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Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada, 2002
Dolly Baliunas, Jayadeep Patra, Jürgen Rehm, Svetlana Popova, Benjamin Taylor
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-247
Abstract: Distribution of exposure was taken from a major national survey of Canada, the Canadian Community Health Survey. For chronic diseases, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific smoking-attributable fractions (SAFs). For fire deaths, SAFs were taken directly from available statistics. Information on morbidity, with cause of illness coded according to the International Classification of Diseases version 10, was obtained from the Canadian Institute for Health Information.For Canada in 2002, 339,179 of all hospital diagnoses were estimated to be attributable to smoking and 2,210,155 acute care hospital days. Ischaemic heart disease was the largest single category in terms of hospital days accounting for 21 percent, followed by lung cancer at 9 percent. Smoking-attributable acute care hospital days cost over $2.5 billion in Canada in 2002.Since the last major project produced estimates of this type, the rate of hospital days per 100,000 population has decreased by 33.8 percent. Several possible factors may have contributed to the decline in the rate of smoking-attributable hospital days: a drop in smoking prevalence, a decline in overall hospital days, and a shift in distribution of disease categories. Smoking remains a significant health, social, and economic burden in Canada.Smoking is responsible for high levels of morbidity and mortality. Smoking causes substantially increased risk of lung cancer, upper aerodigestive cancer, several other cancers, heart disease, stroke, chronic respiratory disease and a range of other medical conditions[1]. In 1996, a major study estimating the economic costs attributable to substance abuse in Canada (1992 data), was published[2]. As part of the analysis, the numbers of hospital separations and days of hospital treatment that could be attributed to smoking tobacco were estimated to be 208,095 and 3,024,265 respectively. This paper updates the estimates for th
Situational Analysis and Expert Evaluation of the 1000 Days: Nutritional and Health Status in 4 Countries in Latin America  [PDF]
Andrea Ramírez, Sofía Velasco, Oscar Bernal, José Fernando Vera-Chamorro, Gabriela Olagnero
Health (Health) , 2016, DOI: 10.4236/health.2016.85047
Abstract: Background: The first 1000 days of life, including pregnancy and the first 2 years of age have been considered essential for an adequate development and growth. Several studies have stated that malnutrition during pregnancy and not having a normal birth weight have negative impact on childhood and adulthood, and contribute to burden of disease. Adequate information on this matter provides the possibility for making recommendations on health and nutrition policies. Objective: The aim is to describe the nutritional status during the first 1000 days in four countries of Latin America: Colombia, Argentina, Chile and Brazil. Methods: The analysis consists of two complementary approaches: 1) An extensive search on published and gray literature and a critical analysis of secondary data bases was conducted in Colombia, Argentina, Chile and Brazil following a standardized methodology in 2013. Maternal and child nutritional status, breast feeding, nutri-tional deficiencies, and dietary habits during the first 1000 days were the variables of interest; 2) Information gaps were identified, interviews to local experts from academia, government and hospitals were conducted to fill each of the countries information gap. Data was organized in an online data base called NutriPl@net. Results: Despite the inherent country differences, the nutritional challenges during the first 1000 days are similar. Obesity prevalence is increasing in pregnant women. Under weight remains a problem in all 4 countries, with the highest prevalence in Argentina. Over weight prevalence is highest in Chile and obesity prevalence in Brazil. Micronutrient deficiencies in pregnant women have been described, especially high for folic acid, iron, zinc, vitamins A, B6, B12, C, E and riboflavin. Moreover, in the region, anemia is the most common micronutrient deficiency during pregnancy. Gestational diabetes, hypertension, obesity and pre-eclampsia are major causes of maternal, perinatal and infant morbidity and mortality. Conclusions: In order to understand regional and country-specific needs, it is fundamental to collect standardized information related to the nutrition status during the first 1000 days. The low prevalence of exclusive breastfeeding and micronutrient deficiencies such as iron, zinc and vitamin A as risk factors for morbidity and mortality in children 0 - 2 years old is common and priority issues in the region. Persistence of anemia despite the use of fortified foods and supplementation remains a problem, and no complete data regarding sugar, sodium and fatty acids consumption and
Breastfeeding and the risk for diarrhea morbidity and mortality  [cached]
Lamberti Laura M,Fischer Walker Christa L,Noiman Adi,Victora Cesar
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-s3-s15
Abstract: Background Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness. Methods We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category. Results We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52) and to any breastfeeding among children aged 6-23 months (RR: 2.18). Conclusions Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.
Postmenopausal breast cancer in Iran; risk factors and their population attributable fractions  [cached]
Ghiasvand Reza,Bahmanyar Shahram,Zendehdel Kazem,Tahmasebi Sedigheh
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-414
Abstract: Background Causes of the rapidly increasing incidence of breast cancer in Middle East and Asian countries are incompletely understood. We evaluated risk factors for postmenopausal breast cancer and estimated their attributable fraction in Iran. Methods We performed a hospital-based case–control study, including 493 women, diagnosed with breast cancer at 50 years or later between 2005–2008, and 493 controls. We used logistic regression models to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI), and population attributable fractions (PAF) for significant risk factors. Results The risk of breast cancer decreased with increasing parity. Compared with nulliparous women, the adjusted OR (95% CI) was 0.53 (0.25-1.15) for parity 1–3, 0.47 (0.29-0.93) for parity 4–6 and 0.23 (0.11-0.50) for parity ≥7. The estimated PAF for parity (<7) was 52%. The positive association between body mass index (BMI) and breast cancer risk was confined to women diagnosed at 58 years or later. Compared with normal weight women (BMI 18.5-24.9), overweight (BMI 25–29.9) and obese (BMI ≥30) women were at increased risk of breast cancer diagnosed at 58 years or later (ORs [95% CI] 1.27 [0.97-2.65] and 2.34 [1.33-4.14], respectively). The estimated PAF for obesity/overweight (BMI >25) was approximately 25%. The family history was significantly associated with increased breast cancer risk, but not increasing height, early age at menarche, late age at first birth or short breastfeeding. Conclusions Decreasing parity and increasing obesity are determinants of increasing breast cancer incidence among Iranian women. These trends predict a continuing upward trend of postmenopausal breast cancer.
Tobacco smoke in Piedmont: attributable morbidity and impact on hospital costs  [cached]
Elisabetta Versino,Maria Michela Gianino,Giovanni Renga
Italian Journal of Public Health , 2006, DOI: 10.2427/5939
Abstract: Background: Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this research is to estimate the smoke attributable morbidity for Piedmont residents in the years 1997-2002 and the related costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods: extraction of hospital admissions for smoking-related diseases; estimate of the proportion of hospital admittances attributable to smoking; estimate of the overall cost and the smoke attributable cost for each year. Results: The attributable proportion in men is clearly higher than in women. In men it decreases from 10.6% in 1997 to 8.2% in 2002, while values among women seem to have reached a plateau. The economic value of the attributable admissions, at current prices, shows a downward trend for men from 1997 to 2001 and an upward one in the year 2002, while for women the trend is fluctuating. Conclusions: This method demonstrates the following original features: we used metanalytic relative risks real prevalence data, considering a fifteen-year latency period between exposure and effect on health.The model that we developed adheres more adherent to the natural history of the disease and to the local health problem, giving us a useful tool for planning purposes.Furthermore, the economic estimate is made for each single DRG instead of applying medium rates for MDC, which happens more frequently at the national level.
Breastfeeding and obesity: a meta-analysis  [PDF]
Jeanne M. Stolzer
Open Journal of Preventive Medicine (OJPM) , 2011, DOI: 10.4236/ojpm.2011.13013
Abstract: Over the last decade, obesity rates have reached epidemic proportions in the United States of America. Comorbidities associated with overweight and obesity include, but are not limited to, hypertension, type 2 diabetes, cardiovascular disease, and elevated cholesterol levels. As a direct result of obesity, data indicates that these diseases are now being detected in an unprecedented number of American children, adolescents, and adults. Although the major cause of the obesity epidemic in America has thus far been attributed to excessive caloric intake and lack of physical activity, this paper will explore the pivotal role that breastfeeding plays in the prevention of overweight and obesity throughout the life course. Epidemiological data demonstrates that breastfeeding significantly reduces the incidence of overweight and obesity and that exclusive and long term breastfeeding has been strongly correlated with a reduction in LDL cholesterol, blood pressure related disorders, type 2 diabetes, and cardiovascular dysfunction. While it is certain that diet and exer cise are integral factors associated with overweight and obesity, the time has come for a collective recognition of the protective effects associated with breastfeeding if we are serious in our endeavor to eradicate the overweight and obesity epidemic in America.
Tobacco attributable morbidity and hospital costs in Piedmont: forecast for the years 2003-2014
Elisabetta Versino,Maria Michela Gianino,Giovanni Renga
Italian Journal of Public Health , 2007, DOI: 10.2427/5892
Abstract: Background: Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this study is to forecast the smoke-related morbidity for the residents in Piedmont for the years 2003-2014 and the relative costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods: The model uses the risk of hospitalisation among non smokers to predict smoke related morbidity for the period 2003-2014 for both smokers and ex-smokers, by using relative risks (RRs) and smoking prevalence. It should be noted that, because of the 15-year latency between smoke exposure and health outcomes, smoking prevalence of the appropriate time period has been applied to the morbidity data of the following 15 years, thus because of the shift of birth cohorts we are able to make forecasts up until the year 2014. Basing on these data it is possible estimate, separately for smokers and ex-smokers, the aetiological fraction (PAR%) used to estimate smoking attributable admissions and smoking attributable costs. The costs attributable to admissions for smoke-related diseases have been estimated using prices set for 2002 as well as prices adjusted for inflation. Results: A total of 145801 hospitalizations are expected among men and 36959 among females for the period 2003-2014. The economic value of the attributable admissions, at prices adjusted for inflation, increases in the period 2003-2014 with a slowdown in 2014. Data show that in 2014, compared to 2003, a smaller amount of resources, in true value, have been allocated to smoking related admissions (- 11.08%). Conclusions. The model used meta-analytic RR real prevalence data, considering a fifteen-year latency period between exposure and its effect on health. Furthermore, an economic estimate is made for each DRG instead of applying medium rates for Major Diagnostic Categories as is frequently seen at a national level.
Alternative Hospital Gift Bags and Breastfeeding Exclusivity  [PDF]
Yeon Bai,Shahla M. Wunderlich,Rickie Kashdan
ISRN Nutrition , 2013, DOI: 10.5402/2013/560810
Abstract: The type of gift bags given to new mothers at the time of discharge from the hospital can influence their confidence in breastfeeding. Most hospitals in the US continue to distribute commercial gift bags containing formula samples despite the reported negative influence of commercial bags on the duration of breastfeeding. This study compared breastfeeding outcomes in women receiving three different kinds of gift bags at discharge. A prospective intervention study was conducted during 2009-2010 in New Jersey. Three breastfeeding cohorts were recruited and assigned to three groups: COMMERCIAL received discharge bags containing formula samples, BF-INFO received breastfeeding information and supplies, and PUMP received breastfeeding information/supplies plus a manual breast pump. Follow-up contacts were at 2, 4, and 12 postpartum weeks to determine breastfeeding outcome. The mean durations of exclusive (EBF) and partial breastfeeding were compared between groups using ANOVA. A total of 386 participants completed the study. The mean EBF duration (weeks) in the PUMP ( , ) and BF-INFO ( , ) were significantly longer ( ) than COMMERCIAL ( , ). The rate of EBF through 12 weeks in PUMP was most consistent. The mean duration of partial breastfeeding showed similar results: significantly longer in PUMP and BF-INFO than COMMERCIAL ( ). 1. Introduction Breast milk provides an abundance of nutrients in bioavailable forms that are crucial for the infant’s normal growth and development [1]. Exclusive breastfeeding provides strong protection against lower respiratory tract infections, gastroenteritis, middle ear infections, and childhood obesity [2–5]. Currently only 14.1% of infants in the US are breastfed exclusively through 6 months, below the target rate of 25.5% in the Healthy People 2020 objectives [6]. Breastfeeding mothers may encounter cultural and commercial barriers that make it difficult for them to sustain exclusive breastfeeding for the recommended duration [7]. Due to escalating acceptance of infant formula use by doctors and hospitals, breastfeeding can become something people feel they can opt in or out of and may lose its place as an essential part of infant development [8, 9]. Following the birth of a baby, information given to the mother can influence her confidence and adaptation to breastfeeding. Hospital practices that avoid formula supplementation and encourage early maternal contact with the newborn (e.g., holding baby skin-to-skin right after birth) and rooming-in support breastfeeding. However, by distributing commercial gift bags containing
The use and limitations of ultrasonography in the diagnosis of liver morbidity attributable to Schistosoma mansoni infection in community-based surveys
Nooman, Z. M.;Hassan, A. H.;Mishrirky, A. M.;Ragheb, M.;Abu-Saif, A. N.;Abaza, S. M.;Serwah, A. A.;Kamal, M.;Fouad, M.;
Memórias do Instituto Oswaldo Cruz , 1995, DOI: 10.1590/S0074-02761995000200004
Abstract: the objective of this population-based study was to estimate the liver morbidity attributable to schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the cairo meeting on ultrasonography, 1991. we examined 2384 individuals representing 20 of the households of the rural population of the ismailia governorate, east of delta, egypt. prevalence of s. mansoni and s. haematobium infections were 40.3 and 1.7 respectively. portal tract thickening (ptt) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1, 1.3 and 0.2 individuals respectively. generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. comparing individuals with and without s. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case. in conclusion: ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. the criteria of diagnosing grade i portal fibrosis need to be revised as well as the staging system proposed by the cairo meeting on ultrasonography in schistosomiasis.
Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada  [PDF]
Svetlana Popova,Jayadeep Patra,Jürgen Rehm
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6082179
Abstract: The impact of four effective population-based interventions, focusing on individual behavioural change and aimed at reducing tobacco-attributable morbidity, was assessed by modeling with respect to effects on reducing prevalence rates of cigarette smoking, population-attributable fractions, reductions of disease-specific morbidity and its cost for Canada. Results revealed that an implementation of a combination of four tobacco policy interventions would result in a savings of 33,307 acute care hospital days, which translates to a cost savings of about $37 million per year in Canada. Assuming 40% coverage rate for all individually based interventions, the two most effective interventions, in terms of avoidable burden due to morbidity, would be nicotine replacement therapy and physicians’ advice, followed by individual behavioural counselling and increasing taxes by 10%. Although a sizable reduction in the number of hospital days and accumulated costs could be achieved, overall these interventions would reduce less than 3% of all tobacco-attributable costs in Canada.
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