Paulo Pinheiro

New Methodology for Estimating the Burden of Infectious Diseases in Europe

Mirjam Kretzschmar and colleagues describe the BCoDE project, which uses a pathogen-based incidence approach to better estimate the infectious disease burden in Europe.

The disease burden of hepatitis B, influenza, measles and salmonellosis in Germany: first results of the Burden of Communicable Diseases in Europe Study†

Setting priorities in the field of infectious diseases requires evidence-based and robust baseline estimates of disease burden. Therefore, the European Centre for Disease Prevention and Control initiated the Burden of Communicable Diseases in Europe (BCoDE) project. The project uses an incidence- and pathogen-based approach to measure the impact of both acute illness and sequelae of infectious diseases expressed in disability-adjusted life years (DALYs). This study presents first estimates of disease burden for four pathogens in Germany. The number of reported incident cases adjusted for underestimation served as model input. For the study period 2005-2007, the average disease burden was estimated at 33 116 DALYs/year for influenza virus, 19 115 DALYs/year for Salmonella spp., 8708 DALYs/year for hepatitis B virus and 740 DALYs/year for measles virus. This methodology highlights the importance of sequelae, particularly for hepatitis B and salmonellosis, because if omitted, the burden would have been underestimated by 98% and 56%, respectively.

The burden of chronic mercury intoxication in artisanal small-scale gold mining in Zimbabwe: data availability and preliminary estimates

BackgroundArtisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe.MethodsCases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms.ResultsMiners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe’s total population in 2004.ConclusionsThis analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO’s GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.

The Global Burden of Infectious Diseases

Over the last century, infectious diseases have lost a lot of their threat to individuals’ health as well as to the health of populations living in industrialized countries. The continuous reduction and effective control of both mortality and morbidity from infectious diseases marks an impressive story of success in the history of public health in the developed world and has been linked to a wide range of improvements that occurred alongside the socioeconomic modernization of these societies. Although many factors (e.g., improved sanitation, development of antibiotics and vaccines, improved living conditions and food quality/availability, and improved health care and surveillance systems) that contributed significantly to the success have been identified, there are, however, still uncertainties about the underlying mechanisms and interactions that led to the decline of infectious disease mortality

Calculation of health expectancies with administrative data for North Rhine-Westphalia, a Federal State of Germany, 1999-2005.

ObjectivesThe main objectives of this study were to prove the feasibility of health expectancy analyses with regional administrative health statistics and to explore the utility of the calculated health expectancies in describing the health state of the population living in North Rhine-Westphalia, a Federal State of Germany.Materials and methodsAdministrative population and mortality data as well as health data on disability and long-term care provided by public services were used to calculate: a) the life expectancy and b) the health expectancies Severe-Disability-Free Life Expectancy (SDFLE) and Long-Term-Care-Free Life Expectancy (LTCFLE) from 1999 to 2005. Calculations were done using the Sullivan method.ResultsSDFLE at birth was 69.9 years (males 66.2 and females 73.2 years) in 1999 and it increased to 71.7 years (males 68.6 and females 74.7 years) in 2005. The proportion of the SDFLE on the total life expectancy at birth was 89.8% (males 88.6 and females 90.8%) in 1999 and 90.7% (males 89.8 and females 91.4%) in 2005.LTCFLE at birth was 75.3 years (males 73.1 and females 77.5 years) in 1999 and it increased to 76.6 years (males 74.7 and females 78.6 years) in 2005. The proportion of the LTCFLE on the total life expectancy at birth was 96.8% (males 97.8 and females 96.1%) in 1999 and 96.8% (males 97.8 and females 96.2%) in 2005.Discussion and conclusionBoth health expectancies indicate an improvement in the quantity as well as in the quality of healthy life for the population living in North Rhine Westphalia and therefore suggest a compression of morbidity from 1999 to 2005. The findings however have several limitations in their sensitivity, since we applied dichotomous valuations to the health states. In addition, the results are restricted to comparisons over time because the morbidity concepts do not allow for comparisons with populations other than the German one. Refined calculations with other summary measures of population health and with health data on other morbidity concepts are therefore reasonable.

Measuring the burden of disease due to premature mortality using Standard Expected Years of Life Lost (SEYLL) in North Rhine-Westphalia, a Federal State of Germany, in 2005

Aims and subjectsBurden of disease (BoD) estimates are increasingly used in public health for assessing population health. Disability Adjusted Life Years (DALYs)—a summary measure frequently used in BoD studies—sum up the impact on health due to premature death and non-fatal health outcomes and allow for comprehensive and comparable assessments. To provide first estimates on the burden of disease in North Rhine-Westphalia (NRW), we calculated the burden due to premature death using Standard Expected Years of Life Lost (SEYLL), which is one of the two components of DALYs.Materials and methodsMethods provided by the World Health Organisation (WHO) and developed for the Global BoD (GBoD) study were used to estimate SEYLL in NRW in 2005. We used administrative death and cause of death statistics provided by local authorities.ResultsIn 2005, the total burden of disease due to premature death was 1,774,926 SEYLLs. According to the GBoD disease categories, non-communicable (group II) diseases accounted for 89.1% of the burden. Communicable, maternal, perinatal and nutritional (group I) conditions contributed to 5.6% and injuries (group III conditions) to 5.3% of the total burden. The three leading single causes of the burden of disease due to premature death were ischaemic heart diseases, lung cancers and cerebrovascular diseases, together accounting for 558,785 SEYLLs (32%).ConclusionFirst estimates of the burden of disease were feasible for NRW by use of WHO tools and administrative data. The findings of our study are consistent with WHO GBoD estimates and studies performed for other high-income countries. Our SEYLL results usefully complement the available health statistics highlighting diseases and injuries leading to death at an early age of life. However, our estimates are restricted to the impact of premature death and do not provide information on non-fatal health outcomes. Thus, future work should target estimates of the Years of Life Lost due to Disability (YLD) to provide a comprehensive assessment of the burden of disease in NRW.

The Burden of Disease Approach for Measuring Population Health

Quantitative assessments of the health status of a population are undisputedly an important source of information to support decision-making and priority-setting processes in the field of Public Health. A common practice to (a) indicate the average level and the distribution of health in a population and (b) identify the impact of diseases on population health has been the use of findings on the epidemiology of diseases and injuries, their causes and risk factors. One major part of such efforts has targeted the determination of mortality patterns based on death and causes of death statistics. In addition, findings on mortality and its derivative life expectancy have widely been used as surrogates to inform about the overall health status as well as to identify the most important health problems in a population.

„Health Literacy“ im Kindes- und Jugendalter

ZusammenfassungHintergrundStudien belegen die gesundheitliche Relevanz von „Health Literacy“ (HL), etwa für die Inanspruchnahme von präventiven und kurativen Angeboten. Der Kindheits- und Jugendphase kommt hierbei für die gesundheitliche Entwicklung sowie für die Nachhaltigkeit von Angeboten der Prävention und Gesundheitsförderung eine zentrale Bedeutung zu. Die Befundlage zeigt jedoch, dass Kinder und Jugendlichen bislang nicht ausreichend adressiert sind.FragestellungIm Mittelpunkt steht die Entwicklung eines theoretischen Rahmens für die Förderung von HL im Kindes- und Jugendalter. Des Weiteren geht es um die Entwicklung, Erprobung und Evaluation von Maßnahmen zur Förderung von HL sowie von Prävention und Gesundheitsförderung am Beispiel von Mental HL und eHL. Es sind insgesamt 9 theoretisch und anwendungsorientiert ausgelegte Projekte geplant.Methode und MaterialDer Verbund wird Methoden zur Erfassung von HL bei Kindern und Jugendlichen entwickeln, testen und validieren. Hierbei werden sowohl quantitative als auch qualitative Methoden und Materialien zur Anwendung kommen.ErgebnisseDas Verbundvorhaben wird dazu beitragen, die Rahmenbedingungen für die bedarfsspezifische Gestaltung von Interventionen im Bereich Primärprävention und Gesundheitsförderung für Kinder und Jugendliche konzeptionell und methodisch weiter zu entwickeln.SchlussfolgerungDer HLCA-Verbund wird durch die theoretisch fundierte Konzeptualisierung des HL-Konzepts für die Zielgruppe „Kinder und Jugendliche“ die Entwicklung, Erprobung und den Praxistransfer von bedarfsspezifischen Maßnahmen der Gesundheitsförderung und Primärprävention fördern. Der vorliegende Artikel beschreibt kursorisch das Forschungsprogramm, die Verbundstruktur und die beteiligten Forschungseinrichtungen.AbstractBackgroundScientific research consistently confirms the relevance of health literacy (HL), e.g., utilization of preventive and curative services. Screening of the scientific literature, however, reveals that children and adolescents have poorly been included in HL research in the past. This is in contrast with the importance given to the phase of childhood and adolescence for the individual’s future health development and for sustainable health promotion and primary prevention.ObjectivesThe HLCA Consortium aims at contributing to the comprehensive understanding of HL in children and adolescents by developing, adjusting, implementing, and evaluating theoretical, conceptual, and methodological HL approaches. A total of nine projects focusing on basic research and applied research (mental HL, eHL) will offer a solid base to substantially contribute to the understanding of the topic.Materials and methodsA multidisciplinary approach has been adopted by the HLCA Consortium in order to develop, test, and validate methods of measurement and evaluation of HL in children and adolescents. Both quantitative and qualitative methods and materials will be utilized.ResultsThe HLCA Consortium will contribute to further develop the conceptional and methodological framework of HL in order to make the design of needs-based interventions for primary prevention and health promotion for children and adolescents possible.ConclusionsThe HLCA Consortium aims at contributing to a comprehensive understanding of HL in children and adolescents. This paper gives an overview of the HLCA Consortium, its research projects, and the participating research institutions.

[Health literacy in childhood and adolescence: An overview and current state of research].

ZusammenfassungHintergrundHealth Literacy ist ein multidisziplinäres Konzept, das in Europa zunehmend an Bedeutung gewinnt in den Bereichen Krankheitsversorgung, Gesundheitsförderung und Prävention sowie in der Gesundheitspolitik. Theoretische Konzept- und Methodenentwicklungen, evidenzbasierte Forschung und Policy-Dokumente adressieren vornehmlich Erwachsene, Kinder und Jugendliche sind eine bisher ebenso marginalisierte Zielgruppe von Wissenschaft und Politik wie das Bildungs- und Erziehungssystem.ZielZiel des vorliegenden Beitrages ist es, neben dem Blick auf den aktuellen Forschungsstand, einige der Desiderate der Diskussion über Health Literacy im Kindes- und Jugendalter zu beschreiben.Material und MethodenDie Ergebnisse wurden auf Grundlage einer Literaturrecherche erstellt.ErgebnisseDas Fehlen konzeptioneller Zugänge hinsichtlich alters- und entwicklungsstufenangepasster Modelle und von Prävalenzdaten erschwert den theoretischen und methodischen Zugang zum Thema „Health Literacy im Kindes- und Jugendalter“. Hier herrscht dringender Forschungsbedarf. Zudem könnte schulische Gesundheitsförderung eine effektive Plattform sein, um Health Literacy bereits ab den frühen Lebensphasen zu fördern.DiskussionNeben der Anschlussfähigkeit der benachbarten Literacy-Perspektive, der Nähe zu anderen Konzepten der Gesundheitsförderung und der Bedeutung des schulischen Settings gehören in grundlagen- und anwendungsorientierter Hinsicht die Analyse und Erforschung der Determinanten von Health Literacy, von Health Literacy als Determinante von Gesundheit sowie die systematisch implementierte Umsetzung von Health-Literacy-Programmen zu den Bereichen, in denen Forschungsbedarf besteht.AbstractBackgroundHealth literacy is multidisciplinary and brings together many concepts, and is of increasing importance for disease protection, health promotion, and prevention, and for health policy within Europe. Although its importance is increasingly recognised, adults are mostly the target audience, whereas children and adolescents, in addition to education and schools, have so far been neglected.ObjectivesThe aim is to give an overview of the state of the art in childhood and adolescence health literacy research, and to identify any existing gaps.MaterialsA literature review has been performed to identify the relevant research data.ResultsLimitations in developmental and age-adjusted conceptual frameworks and a lack of prevalence data, however, significantly impede our understanding of the meaning of health literacy in children and adolescents. School health promotion programmes could serve as a platform for effective health literacy education, beginning in early childhood.ConclusionsIn addition to compatibility with a broader literacy perspective, the proximity to several theories of health promotion and defined concepts, and the importance of school health promotion and education, it is vital to focus research on current gaps in the understanding of health literacy determinants, health literacy as a determinant of health, and in terms of the design and systematic implementation of intervention programmes.BACKGROUND Health literacy is multidisciplinary and brings together many concepts, and is of increasing importance for disease protection, health promotion, and prevention, and for health policy within Europe. Although its importance is increasingly recognised, adults are mostly the target audience, whereas children and adolescents, in addition to education and schools, have so far been neglected. OBJECTIVES The aim is to give an overview of the state of the art in childhood and adolescence health literacy research, and to identify any existing gaps. MATERIALS A literature review has been performed to identify the relevant research data. RESULTS Limitations in developmental and age-adjusted conceptual frameworks and a lack of prevalence data, however, significantly impede our understanding of the meaning of health literacy in children and adolescents. School health promotion programmes could serve as a platform for effective health literacy education, beginning in early childhood. CONCLUSIONS In addition to compatibility with a broader literacy perspective, the proximity to several theories of health promotion and defined concepts, and the importance of school health promotion and education, it is vital to focus research on current gaps in the understanding of health literacy determinants, health literacy as a determinant of health, and in terms of the design and systematic implementation of intervention programmes.

Health Literacy bei Kindern und Jugendlichen

ZusammenfassungHintergrundHealth Literacy ist ein multidisziplinäres Konzept, das in Europa zunehmend an Bedeutung gewinnt in den Bereichen Krankheitsversorgung, Gesundheitsförderung und Prävention sowie in der Gesundheitspolitik. Theoretische Konzept- und Methodenentwicklungen, evidenzbasierte Forschung und Policy-Dokumente adressieren vornehmlich Erwachsene, Kinder und Jugendliche sind eine bisher ebenso marginalisierte Zielgruppe von Wissenschaft und Politik wie das Bildungs- und Erziehungssystem.ZielZiel des vorliegenden Beitrages ist es, neben dem Blick auf den aktuellen Forschungsstand, einige der Desiderate der Diskussion über Health Literacy im Kindes- und Jugendalter zu beschreiben.Material und MethodenDie Ergebnisse wurden auf Grundlage einer Literaturrecherche erstellt.ErgebnisseDas Fehlen konzeptioneller Zugänge hinsichtlich alters- und entwicklungsstufenangepasster Modelle und von Prävalenzdaten erschwert den theoretischen und methodischen Zugang zum Thema „Health Literacy im Kindes- und Jugendalter“. Hier herrscht dringender Forschungsbedarf. Zudem könnte schulische Gesundheitsförderung eine effektive Plattform sein, um Health Literacy bereits ab den frühen Lebensphasen zu fördern.DiskussionNeben der Anschlussfähigkeit der benachbarten Literacy-Perspektive, der Nähe zu anderen Konzepten der Gesundheitsförderung und der Bedeutung des schulischen Settings gehören in grundlagen- und anwendungsorientierter Hinsicht die Analyse und Erforschung der Determinanten von Health Literacy, von Health Literacy als Determinante von Gesundheit sowie die systematisch implementierte Umsetzung von Health-Literacy-Programmen zu den Bereichen, in denen Forschungsbedarf besteht.AbstractBackgroundHealth literacy is multidisciplinary and brings together many concepts, and is of increasing importance for disease protection, health promotion, and prevention, and for health policy within Europe. Although its importance is increasingly recognised, adults are mostly the target audience, whereas children and adolescents, in addition to education and schools, have so far been neglected.ObjectivesThe aim is to give an overview of the state of the art in childhood and adolescence health literacy research, and to identify any existing gaps.MaterialsA literature review has been performed to identify the relevant research data.ResultsLimitations in developmental and age-adjusted conceptual frameworks and a lack of prevalence data, however, significantly impede our understanding of the meaning of health literacy in children and adolescents. School health promotion programmes could serve as a platform for effective health literacy education, beginning in early childhood.ConclusionsIn addition to compatibility with a broader literacy perspective, the proximity to several theories of health promotion and defined concepts, and the importance of school health promotion and education, it is vital to focus research on current gaps in the understanding of health literacy determinants, health literacy as a determinant of health, and in terms of the design and systematic implementation of intervention programmes.BACKGROUND Health literacy is multidisciplinary and brings together many concepts, and is of increasing importance for disease protection, health promotion, and prevention, and for health policy within Europe. Although its importance is increasingly recognised, adults are mostly the target audience, whereas children and adolescents, in addition to education and schools, have so far been neglected. OBJECTIVES The aim is to give an overview of the state of the art in childhood and adolescence health literacy research, and to identify any existing gaps. MATERIALS A literature review has been performed to identify the relevant research data. RESULTS Limitations in developmental and age-adjusted conceptual frameworks and a lack of prevalence data, however, significantly impede our understanding of the meaning of health literacy in children and adolescents. School health promotion programmes could serve as a platform for effective health literacy education, beginning in early childhood. CONCLUSIONS In addition to compatibility with a broader literacy perspective, the proximity to several theories of health promotion and defined concepts, and the importance of school health promotion and education, it is vital to focus research on current gaps in the understanding of health literacy determinants, health literacy as a determinant of health, and in terms of the design and systematic implementation of intervention programmes.