Il Global Burden of Disease è lo studio epidemiologico osservazionale più completo a livello mondiale fino ad oggi. Descrive la mortalità e la morbilità da malattie maggiori, lesioni e fattori di rischio per la salute a livello globale, nazionale e regionale. Esaminando le tendenze dal 1990 ad oggi e facendo confronti tra le popolazioni, è possibile capire le sfide inerenti la salute che vengono affrontate in tutto il mondo nel 21° secolo. The Lancet ha dedicato una serie di articoli al GBD 2016. Dati e commenti possono essere consultati anche nel sito Institute for Health Metrics and Evaluation (IHME)
The Lancet, Vol. 390, No. 10100
Published: September 16, 2017
GBD 2016. Five papers from the Global Burden of Disease (GBD) 2016 Study group provide worldwide data trends, including mortality and risk factors and injuries.
GBD 2016 SDG Collaborators, and others
Open Access
GBD 2016 Mortality Collaborators
Open Access
GBD 2016 Causes of Death Collaborators
Open Access
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators
Open Access
GBD 2016 DALYs and HALE Collaborators
Open Access
GBD 2016 Risk Factors Collaborators
Open Access
| Viewpoint.Christopher J L Murray, Alan D Lopez. Measuring global health: motivation and evolution of the Global Burden of Disease Study | |
| Editorial. Life, death, and disability in 2016 |
New global study finds countries saving more lives, despite a ‘triad of troubles’ in obesity, violence, and mental illness.
Annual Global Burden of Disease study – world’s largest scientific collaboration on population health -- reveals new trends in illnesses, deaths, and risk factors leading to poor health.
Countries have saved more lives over the past decade, especially among children under age 5, but persistent health problems, such as obesity, conflict, and mental illness, comprise a “triad of troubles,” and prevent people from living long, healthy lives, according to a new scientific study.
“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “But, we’re been much less motivated to address issues leading to illnesses. A ‘triad of troubles’ – obesity, conflict, and mental illness, including substance use disorders – poses a stubborn and persistent barrier to active and vigorous lifestyles.”
The annual Global Burden of Disease study (GBD) found that since 2006, substantial progress has been made in driving down death rates from some of the world’s most pernicious diseases and conditions. Among the leading drivers of the overall disease burden, lower respiratory infections, diarrhea, neonatal preterm birth, HIV/AIDS, and malaria, all declined by 30% or more in just one decade.
Moreover, in 2016, for the first time in modern history, fewer than 5 million children under age 5 died in one year, as compared to 1990 when 11 million died.
Researchers attribute this global health landmark to improvements in increased educational levels of mothers, rising per capita incomes, declining levels of fertility, increased vaccination programs, mass distribution of insecticide-treated bed nets, improved water and sanitation, and a wide array of other health programs funded by development funding for health.
The GBD study was published today in the international medical journal, The Lancet, marking the 20th anniversary edition of the study, which first appeared in the peer-review journal in 1997.
In addition, visualizations have been created from which to compare and contrast data among nations and by health conditions.
Despite progress on reducing deaths, this "triad of troubles" – obesity, conflict, and mental illness, including substance use disorders – is preventing further progress.
One of the most alarming risks in the GBD is excess body weight. The rate of illness related to people being too heavy is rising quickly, and the disease burden can be found in all sociodemographic levels. High body mass index (BMI) is the fourth largest contributor to the loss of healthy life, after high blood pressure, smoking, and high blood sugar.
Deaths over the past decade due to conflict and terrorism more than doubled. Recent conflicts, such as those in Syria, Yemen, South Sudan, and Libya, are major public health threats, both in regard to casualties and because they lead to long-term physical and mental consequences.
Mental illness and substance use disorders continued to contribute substantially to the loss of healthy life in 2016, affecting all countries regardless of their socioeconomic status. Treatment rates for mental and substance use disorders remain low. Even in high-income countries where treatment coverage has increased, the prevalence of the most common disorders has not changed.
The GBD is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 2,500 collaborators from more than 130 countries and territories. IHME coordinates the study. This year, several billion data points are included.
The papers provide in-depth analyses of life expectancy and mortality, causes of death, overall disease burden, years lived with disability, and risk factors that lead to health loss. One paper examines progress toward achieving the health-related Sustainable Development Goals (SDGs). It was published online earlier this week to coincide with the release of a report by the Bill & Melinda Gates Foundation. That report, Goalkeepers: The Stories Behind the Data, is the Foundation’s first annual progress report on the SDGs and was produced in partnership with IHME.
This year’s GBD improves upon the previous annual study through new data sources, improvements in methodology, and a measure for tracking completeness of vital registration information.
The study’s other findings include:
In addition, the top conditions in 2016 that made people sick, but were not necessarily fatal were: low back pain, migraine headaches, hearing loss, iron-deficiency anemia, and major depressive disorders.
“Unless and until the world addresses behavioral risks effectively, advances in life expectancy and well-being will continue to be compromised,” Dr. Murray said. “Anyone associated with the delivery of health care – clinicians, administrators, policymakers and others – would be well-served by examining the GBD findings.”
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
Background
The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia.
Methods
We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality.
Findings
Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69–0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality.
Interpretation
Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day).
Miller V, Mente A, Dehghan M, et al; Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017 Aug 28. pii: S0140-6736(17)32253-5. doi: 10.1016/S0140-6736(17)32253-5. [Epub ahead of print] PubMed PMID: 28864331.
Infectious Diseases, Third Edition
Cohen, Jonathan; Opal, Steven M; Powderly, William G
2010
La terza edizione di questo volume fornisce linee guida complete sulla diagnosi, il trattamento e la prevenzione di ogni malattia infettiva osservata nella pratica clinica corrente. Più di 300 professionisti di livello mondiale illustrano l'intera gamma di infezioni cliniche, agenti microbici, virus, micobatteri, funghi e parassiti e descrivono tutti i test diagnostici contemporanei, le terapie antimicrobiche e le misure di profilassi.
Infectious Diseases, Third Edition
Cohen, Jonathan; Opal, Steven M; Powderly, William G
2010
La terza edizione di questo volume fornisce linee guida complete sulla diagnosi, il trattamento e la prevenzione di ogni malattia infettiva osservata nella pratica clinica corrente. Più di 300 professionisti di livello mondiale illustrano l'intera gamma di infezioni cliniche, agenti microbici, virus, micobatteri, funghi e parassiti e descrivono tutti i test diagnostici contemporanei, le terapie antimicrobiche e le misure di profilassi.
La malaria purtroppo, nonostante l'impegno dell'Organizzazione mondiale della sanità, continua a colpire. E lo fa proprio in Italia, a Trento, dove è deceduta una bambina di 4 anni. Secondo dati epidemiologici recenti, relativi al 2010-2015, i casi di malaria notificati sono 3.633, di cui 89% con diagnosi confermata. La quasi totalità di casi sono d’importazione, i casi autoctoni riportati sono stati soltanto sette. Tra i cittadini italiani si è riscontrato il 20% dei casi. Continuano anche gli sforzi per raggiungere un vaccino efficace.
World Health Organization. Ghana, Kenya and Malawi to take part in WHO malaria vaccine programme
24 April 2017
The WHO Regional Office for Africa (WHO/AFRO) announced today the names of the three countries participating in the WHO-led pilot programme for the RTS,S/AS01 malaria vaccine. The vaccine was developed to protect young children from infection by Plasmodium falciparum, the most deadly malaria parasite globally.
Steady progress toward a malaria vaccine.
Lyke KE. Curr Opin Infect Dis. 2017 Oct;30(5):463-470. doi: 10.1097/QCO.0000000000000393. PMID:28731898
PURPOSE OF REVIEW. Great progress has been made in reducing malaria morbidity and mortality, yet the parasite continues to cause a startling 200 million infections and 500 000 deaths annually. Malaria vaccine development is pushing new boundaries by steady advancement toward a licensed product.
RECENT FINDINGS. Despite 50 years of research, the complexity of Plasmoidum falciparum confounds all attempts to eradicate the organism. This very complexity has pushed the boundaries of vaccine development to new heights, yet it remains to be seen if an affordable vaccine can provide durable and high-level protection. Novel vaccines such as RTS,S/AS01E are on the edge of licensure, but old techniques have resurged with the ability to deliver vialed, whole organism vaccines. Novel adjuvants, multistage/multiantigen approaches and transmission blocking vaccines all contribute to a multipronged battle plan to conquer malaria.
SUMMARY. Vaccines are the most cost-effective tools to control infectious diseases, yet the complexity of malaria has frustrated all attempts to develop an effective product. This review concentrates on recent advances in malaria vaccine development that lend hope that a vaccine can be produced and malaria eradicated.
Vaccines to Accelerate Malaria Elimination and Eventual Eradication.
Healer J, Cowman AF, Kaslow DC, Birkett AJ.
Cold Spring Harb Perspect Med. 2017 Sep 1;7(9). pii: a025627. doi: 10.1101/cshperspect.a025627. Review. PMID:28490535
Abstract
Remarkable progress has been made in coordinated malaria control efforts with substantial reductions in malaria-associated deaths and morbidity achieved through mass administration of drugs and vector control measures including distribution of long-lasting insecticide-impregnated bednets and indoor residual spraying. However, emerging resistance poses a significant threat to the sustainability of these interventions. In this light, the malaria research community has been charged with the development of a highly efficacious vaccine to complement existing malaria elimination measures. As the past 40 years of investment in this goal attests, this is no small feat. The malaria parasite is a highly complex organism, exquisitely adapted for survival under hostile conditions within human and mosquito hosts. Here we review current vaccine strategies to accelerate elimination and the potential for novel and innovative approaches to vaccine design through a better understanding of the host-parasite interaction.
The GMZ2 malaria vaccine: from concept to efficacy in humans.
Theisen M, Adu B, Mordmüller B, Singh S.
Expert Rev Vaccines. 2017 Sep;16(9):907-917. doi: 10.1080/14760584.2017.1355246. Epub 2017 Jul 21. PMID:28699823
GMZ2 is a recombinant protein consisting of conserved domains of GLURP and MSP3, two asexual blood-stage antigens of Plasmodium falciparum, and is designed with the aim of mimicking naturally acquired anti-malarial immunity. The rationale for combining these two antigens is based on a series of immune epidemiological studies from geographically diverse malaria endemic regions; functional in vitro studies; and pre-clinical studies in rodents and New World monkeys. GMZ2 adjuvanted with alhydrogel® (alum) was well tolerated and immunogenic in three phase 1 studies. The recently concluded phase 2 trial of GMZ2/alum, involving 1849 participants 12 to 60 month of age in four countries in West, Central and Eastern Africa, showed that GMZ2 is well tolerated and has some, albeit modest, efficacy in the target population. Areas covered: PubMed ( www.ncbi.nlm.nih.gov/pubmed ) was searched to review the progress and future prospects for clinical development of GMZ2 sub-unit vaccine. We will focus on discovery, naturally acquired immunity, functional activity of specific antibodies, sequence diversity, production, pre-clinical and clinical studies. Expert commentary: GMZ2 is well tolerated and has some, albeit modest, efficacy in the target population. More immunogenic formulations should be developed.
