Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months—A Case Study under the RiskBenefit4EU Project

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk–benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

Factors of Quality of Life in a Group of Selected European Union and OECD Countries

This work focuses on the evaluation of the factors of quality of life in a sample of 26 countries. Quality of life is a complex, multidimensional concept, which includes various social, cultural, economic, political, demographic and environmental aspects. Regarding this, principal component analysis and regression analysis were chosen as relevant methods to analyse relationships among twenty-five variables related to quality of life, and their rela-tionships with three composite indices reflecting crucial aspects of quality of life, wellbeing and sustainability. These indices, applied as the response variables in the regression analysis, include the inequality-adjusted alter-native of the Human Development Index (IHDI), the Happy Planet Index (HPI), and Healthy Life Years (HLY). The IHDI represents an objective indicator of human development and wellbeing. HLY reflects quality of life in terms of health. The HPI combines the ecological efficiency with which human wellbeing is delivered, while it also includes a subjective measure of wellbeing. Since each of these indices represent different aspects of quality of life to a certain extent, some of the factors (represented by selected indicators) affected them in different ways. After applying a Lasso regression, nine of the 25 indicators – representing crucial factors of quality of life – were identified. Homicide rate (representing the factor of safety) affected all three indices in a negative way, whereas Years in education (representing the factor of education) and Life satisfaction – a subjective indicator of wellbeing representing the dimension of the same name, affected them positively.

Estimating the total morbidity burden of COVID-19

BackgroundCalculations of disease burden of COVID-19 are used to allocate scarce resources and historically have focused on mortality, with little attention to morbidity such as postviral ‘post-COVID,’ similar to chronic fatigue syndrome (CFS), which strikes 4 and 16% of male and female survivors. This paper quantifies post-COVID disability burden and combines it with case fatality to estimate total morbidity per COVID-19 case.MethodsHealthy life years lost per COVID-19 case were computed as the sum of (incidence*disability weight*remaining lifespan) for death and post-COVID (modeled as CFS) by sex and 10-year age category. In addition to death, the main model considered lifelong mild, moderate or severe CFS; Model 2, CFS which resolved in ten years; Model 3, no CFS but 10% risk of death 10 years later.ResultsIn all models, acute mortality was only a small share of total morbidity. For lifelong moderate CFS symptoms, healthy years lost per COVID-19 case ranged from 0.92 (male in his 30s) to 5.71 (girl under 10) and were 3.5 and 3.6 for the oldest females and males. At higher symptom severities, young people and females bore larger shares of total morbidity; if symptoms were persistent or survivors’ later mortality increased, young people of both sexes were at highest risk.ConclusionsCompared to post-COVID, acute mortality contributes only a small share of total COVID-19 morbidity. Total burden falls heavily on the young, who are currently deprioritized for preventive interventions such as vaccines. To fairly allocate scarce resources, decisionmakers should consider all morbidity.

Estimating the risk of aflatoxin-induced liver cancer in Tanzania based on biomarker data

Evidence about the magnitude of the aflatoxin menace can help policy makers appreciate the importance of the problem and strengthen policies to support aflatoxin mitigation measures. In this study, we estimated aflatoxin-induced liver cancer risk in 2016 for Tanzania and used the information to estimate the health burden due to the aflatoxin exposure in the country. The burden of aflatoxin-induced liver cancer was assessed based on available aflatoxin biomarker data from a previous epidemiology study, hepatitis B virus infection prevalence and population size of Tanzania in 2016. The health burden due to aflatoxin-induced liver cancer was estimated using disability adjusted life years (DALYs). The aflatoxin exposures ranged from 15.0–10,926.0 ng/kg bw/day (median, 105.5 ng/kg bw/day). We estimated that in 2016 there were about 1,480 (2.95 per 100,000 persons) new cases of aflatoxin-induced liver cancer in Tanzania and assumed all of them would die within a year. These morbidity and mortality rates led to a total loss of about 56,247.63 DALYs. These results show, quantitatively, the cases of liver cancer and related deaths that could be avoided, and the healthy life years that could be saved, annually, by strengthening measures to control aflatoxin contamination in Tanzania.

Abstract 17: Time-Benefit Association is Magnified in Door-To-Puncture Window: Lose 1 Second, Lose 2.2 Hours of Healthy Life

Background: The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the magnitude of the time-benefit relation because time of onset (last known well ”LKW”) is imprecisely known, and analyses including late-arriving patients have under-representation of “fast-progressors.” Methods: Patient level data were pooled by the HERMES Investigators from all 7 RCTs of stent retriever thrombectomy devices (entirely or predominantly) versus medical therapy. Analysis was confined to early-treated patients (LKW-to-puncture≤4h). Exposures: last known well-to-door (LKWTD) time; door-to-puncture (DTP) time; door-to-reperfusion (DTR) time. Outcomes: stroke-related quality of life at 3m (utility-weighted modified Rankin Scale); years of healthy life lost [disability-adjusted life years (DALYs)]. Results: Among the 781 EVT-treated patients, 406 (52.0%) were treated within 4h of LKW, with LKW-to-Door time median 188 minutes (IQR 151-215) and DTP time 105 minutes (IQR 76-135). Among the 295/372 (79.3%) with substantial reperfusion, DTR time was median 145 minutes (IQR 111-186). Care process delays were more strongly associated with worse clinical outcomes in the DTP and DTR epochs than the LKW-To-Door epoch (Table 1A), e.g., for each 10 minute delay, healthy life-years lost were: DTP 1.8 months vs LKW-to-Door 0.0 months, p < 0.0001. Considering granular time increments, the amount of healthy life-years lost associated with each 1 second of delay was: DTP 2.2 hours, DTR 2.1 hours.(Table 1B) Conclusion: Post-arrival care delays are strongly associated with worse EVT patient outcomes in the early post-arrival time period. With every 1 second of delay in EVT delivery, patients lose 2.2 hours of healthy life-years. Continuous quality improvement to minimize delays in DTP and DTR for endovascular thrombectomy is warranted.

Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study

Background: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs.Methods: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of medicines, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. Results: The health impacts are calculated in terms of healthy life years gained, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in basic scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5,550 US dollars for Iran.Conclusions: Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly.

Mixed evidence for the compression of morbidity hypothesis for smoking elimination—a systematic literature review

Background There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity. Methods Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently. Results The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity). Conclusions Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.