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BACKGROUND AND AIMS: Arginase 1 deficiency (ARG1-D) is a ultrarare disease with manifestations that cause mobility and cognitive impairment that progress over time and may lead to early mortality. Diseases such as ARG1-D have a major impact also outside of the health care sector and the aim of this study was to estimate the current burden of disease associated with ARG1-D from a societal perspective. METHODS: The study was performed as a web-based survey of patients with ARG1-D and their caregivers in four European countries (France, Portugal, Spain, United Kingdom). The survey was distributed at participating clinics and included questions on e.g. symptoms (including the Gross Motor Function Classification System, GMFCS, and cognitive impairment), health care use, medication, ability to work, caregiving, and impact on health-related quality-of-life (HRQoL) using the EQ-5D-5L. RESULTS: The estimated total mean societal cost per patient and year was £63,775 (SD: £49,944). The cost varied significantly with both mobility impairment (from £49,809 for GMFCS level 1 to £103,639 for GMFCS levels 3-5) and cognitive impairment (from £43,860 for mild level to £99,162 for severe level). The mean utility score on the EQ-5D-5L for patients was 0.498 (SD: 0.352). The utility score also varied significantly with both mobility impairment (from 0.783 for GMFCS level 1 to 0.153 for GMFCS level 3-5) and cognitive impairment (from 0.738 for mild level to 0.364 for severe level). CONCLUSIONS: Similar to other studies of rare diseases, the study is based on a limited number of observations. However, the sample appear to be reasonably representative when comparing to previous studies of ARG1-D. This study shows that ARG1-D is associated with a high societal cost and significant impact on HRQoL. Earlier diagnosis and better treatment options that can postpone or withhold progression may therefore have a potential for improved HRQoL and savings for the patient, caregiver, and society.

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Background: In low- and middle-income countries (LMICs) and territories, maternal infections impose a non-negligible disease burden. We aimed to analyse the secular trends, age distribution, and associated factors of maternal sepsis and other maternal infections (MSMI) across 131 LMICs from 1990 to 2019. Methods: We collected yearly data of incidences, deaths, and disability adjusted life years (DALYs) on MSMI in 131 LMICs from 1990 to 2019 from the Global Burden of Disease 2019 (GBD 2019). The sociodemographic index (SDI) and universal health coverage effective coverage index (UHCI) were also acquired. Relative percent change and estimated annual percentage change (EAPC) were used to assess the secular trends. Correlation analyses were also employed to explore the associations between the burden of MSMI with SDI and UHCI. Results: Between 1990 and 2019, the age-standardised incident rates (ASIRs), age-standardised maternal mortality ratios (ASMMRs) and age-standardised DALYs rates of low-income countries (LICs) were much higher than that of lower-middle-income countries (LMCs) and upper-middle income countries (UMCs), although they all continued to decline. At least six of 131 LMICs had ASMMR greater than 70.00 per 100 000 live births in 2019. The incidences of MSMI increased first till 20-24 years and then decreased with age both in 1990 and 2019, while the ASMMRs were higher in the youngest and the oldest age group. With the growth of SDI and UHCI in 2109, the decreasing trend of ASIR, ASMMR, and age-standardised DALYs rates slowed down. Conclusions: Although the progress has been made in reducing the burden of MSMI in 131 LMICs, the disease burden in LICs far exceeded that of LMCs and UMCs. Socio-economic status and universal health coverage were both associated with the MSMI burden, and further research is needed to explore the underlying factors contributing to these disparities and to identify effective strategies for reducing the burden of MSMI.

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BACKGROUND: Cancer is a major health concern in China. Understanding the epidemiology of cancer can guide the development of effective prevention and control strategies. This study aimed to comprehensively analyze the cancer burden, time trends, and attributable risk factors of cancers in China and compare them with those in India. METHODS: We utilized the GLOBOCAN database for 2022, Cancer Incidence in Five Continents (C15 plus) series, and Global Burden of Disease (GBD) 2021 to extract data on cancer incidence, mortality, disability-adjusted life years (DALYs), and risk factors. Time-trend analysis was performed using a join-point regression model. Correlations between cancer DALY rates and risk factors were analyzed using linear regression. RESULTS: In 2022, China experienced 4,824,703 new cancer cases and 2,574,176 cancer-related deaths. Cancers also caused approximately 71.2 million DALYs in China in 2021. Compared with India, China has higher incidence, mortality, and DALY rates for various cancers. Breast and thyroid cancers in China have shown a rapid increase in the age-standardized incidence rate (ASIR), along with a substantial burden of lung, stomach, esophageal, and colorectal cancer. However, stomach and liver cancers in China showed a downward trend in ASIR. In 2021, diet low in milk was a major risk factor among females for colorectal cancer DALYs in China (23% of age-standardized DALYs) and India (22.9%). In China, smoking has been associated with increased DALYs due to lung cancer. CONCLUSIONS: China has a heavier cancer burden than India. The heavy burden of lung, stomach, esophageal, and colorectal cancers, combined with the rising incidence of breast and thyroid cancers, pose a critical challenge to public health in China. Cancer burden may be reduced through public health initiatives that prioritize primary prevention, prompt identification, and therapeutic intervention.

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A rare disease is that with a low prevalence in the population. However, it is estimated that there are between 6,000 and 8,000 different types of rare diseases in the world and, generally, they are incurable and deadly. Machado-Joseph's disease (MJD) is one of these cases; of genetic origin, autosomal dominant, with a high chance of transmission between generations and without curative treatment. Given the specificities of MJD and the lack of economic studies associated with it, this article aims to estimate the direct and indirect health-related costs of lost productivity attributable to Machado-Joseph's Disease. The data used were primarily collected at the Hospital de Clínicas de Porto Alegre (HCPA), during the period between October 2019 and March 2020. The bottom-up cost methodology was used, that is to say, to estimate costs across a sample of patients to produce an annual cost per patient. Among the main results, it was found that 90.8% of the sample does not work and of these, 72.73% reported that the reason they had stopped working was due to Machado-Joseph's disease. The average age of men when they stopped working was 39.05 years of age and for women it was 39.64 years of age. In relation to direct non-medical costs, with rehabilitation and transport, it was found that these items affect about 32% of men's income and 36% of women's income, as well as medication and diapers costs affect about 15% of women's income and 14% of the income of men who are no longer able to work. The study also showed that 50% of caregivers, who are generally close relatives of the patient, do not work. Of these, 33.3% reported having left the labor market to provide assistance to the patient, which means that the cost for families is even higher than that estimated for the patient.

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BACKGROUND: Patients with mucopolysaccharidosis (MPS) often face delayed diagnoses, limited treatment options and high healthcare costs, that may significantly affect patients' quality of life. The objective of this study was to understand medical service utilization related to diagnosis and treatment, economic burden during diagnosis period, and health-related quality of life among MPS patients in China. METHODS: A series of patients diagnosed with MPS registered in the national patient organization were recruited for a cross-sectional survey from May to July 2019. Information were collected from patients or their parents via phone interview, including demographic data, utilization of services related to diagnosis and treatment, total cost during the period of MPS diagnosis and health-related quality of life (HRQoL). HRQoL was assessed by PedsQL 4.0 Generic Core Scale (PedsQL) and 36-item short-form health survey (SF-36) depending on the age of patients with MPS and compared with the general Chinese population. RESULTS: A total of 180 MPS patients (50, 67, 15, 46, 1 and 1 for type I, II, III, IV, VI and VII), with a mean age of 9.54 years and 137 (76.11%) males, were included in analysis. The mean age at first visit to a medical doctor for MPS related symptoms was 3.65 ± 2.58 years old, while only 12 patients (6.67%) were diagnosed on their first visit. The mean diagnostic delay, which is defined as the time between the first visit to a medical doctor for MPS related symptoms and the final diagnosis, was 9.42 months, with no significant difference between types. The average number of misdiagnosis was 4.56. Before the confirmed diagnosis, the patients made an average of 6.31 visits and visited 4.3 hospitals. During diagnosis period, the mean of ¥81,086.72 direct medical costs accounted for 63.75% of the total cost. Only 32.78% of the patients had ever received specific treatments. The mean scores of PedsQL and SF-36 of patients were significantly lower than the Chinese norms. Household annual income per person, specific treatment use and MPS subtype were significantly associated HRQoL of patients. CONCLUSION: The results highlight challenges faced by MPS patients in terms of diagnosis, access to specific treatments, economic burden and low HRQoL. There is an urgent need to improve early detection and diagnosis, create fair and consistent mechanisms to increase access to specialized treatment and reduce the economic burden of MPS patients in China.

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The significant impact of acute respiratory tract infections on healthcare systems is well-documented, given their contribution to emergency department admissions, hospitalizations, and increased use of antibiotics and other medications. However, further research is needed to understand the burden of acute respiratory tract infections in pediatric community care to develop effective public health interventions and improve child health outcomes. Real-world data were retrieved from Pedianet, an Italian network of over 200 family pediatricians. Acute respiratory tract infection visits were identified and analysed using an infection-duration algorithm to extract individual cases. The number of follow-up visits per 100 cases was calculated to assess the burden on the Italian National Health Service. Comparisons were made overall and stratified by type of acute respiratory tract infections and epidemiological season. A total of 1,402,953 acute respiratory infections-related visits were recorded, with an overall rate of 12 visits per 100 cases. Upper respiratory tract infections had an average of 9 visits per 100 cases. Lower respiratory tract infections exhibited a higher burden, with 29 visits per 100 cases. Pneumonia showed a declining trend in the pre-pandemic era (62 to 48 visits) but rebounded in the post-COVID-19 years (32 to 42 visits). This study underscores the importance of monitoring and managing acute respiratory infections, especially lower respiratory tract infections, in pediatric care.

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The objective of this systematic review was the evaluation of the burden of family caregivers of patients on hemodialysis and its correlation with caregivers' quality of life. Articles from PubMed and Scopus published between 2012 to 2022 were retrieved from using the key words burden, family caregivers, quality of life, and hemodialysis patients. Articles reviewed included quantitative data indicating the family caregiver burden ranged from moderate to severe. The correlation between burden and quality of life was negative. Nephrology nurses in hemodialysis units should contribute to the design and implementation of educational programs and support strategies for family caregivers of patients on hemodialysis to support caregivers, reduce their burden, and improve their quality of life.

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The Global Burden of Animal Diseases provides an analytical framework to measure the overall health of various farmed animal populations, to estimate the farm-level burden of different diseases, incorporating production losses due to morbidity and mortality as well as health expenditure, and to identify the wider economic and human health impacts of animal disease. Attributing the burden of animal diseases to specific causes or groups of causes requires methodological choices, including the classification of diseases and the resulting health states that manifest in loss of production. The aim of this article is to address the key challenges in the process of estimating farm-level disease burden, including ambiguity in terminology, data availability and collation, and adjustments for comorbidity. Using infection with zoonotic Brucella spp. in small ruminants as an aetiological cause of disease and abortion as a sequela of multiple diseases, practical examples of the framework are provided. Cause-specific attribution of the burden of animal disease captures temporal and spatial trends, an understanding of which is essential for planning, monitoring and evaluating animal health programmes and disease interventions.

Le programme " Impact mondial des maladies animales " fournit un cadre analytique pour mesurer l'état de santé général de diverses populations d'animaux d'élevage, estimer la charge de morbidité associée à certaines maladies à l'échelle d'une exploitation, prendre en compte aussi bien les pertes de production dues à la morbidité et à la mortalité que les dépenses de santé, et mettre en lumière les effets plus larges des maladies animales sur l'économie et la santé humaine. Des choix méthodologiques doivent être faits pour attribuer l'impact des maladies animales à des facteurs spécifiques ou à des séries de facteurs, en classant les maladies et en définissant les profils sanitaires qui en résultent et qui induisent des pertes de production. L'objectif de cet article est d'aborder les principales difficultés rencontrées lors de l'estimation de la charge de morbidité à l'échelle des exploitations, en particulier celles relevant d'une terminologie ambiguë, de la disponibilité et modalités de collecte des données, et des ajustements à effectuer en cas de comorbidité. Les auteurs donnent des exemples concrets du cadre proposé, en prenant d'une part l'infection zoonotique par des Brucella spp. chez les petits ruminants comme cause étiologique de la maladie, et d'autre part les avortements comme séquelles de plusieurs maladies. L'attribution de l'impact des maladies animales à des facteurs spécifiques permet de saisir les tendances aussi bien dans le temps que dans l'espace, dont la connaissance se révèle indispensable pour assurer la planification, le suivi et l'évaluation des programmes de santé animale et des interventions liées aux maladies.

El impacto global de las enfermedades animales proporciona un marco analítico para medir la sanidad general de diversas poblaciones de animales de granja, estimar el impacto de las distintas enfermedades en las explotaciones, incorporando las pérdidas de producción debidas a la morbilidad y a la mortalidad, así como los gastos sanitarios, y determinar las repercusiones más amplias de las enfermedades animales en la economía y la salud humana. Para atribuir el impacto de las enfermedades animales a causas o grupos de causas específicos es necesario tomar decisiones metodológicas, incluida la clasificación de las enfermedades y de los estados sanitarios resultantes, que se traducen en pérdidas de producción. El objetivo de este artículo es abordar las principales dificultades que se plantean en el proceso de la estimación del impacto de las enfermedades en las explotaciones, entre ellas la ambigûedad terminológica, la disponibilidad y el cotejo de datos, y los ajustes por comorbilidad. Utilizando la infección zoonótica por Brucella spp. en pequeños rumiantes como causa etiológica de enfermedad y el aborto como secuela de múltiples enfermedades, se ofrecen ejemplos prácticos del marco. La atribución del impacto de las enfermedades animales a causas específicas permite captar tendencias temporales y espaciales cuya comprensión es esencial para planificar, supervisar y evaluar programas de sanidad animal e intervenciones relacionadas con enfermedades.

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BACKGROUND: Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection. OBJECTIVE: This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination. METHODS: This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (≥18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index. RESULTS: A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80%) adults aged ≥18 years and 8328 (20%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care, specialist, and emergency services, was more pronounced in the pre-Omicron wave. CONCLUSIONS: The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system.

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Attracting and sustaining investment in Veterinary Services and animal health programmes from national government budgets, development aid and grants, and philanthropic donors requires economic rationale using relevant, reliable and validated analytical approaches. The complex interwoven relationships between animal health, livestock husbandry systems, national food security, global health security and environmental sustainability emphasise the importance of improving data governance and stewardship and applying economic analysis to understand animal disease burdens. These efforts should enable prioritised investment of limited resources and effective monitoring of the impact of programmes over time. Data governance and stewardship capacities are fundamental to development, implementation and performance monitoring of evidence-based policies in animal health. There are challenges in data availability for national and subnational livestock populations in different sectors, for disease incidence and prevalence, and for animal health expenditure in support of optimised allocation of scarce resources, be they finance, land, labour, or management attention and policy focus. Animal health data systems governance and stewardship and economic analysis are core skills for Veterinary Services in developing and applying evidence-based policy, but capability probably varies among World Organisation for Animal Health (WOAH) Members. The WOAH Performance of Veterinary Services programme has several critical competencies that are relevant to economics of animal health and to data governance and stewardship, but these have not yet been targeted for coordinated capacity development. Implementation of publicâ€"private partnership approaches for animal health programmes creates increasing expectations of robust data and methods for prioritisation, options analysis, and assessing impacts and costs. Experience and examples from national systems in New Zealand, Australia, Ethiopia and Indonesia illustrate current challenges associated with prioritisation of animal health programmes using economic analysis. The Global Burden of Animal Diseases programme intends to support WOAH Members and partners to develop capacities for and standardise approaches to economic analysis and prioritisation in animal health programmes.

Les investissements dans les Services vétérinaires et dans les programmes de santé animale à partir des budgets publics nationaux, des aides et subventions au développement et des fonds alloués par des donateurs philanthropiques peuvent être encouragés et pérennisés au moyen d'une argumentation économique solide fondée sur des méthodes analytiques pertinentes, fiables et validées. La complexité et l'imbrication des relations entre la santé animale, les systèmes d'élevage, la sécurité de l'approvisionnement alimentaire à l'échelle nationale, la sécurité sanitaire mondiale et la durabilité environnementale imposent d'améliorer la gouvernance et la gestion des données et de recourir à des analyses économiques pour mieux comprendre l'impact des maladies animales. Ces efforts devraient permettre de définir les investissements prioritaires dans un contexte de ressources limitées et d'assurer un suivi efficace de l'impact des programmes dans le temps. L'existence de capacités de gouvernance et de gestion des données est donc une condition essentielle pour concevoir et mettre en oeuvre des politiques de santé animale fondées sur des données factuelles et pour suivre leurs performances. Les données disponibles sur les populations d'animaux d'élevage des différentes filières aux niveaux national ou infranational, sur l'incidence et la prévalence des maladies ou sur les dépenses de santé animale sont parfois insuffisantes pour étayer une utilisation optimale de ressources limitées, qu'il s'agisse de moyens financiers, des terres, de la main-d'oeuvre, voire des efforts de gestion ou de la volonté politique. La gouvernance et la gestion des systèmes de données de santé animale et la conduite d'analyses économiques sont des compétences cruciales des Services vétérinaires, que ceux-ci mobilisent pour concevoir et mettre en oeuvre des politiques fondées sur des données factuelles ; il est néanmoins peu probable que ces capacités soient d'un niveau homogène parmi tous les Membres de l'Organisation mondiale de la santé animale (OMSA). Le Processus d'évaluation de la Performance des Services vétérinaires mis en place par l'OMSA définit un certain nombre de compétences critiques dans le domaine de l'économie de la santé animale et de la gouvernance et gestion des données, mais ces compétences n'ont pas encore été intégrées dans un effort coordonné de renforcement des capacités. Les stratégies consistant à confier la mise en oeuvre de programmes de santé animale à des partenariats public-privé suscitent des besoins accrus en données et en méthodes robustes pour l'établissement des priorités, l'analyse des options et l'évaluation des impacts et des coûts. Les auteurs mentionnent les expériences et exemples de systèmes nationaux en Nouvelle-Zélande, en Australie, en Ethiopie et en Indonésie pour illustrer les enjeux actuels liés à l'utilisation des analyses économiques pour définir les priorités des programmes de santé animale. Le programme " Impact mondial des maladies animales " vise à aider les Membres et les partenaires de l'OMSA à renforcer leurs capacités dans le domaine de l'analyse économique et de la définition des priorités des programmes de santé animale et à normaliser leurs approches en la matière.

Para atraer y mantener las inversiones en los Servicios Veterinarios y los programas de sanidad animal procedentes de los presupuestos de los gobiernos nacionales, la ayuda para el desarrollo y las subvenciones, así como de donantes filántropos, se requiere un razonamiento económico en el que se utilicen enfoques analíticos pertinentes, fiables y validados. Las complejas relaciones entre la sanidad animal, los sistemas de ganadería, la seguridad alimentaria nacional, la seguridad sanitaria mundial y la sostenibilidad ambiental ponen de relieve la importancia de mejorar la gobernanza y la gestión de datos y de aplicar el análisis económico para comprender el impacto de las enfermedades animales. Estos esfuerzos deberían permitir establecer prioridades para la inversión de los limitados recursos y realizar un seguimiento eficaz de las repercusiones de los programas a lo largo del tiempo. Las capacidades de gobernanza y gestión de datos son fundamentales para el desarrollo y la implementación de políticas de sanidad animal con una base empírica y para el seguimiento de sus resultados. Existen dificultades en cuanto a la disponibilidad de datos sobre las cabañas ganaderas nacionales y subnacionales de los distintos sectores, la incidencia y prevalencia de las enfermedades y el gasto en sanidad animal que plantean problemas a la hora de optimizar la asignación de unos recursos que son escasos, ya sean los recursos financieros, las tierras, la mano de obra o la atención a la gestión y la orientación de las políticas. La gobernanza y la gestión de los sistemas de datos zoosanitarios y el análisis económico son competencias esenciales para que los Servicios Veterinarios elaboren y apliquen políticas con base empírica, pero es probable que la capacidad varíe entre los Miembros de la Organización Mundial de Sanidad Animal (OMSA). El Proceso de Prestaciones de los Servicios Veterinarios de la OMSA abarca varias competencias esenciales que son relevantes para la economía de la sanidad animal y para la gobernanza y la gestión de datos, pero que aún no han sido objeto de actividades coordinadas de desarrollo de capacidades. La aplicación de enfoques de asociación público-privada para los programas de sanidad animal aumenta aún más las expectativas de datos y métodos sólidos para el establecimiento de prioridades, el análisis de opciones y la evaluación de las repercusiones y los costos. La experiencia y los ejemplos de los sistemas nacionales de Nueva Zelanda, Australia, Etiopía e Indonesia ilustran los retos actuales asociados al establecimiento de prioridades en los programas de sanidad animal mediante el análisis económico. El programa sobre el impacto global de las enfermedades animales pretende ayudar a los Miembros y socios de la OMSA a desarrollar capacidades y armonizar enfoques para el análisis económico y el establecimiento de prioridades en los programas de sanidad animal.

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Quantifying the impact of poor animal health outcomes on human health represents a complex challenge. Using the disability-adjusted life year (DALY) metric as an endpoint, this article discusses how animal health outcomes can impact humans through three key processes: directly through zoonotic disease, indirectly via changes in yields and their impacts on nutrition and wealth, and finally, through indirect features associated with the agricultural industry, such as pharmaceuticals and climate change. For each process, the current state of the art and feasibility of global DALY-associated estimates are discussed. Existing frameworks for zoonoses already consider some key pathogens; ensuring completeness in the pathogens considered and consistency in methodological decisions is an important next step. For diet, risk factor frameworks enable a calculation of attributable DALYs; however, significant economic methodological developments are needed to ensure that local production changes are appropriately mapped to both local and global changes in dietary habits. Concerning wealth-related impacts, much work needs to be done on method development. Industry-related impacts require a focus on key research topics, such as attribution studies for animal antimicrobial resistance contributing to human outcomes. For climate change, a critical next step is identifying to what extent associated industry emissions are amenable to change should animal health outcomes improve. Allocation of finite funds to improve animal health must also consider the downstream impact on humans. Leveraging DALYs enables comparisons with other human health-related decisions and would represent a transformative way of approaching animal health decision-making should the obstacles in this article be addressed and new methods be developed.

La quantification de l'impact des problèmes de santé animale sur la santé humaine constitue un défi d'une grande complexité. En se servant de l'indicateur des années de vie ajustées sur l'incapacité (DALY) comme critère d'évaluation, les auteurs examinent trois processus essentiels illustrant l'impact que la situation zoosanitaire peut avoir sur la santé humaine : impact direct résultant des maladies zoonotiques, impact indirect résultant des mauvaises performances des animaux et de leurs conséquences sur la nutrition et la création de richesses, et enfin, effets indirects résultant de facteurs en lien avec le secteur agricole, par exemple l'utilisation de produits pharmaceutiques et le changement climatique. Pour chacun de ces processus, les auteurs font le point sur l'état actuel des connaissances et sur l'applicabilité des évaluations mondiales basées sur l'indicateur DALY. Les cadres existants relatifs aux zoonoses recouvrent déjà certains agents pathogènes majeurs ; la prochaine étape importante consistera à assurer une couverture complète des agents pathogènes et à veiller à la cohérence des décisions méthodologiques. S'agissant de l'alimentation, les cadres basés sur l'analyse des facteurs de risque permettent de calculer les DALY imputables à l'alimentation ; toutefois, d'importantes avancées méthodologiques sur les aspects économiques de cette corrélation seront nécessaires pour s'assurer que tout changement intervenant localement en matière de production animale est correctement mis en correspondance avec les modifications des habitudes alimentaires dans ce même contexte local mais aussi à l'échelle mondiale. S'agissant des impacts liés à la création de richesses, il reste beaucoup à faire dans le domaine méthodologique. La détermination des impacts liés aux filières d'élevage requiert des travaux axés sur des sujets précis, par exemple des études visant à déceler les sources de la résistance aux agents antimicrobiens qui contribuent à l'apparition d'antibiorésistances chez l'être humain. Enfin, pour ce qui concerne le changement climatique, une étape cruciale consistera à déterminer dans quelle mesure les émissions associées à l'élevage sont susceptibles de changer en cas d'amélioration de la situation zoosanitaire. Dans un contexte de ressources limitées, l'affectation de fonds à l'amélioration de la santé animale doit également prendre en compte l'impact en aval sur la santé humaine. L'utilisation de l'indicateur DALY permet des comparaisons avec d'autres décisions de santé publique et représenterait une approche transformative de la prise de décision en santé animale, dès lors que les obstacles mentionnés dans cet article sont surmontés et que de nouvelles méthodes sont mises au point.

Cuantificar el impacto de una mala sanidad animal en la salud humana es un desafío complejo. Utilizando el parámetro de años de vida ajustados en función de la discapacidad (AVAD o DALY) como criterio de valoración, en este artículo se examina cómo la sanidad animal puede repercutir en los seres humanos a través de tres procesos clave: directamente, a través de las zoonosis; indirectamente, a través de cambios en los rendimientos y sus repercusiones en la nutrición y la riqueza; y, por último, a través de factores indirectos asociados a la industria agropecuaria, como los fármacos y el cambio climático. Para cada uno de estos procesos, se examinan el estado actual y la viabilidad de estimar AVAD a escala mundial. Los marcos existentes para la zoonosis ya tienen en cuenta algunos patógenos claves; garantizar la exhaustividad de los patógenos considerados y la coherencia en las decisiones metodológicas es un próximo paso importante. En lo que respecta a la alimentación, aunque los marcos de factores de riesgo permiten calcular los AVAD atribuibles, se necesitan importantes avances metodológicos en el ámbito económico para asegurar que los cambios en la producción local se correspondan adecuadamente con los cambios locales y mundiales en los hábitos alimentarios. En cuanto a las repercusiones en la riqueza, queda mucho trabajo por hacer en el desarrollo de métodos. Para abordar las repercusiones relacionadas con la industria, es necesario centrarse en temas clave de investigación, como los estudios de atribución relativos al impacto en la salud humana de la resistencia a los antimicrobianos en los animales. En lo que se refiere al cambio climático, un próximo paso crucial es determinar en qué medida las emisiones de la industria podrían cambiar, en función de la mejora de los resultados en materia de sanidad animal. Al asignar fondos limitados para la mejora de la sanidad animal también se deben tener en cuenta las repercusiones correspondientes en los seres humanos. Utilizar los AVAD permite hacer comparaciones con otras decisiones importantes relacionadas con la salud humana y representaría una forma transformadora de enfocar la toma de decisiones en materia de sanidad animal, en caso de que se aborden los obstáculos presentados en ese artículo y se desarrollen nuevos métodos.

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This article focuses on identifying the loss of production and costs (or lack thereof) associated with livestock health as well as animal disease externalities, with the intent to estimate economy-wide burden. It limits its scope to terrestrial livestock and aquaculture, wherein economic burden is predominately determined by market forces. Losses and costs are delineated into both direct losses and costs and indirect losses and costs, as well as ex post costs and ex ante costs. These costs include not only private expenditures but also public expenditures related to the prevention of, treatment of, and response to livestock disease. This distinction is important because a primary role of government is to mitigate externalities. The article then discusses market impacts and investments. Finally, it provides selected examples and illustrative observations and discusses future directions for research and application.

Cet article examine les pertes de production et les coûts associés (ou non) à la santé animale ainsi que les externalités liées aux maladies animales, dans le but d'estimer le fardeau pour l'ensemble de l'économie. L'examen se limite à la production d'animaux terrestres et aquatiques, secteurs où le fardeau économique est principalement déterminé par les forces du marché. Les pertes et les coûts sont répartis en pertes et coûts directs et indirects, ainsi qu'en coûts ex post et ex ante. Ces coûts comprennent non seulement les dépenses privées, mais aussi les dépenses publiques liées à la prévention, au traitement et aux réponses aux maladies des animaux d'élevage. Il s'agit d'une distinction importante car l'une des fonctions premières d'un gouvernement est d'atténuer les externalités. Les auteurs examinent ensuite les impacts sur les marchés et les investissements. Pour conclure, à partir d'exemples choisis et d'observations illustrant leur propos, les auteurs proposent des voies d'exploration pour la recherche et ses applications.

Este artículo se centra en determinar las pérdidas de producción y los costos (o la ausencia de ellos) asociados con las externalidades de la sanidad del ganado y las enfermedades animales, con el objetivo de estimar su impacto en toda la economía. El ámbito del artículo se limita a la ganadería terrestre y la acuicultura, donde el impacto económico está principalmente determinado por las fuerzas del mercado. Las pérdidas y los costos se clasifican en pérdidas y costos directos e indirectos, así como en costos ex post y ex ante. Dichos costos incluyen no solo los gastos privados, sino también los gastos públicos relacionados con la prevención y el tratamiento de las enfermedades del ganado y la respuesta ante estas, una distinción que es importante habida cuenta de que una de las principales funciones del gobierno es mitigar las externalidades. En el artículo se analizan a continuación las repercusiones en el mercado y las inversiones y, por último, se presentan algunos ejemplos y observaciones ilustrativas y se examinan las orientaciones futuras de la investigación y sus aplicaciones.

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INTRODUCTION: In sub-Saharan Africa (SSA), the number of cancer deaths is expected to double between 2020 and 2030; however, financial costs remain a barrier to accessing cancer treatment and care. There is an evidence gap on financial toxicity related to cancer care in SSA, both for the patient and for the family members providing care. Against this background, this review aims to analyse cancer care-related financial toxicity for the patient and family caregivers in SSA. METHODS AND ANALYSIS: A comprehensive search of peer-reviewed articles in the English language reporting the financial burden of cancer care on patients and family caregivers in SSA will be conducted using PubMed, Scopus and Web of Science from 1 January 2000 to 13 October 2023. Two researchers will independently review the titles, abstracts and full-text articles, and any disagreements will be resolved through consensus. A risk of bias assessment will be conducted using the assessment tools from the Joanna Briggs Institute Critical Appraisal Checklist. A quantitative and narrative synthesis of included studies, including the prevalence of financial toxicity of cancer care in SSA, will be developed. The review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION: Ethical review is not required because this review draws on published literature. The results will be presented at leading cancer and public health conferences, published in peer-reviewed journals and disseminated via website posts and social media channels to improve access to cancer care and to facilitate evidence-based policymaking in SSA. PROSPERO REGISTRATION NUMBER: CRD42023469011.

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BACKGROUND: Older adults in nursing and care homes (NCHs) are vulnerable to severe respiratory syncytial virus (RSV) infection, hospitalization, and death. This study aimed to gather data on RSV disease among older adults in NCHs and identify reported risk factors for RSV hospitalization and case fatality. METHODS: The study protocol was registered in PROSPERO (CRD42022371908). We searched MEDLINE, EMBASE, and Global Health databases to identify articles published between 2000 and 2023. Observational and experimental studies conducted among older adults in NCHs requiring assistive care and reporting RSV illness were included and relevant data were extracted. RESULTS: Of 18,690 studies screened, 32 were selected for full-text review, and 20 were included. Overall, the number of NCH residents ranged from 42 to 1459 with a mean age between 67.6 and 85 years. Attack rates ranged from 6.7% to 47.6% and annual incidence ranged from 0.5% to 14%. Case fatality rates ranged from 7.7% to 23.1%. We found similar annual incidence rates of RSV-positive acute respiratory infection (ARI) of 4582 (95% CI: 3259-6264) and 4785 (95% CI: 2258-10,141) per 100,000 reported in two studies. Annual incidence rate of RSV-positive lower respiratory tract infection was 3040 (95% CI: 1986-4454) cases per 100,000 adults. Annual RSV-ARI hospital admission rates were between 600 (95% CI: 190-10,000) and 1104 (95% CI: 350-1930) per 100,000 person-years. Among all RSV disease cases, commonly reported chronic medical conditions included chronic obstructive pulmonary disease (COPD), heart failure, ischemic heart disease, coronary artery disease, hypertension, diabetes, kidney dysfunction, cerebrovascular accident, malignancies, dementia, and those with a Charlson comorbidity score > 6.5. CONCLUSION: Data on RSV infection among NCH residents are limited and largely heterogeneous but document a high risk of illness, frequent hospitalization, and high mortality. Preventive interventions, such as vaccination, should be considered for this high-risk population. Nationally representative epidemiologic studies and NCH-based viral pathogen surveillance could more precisely assess the burden on NCH residents.

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The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.

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BACKGROUND: With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributable to high temperature have not been systematically reported. We aimed to analyze vulnerable areas and populations based on a detailed profile for the NCDs burden attributable to high temperature globally. METHODS: We obtained data from the Global Burden of Diseases (GBD) Study (2019) to describe the temporal and spatial patterns of NCDs burden attributable to high temperature globally from 1990-2019. Then we analyzed the differences by region, sex, and socio-demographic index (SDI). Finally, the age­period­cohort (APC) model was utilized to explore the age, period, and cohort effects of NCDs mortality caused by high temperature. RESULTS: In 2019, the number of deaths and Disability-adjusted life years (DALYs) from high-temperature-related NCDs was about 150,000 and 3.4 million globally, of which about 70% were in South Asia and North Africa and Middle East, and the burden was higher in men. Among 204 countries and territories, the highest age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were observed in Oman and United Arab Emirates, respectively. The global burden showed an upward trend from 1990 to 2019, with an EAPC of 3.66 (95%CI: 3.14-4.18) for ASMR and 3.68 (95%CI: 3.16-4.21) for ASDR. Cardiovascular diseases were the main contributors to the global burden of high-temperature-related NCDs in 2019. The age and period effect in APC model showed an increasing trend globally. There was a significant negative correlation between SDI and both ASMR (r = -0.17) and ASDR (r = -0.20) from 1990 to 2019. CONCLUSION: There was an increasing trend of the global burden of high-temperature-related NCDs. The burden was likely to be higher in males and the elderly, as well as in countries and regions with less economically and socially developed and in tropical climates. Surveillance and prevention measures should be implemented with a focus on these vulnerable areas and susceptible populations.

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Background: This study aimed to assess the impact of the COVID-19 pandemic on the disease burden of Taiwan's notifiable infectious diseases (NIDs). We compared disease burdens between the pandemic and pre-pandemic year of 2020 (with non-pharmaceutical interventions (NPIs)) and 2010 (without NPIs), respectively, to understand the overall pandemic impact on NIDs in Taiwan. Methods: Forty-three national NIDs were analyzed using the Statistics of Communicable Diseases and Surveillance Report by estimating the premature death and disability via different transmission categories, sex, and age groups. The study evaluated the impact of diseases by assessing the years lost due to death (YLLs), the duration of living with disability (YLDs), and the overall disability-adjusted life years (DALYs) by measuring both the severity of the illness and its duration. Results: Taiwan recorded 1,577 (2010) and 1,260 (2020) DALYs per million population and lost 43 NIDs, decreasing 317 DALYs per million population. Tuberculosis, HIV/AIDS and acute hepatitis B/D were the leading causes of DALYs, accounting for 89% (2010) and 77% (2020). Conclusion: Overall, this study provided the first insight of changes in disease burdens in NIDs between pre- and post-COVID-19 based on a nationwide viewpoint for further preventive measures and interventions to be focused on specific diseases by associated health administrations and policies.

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OBJECTIVE: Unintentional injuries constitute a significant global public health issue with significant social and economic costs. Previous evidence suggests ambient temperatures are associated with unintentional injury occurrences. However, the impacts of ambient temperature on unintentional injury economic burden have received little research attention. The objective of the study was to examine the association between ambient temperature and economic burden of unintentional injury. DESIGN: Time-stratified case-crossover study. SETTING: This study was performed at Tianjin Hospital, the largest trauma centre in Tianjin, by applying a hospital-based time-stratified case-crossover study. PARTICIPANTS: The 12 241 patients admitted with unintentional injuries and meteorological data were collected in Tianjin, China in 2021. PRIMARY AND SECONDARY OUTCOME: The association between ambient temperature and unintentional injury hospitalisation was evaluated with a distributed lag non-linear model, further temperature-attributable economic burden of unintentional injuries was quantified, and adjusted for demographic characteristics, injury mechanism and injury location of injury. RESULTS: The temperatures below 11.5°C were significantly associated with the increased risk of unintentional injury hospitalisation in Tianjin, in 2021. The effect was maximised on the current day. The relatively low temperature was responsible for 25.44% (95% CI 13.74, 33.09) of unintentional injury patients, and was associated with the number of unintentional injury patients (3114, 95% CI 1608, 4036). The relatively low temperature was associated with the excess economic burden for unintentional injury (¥197.52 million, 95% CI 102.00, 256.00; about 27.10 million dollars), accounting for 26.49% of the total economic burden. The cold temperatures generally had greater impacts on males (¥136.46 million, 95% CI 83.28, 172.42; about 18.67 million dollars) and the elderly (¥74.35 million, 95% CI 14.87, 102.14; about 10.24 million dollars). CONCLUSION: The temperature was associated with approximately 3000 unintentional injury patients and ¥200 million (27 million dollars), accounting for 26% of the total economic burden in Tianjin, 2021.

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Osteoarthritis (OA) is a complex and common condition, especially affecting the knees due to their weight-bearing role. Traditionally seen as a degenerative disease, OA is now understood to have both mechanical and inflammatory causes. Despite its increasing prevalence, there is limited data on OA in Indonesia, resulting in low awareness among clinicians and the public. The aim of this study was to describe the OA burden in Indonesia, focusing on its prevalence, incidence, and years lived with disability (YLD) from 1990 to 2019, using data from the Global Burden of Disease (GBD) study 2019. A descriptive cross-sectional study was conducted to examine the prevalence, incidence, and YLD of OA in Indonesia from the GBD study 2019. OA prevalence and YLD were compared to other countries according to similar social demographics and geographical proximity. OA YLD was also compared to the top causes of death and disability YLD in Indonesia. The study found that OA cases in Indonesia more than doubled from 1990 to 2019, with increases of 153.12% in males and 143.36% in females. Similar trends were observed for knee OA. The age-standardized prevalence rate in Indonesia increased by 11.03% in males and 8.42% in females, and these were higher compared to China, India, Singapore, and the global average. Younger people had a higher OA prevalence rate growth than older groups. The incidence rate for OA also rose significantly, with males seeing a 10.89% increase to 290 per 100,000 people and females with an 8.57% increase to 384 per 100,000 people. Despite lower overall burden rates compared to some countries, Indonesia experienced significant growth in YLD due to OA (12.16% in males and 9.65% in females) since 1990. Although OA was less burdensome than stroke, diabetes, low back pain, and chronic obstructive pulmonary disease (COPD), its YLD growth rate was higher. In conclusion, OA prevalence and incidence in Indonesia significantly increased from 1990 to 2019, with a notable rise among younger populations. OA had a higher YLD growth compared to several other major diseases in Indonesia, highlighting the need for early detection and preventive measures, particularly for the younger population.

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