Mortality Database. We calculated the percentage change (PC) in age-standardized drowning mortality rates and percentage of drowning deaths reported with unspecified codes between 2004 and 2005 and 2014-2015. RESULTS: Of the 61 countries studied, 50 exhibited a reduction in drowning mortality rates from 2004 to 2005 to 2014-2015. Additionally, five countries-Lithuania, Moldova, Kyrgyzstan, Romania, and El Salvador-with a high mortality rate in 2004-2005 (> 40 deaths per 100,000) showed improvement (PC < - 32%). By contrast, four countries-South Africa, Guyana, Morocco, and Guatemala-exhibited a more than twofold increase in mortality rates. Regarding the quality of reporting, 34 countries exhibited a decrease in the percentage of unspecified codes. Additionally, three countries-Paraguay, Serbia, and Croatia-with moderate and high percentages of unspecified codes (> 40%) exhibited a marked reduction (PC < - 60%), whereas three countries-Malaysia, Belgium, and Nicaragua-exhibited a notable increase. CONCLUSIONS: Large international variations in the extent of changes in drowning mortality rates and the quality of reporting specific information on the death certificate were observed during the study period.


Asunto(s)
Certificado de Defunción , Ahogamiento/mortalidad , Salud Global/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Bases de Datos Factuales , Humanos , Lactante , Persona de Mediana Edad , Organización Mundial de la Salud , Adulto Joven
20.
MMWR Morb Mortal Wkly Rep ; 68(39): 855-859, 2019 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-31581161

RESUMEN

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.


Asunto(s)
Erradicación de la Enfermedad , Salud Global/estadística & datos numéricos , Vigilancia de la Población , Síndrome de Rubéola Congénita/prevención & control , Rubéola (Sarampión Alemán)/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Rubéola (Sarampión Alemán)/epidemiología , Síndrome de Rubéola Congénita/epidemiología , Vacuna contra la Rubéola/administración & dosificación
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