Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Patients after colostomy： relationship between quality of life and acceptance of disability and social support

Background The aim of this research was to explore quality of life （QOL） and acceptance of disability and social support of colostomy patients as well as the relationship between these factors. Methods A descriptive, correlational study was conducted using four scales： the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire （EORTC QLQ-C30） and European Organization for Research and Treatment of Cancer Colorectal Cancer-Specific Quality of Life Questionnaire （EORTC QLQ-CR38） scales, the Acceptance of Disability Scale （ADS）, and the Social Relational Quality Scale （SRQS）. A convenience sample of 111 colostomy patients from four hospitals in Guangzhou who underwent colostomy operation at least one month prior to the study and who visited the stoma clinic or association from August 2011 to February 2012 was evaluated for inclusion in the study. All statistical analyses were performed using SPSS 17.0 software （SPSS Inc., Chicago, IL, USA）.

Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

Objective To define TB control priorities using cost-effectiveness and burden of disease.Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in1994.Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.Results DOTS reduced 89.19% of YLL,78.90% of YLD,and 99.98% of infectivity BOD.One DALY could be saved with 45.70% Yuan by DOTS with 3% discount.Sensitivity analysis showed that discount had effect on CER.Weight of age was insensitive to CER.The higher the DOTS coured rate,the more the cost-effectiveness.Conclusions DOTS is a good cost-effectiveness TB control strategy.Cost-effectiveness and burden of disease can be used to define TB control priorities.

THE LIFE OF THE DISABLED IN TANGSHAN

TANGSHAN, in northeastern Hebei Province, is noted for its coal, steel, iron,porcelain and the great earthquake that astonished the world. When the earthquake occurred in 1976, 240,000 people died and 160,000 people were injured. By now, the

I KNOW I CAN The Special Olympics in Shanghai next year can help more people with intellectual disabilities learn to cope with the challenges of life

Preparations for the Beijing Olympic Games are changing gears, moving from the planning to the operational stage

Burden of onchocerciasis-associated epilepsy:first estimates and research priorities

Background:Since the 1990s,evidence has accumulated of an increased prevalence of epilepsy in onchocerciasisendemic areas in Africa as compared to onchocerciasis-free areas.Although the causal relationship between onchocerciasis and epilepsy has yet to be proven,there is likely an association.Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy(OAE),provide them,detail how such estimates should be refined,and discuss the socioeconomic impact of OAE,including a cost-estimate for anti-epileptic drugs.Main body:Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis-endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services.Epilepsy not only massively impacts the health of those affected,but it also carries a high socioeconomic burden for the households and communities involved.We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases.We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability(YLD)and estimate the cost of treatment.We estimate that in 2015 roughly 117000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control(APOC)mandate where OAE has ever been reported or suspected,and another 264000 persons in onchocerciasis-endemic areas where OAE has never been investigated before.The total number of YLDs due to OAE was 39300 and 88700 in these areas respectively,based on a weighted mean disability weight of 0.336.The burden of OAE is approximately 13%of the total YLDs attributable to onchocerciasis and 10%of total YLDs attributable to epilepsy.We estimated that by 2015 the total costs of treatment with antiepileptic drug for OAE cases would have been a minimum of 12.4 million US$.Conclusions:These estimates suggest a considerable health,social and economic burden of OAE in Africa.The treatment and care for people with epilepsy,especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources.

Distribution of and associated factors for dengue burden in the state of Odisha,India during 2010-2016

This study is aimed to estimate the epidemiological burden of dengue in Odisha,India using the disability adjusted life year(DALY)methods and to explore the associated factors in the year 2010-2016.During the period of 2010-2016,27772 cases(68.4%male)were reported in the state.Mean age(years)of male and female was 31.63 and 33.82,respectively.Mean district wise disability adjusted life years(DALY)per 100000 people was higher in the year 2016(0.45)and mean DALY lost per person was highest in the year 2015(34.90 years).Adjusted regression model indicates,every unit increase in humidity and population density increases DALY by 1.05 and 1.02 units respectively.Whereas,unit change in sex ratio(females per 1000 males)and forest coverage increases the DALY by 0.98 units.Our results indicate geographical variation of DALY in Odisha,which is associated with population density,humidity and forest cover.Discrepancies identified between standard incidence and DALY maps suggests,latter can be used to present disease burden more effectively.More prevalence among young males suggests the need of strengthening the targeted prevention and control measures.