Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden

Nephroprotective effects of Zingiber zerumbet Smith ethyl acetate extract against paracetamol-induced nephrotoxicity and oxidative stress in rats

Paracetamol (PCM) overdose can cause nephrotoxicity with oxidative stress as one of the possible mechanisms mediating the event. In this study, the effects of ethyl acetate extract of Zingiber zerumbet rhizome [200 mg per kg of body weight (mg/kg) and 400 mg/kg] on PCM-induced nephrotoxicity were examined. Rats were divided into five groups containing 10 rats each. The control group received distilled water while other groups were treated with extract alone (400 mg/kg), PCM alone (750 mg/kg), 750 mg/kg PCM+200 mg/kg extract (PCM+ 200-extract), and 750 mg/kg PCM+400 mg/kg extract (PCM+400-extract), respectively, for seven consecutive days. The Z. zerumbet extract was given intraperitoneally concurrent with oral administration of PCM. Treatment with Z. zerumbet extract at doses of 200 and 400 mg/kg prevented the PCM-induced nephrotoxicity and oxidative impairments of the kidney, as evidenced by a significantly reduced (P<0.05) level of plasma creatinine, plasma and renal malondialdehyde (MDA), plasma protein carbonyl, and renal advanced oxidation protein product (AOPP). Furthermore, both doses were also able to induce a significant increment (P<0.05) of plasma and renal levels of glutathione (GSH) and plasma superoxide dismutase (SOD) activity. The nephroprotective effects of Z. zerumbet extract were confirmed by a reduced intensity of renal cellular damage, as evidenced by histological findings. Moreover, Z. zerumbet extract administered at 400 mg/kg was found to show greater protective effects than that at 200 mg/kg. In conclusion, ethyl acetate extract of Z. zerumbet rhizome has a protective role against PCM-induced nephrotoxicity and the process is probably mediated through its antioxidant properties

Unidade de contexto e observação social sistemática em saúde: conceitos e métodos Context unit and systematic social observation: a review of concepts and methods

Assumimos que "onde você mora é importante para sua saúde, para além de quem você é". Entendemos que o impacto do local de moradia ou unidade de contexto (UC) na saúde das populações se deve à heterogeneidade dos atributos do entorno físico e social da UC, para além das características individuais ou agregadas daqueles ali aninhados. Estes atributos, embora dependentes dos indivíduos, são tipicamente externos a eles e potencialmente modificáveis. As UC são compreendidas como unidades ecológicas inseridas em conjuntos sucessivamente mais amplos e interdependentes. Quando relevante para a hipótese do estudo, unidades geográficas administrativas podem ser utilizadas como aproximações da UC. Outra alternativa é a que utiliza a percepção de seus moradores, a "vizinhança percebida". O ressurgimento do interesse com relação à determinação dos efeitos da UC sobre a saúde correlaciona com novas tendências na área da saúde coletiva: incorporação de novos níveis hierárquicos de exposição, as iniqüidades e seus determinantes, a urbanização e seus efeitos e a avaliação de intervenções multi-setoriais. Nosso objetivo central é rever opções para a escolha da UC a ser investigada além de estratégias para a aferição de seus atributos físicos e sociais, utilizando a observação social sistemática (OSS). A combinação de dados originárias de dados administrativos, da vizinhança percebida, dos inquéritos populacionais e da OSS ainda necessita de maiores elaborações conceitual, metodológica e analítica. Entretanto, a compreensão da distribuição dos atributos físicos e sociais da UC permite compor níveis hierárquicos de complexidade relevantes para o entendimento da ocorrência dos eventos relacionados à saúde nas populações.<br>We understand that "where one lives makes a difference to health in addition to who you are", and that the effects of the place of residence or context unit (CU) on public health are due to the heterogeneity of the physical and social environment characteristics, in addition to the individual and aggregate attributes of the population nested in the CU. Those attributes, although intrinsically dependent on the individuals, are typically external to them and susceptible to intervention. Also, the UC's are understood as ecological units nested within successively larger communities. Depending on the study hypothesis, census-defined areas may be used as proxy for the CU. Alternatively, the CU may be defined by the individual's perception of his/her neighborhood. The renewed interest on the health effects of the CU are associated with new trends in public health, namely: new hierarchical levels of exposure beyond individual level characteristics, inequalities and social determinants of health, urbanization and the need to evaluate interventions not traditionally associated to public health. Our objective was, first, to review options while choosing the relevant CU and second, to review strategies to determine and quantify the characteristics of the CU using social systematic observation (SSO). The combination of census-defined data, information on the neighborhood defined by the local population, surveys and SSO still needs conceptual, methodological and analytical development. However, the distribution of the physical and social attributes of the CU will permit to incorporate other hierarchical level of complexity to better understand the incidence and prevalence of health related events in populations