Postbiotics for preventing and treating common infectious diseases in children: A systematic review

Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, −20.31 h, 95% CI −27.06 to −13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat‐inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37–0.71), pharyngitis (RR 0.31, 95% CI 0.12–0.83) and laryngitis (RR 0.44, 95% CI 0.29–0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotic

Una deuda del pasado: efectos de los organoclorados en trabajadores del programa de control de vectores - Colombia

Introducción: En Colombia se supone no se usan organoclorados debido a la ratifcación de la Convención de Estocolmo y el Convenio de Rotterdam, que prohíben el uso de este tipo de sustancias. Objetivo: Evaluar la exposición a plaguicidas organoclorados empleados en salud publica en la población trabajadora del programa de control de vectores en Colombia en 2013. Métodos: Se realizó un estudio descriptivo de corte transversal en el grupo de trabajadores del programa de control de enfermedades transmitidas por vectores. A todos los participantes se aplicó un cuestionario estandarizado para recolectar variables sociodemográfcas, ocupacionales, clínicas y toxicológicas. Se determinaron los niveles de 13 organoclorados en suero mediante cromatografía de gases en el Instituto Nacional de Salud de Colombia. Resultados: El reporte de manipulación de insecticidas organoclorados fue del 39,1%. El 100% de los trabajadores que usaron organoclorados refrieron el uso DDT. El 7,5% refrieron el uso de Aldrin. El 100% de los trabajadores refrió ausencia de elementos de protección individual durante la manipulación de clorados. Los organoclorados con niveles más altos fueron 4,4- DDT y α –HCH. Los síntomas de mayor presentación fueron: cefalea 28,7%, mareo 29,9%, disminución de fuerza en miembros superiores 17,2% y síntomas neuropsiquiátricos 24%. Se encontró una asociación entre la exposición laboral a DDT y síntomas neuropsiquiátricos. Conclusiones: El promedio de DDT en sangre de los trabajadores en Colombia son superiores a los reportados en la literatura. Los hallazgos de síntomas neuropsiquiátricos y la exposición laboral a organoclorados concuerdan con los reportes de la literatura.Palabras Clave: DDT, hidrocarburos clorados, vectores de enfermedades, toxicología, salud laboral, ColombiaA debt from the past: effects of organochlorines in workers of vector control program - Colombia Introduction: It is assumed that in Colombia organochlorides are not used due to the ratifcation of the Stockholm Convention and the Rotterdam Convention, forbidding the use of those substances. Objective: To evaluate exposure to organochloride pesticides used in the working population of the vector control program in Colombia, 2013. Methods: A descriptive cross-sectional study was performed in the group of workers from the vector-borne disease management program. To all participants were applied a standardized questionnaire to collect sociodemographic, occupational, clinical and toxicological variables. Thirteen organochloride levels in serum were measured by gas chromatography at the National Institute of Health of Colombia. Results: The report show using of organochloride insecticides in the 39.1%. One hundred percent of the workers who used organochlorides reported use of DDT. 7,5% reported use of aldrin. One hundred percent or the workers referred the absence of elements of personal protection when implementing chlorinated compounds. Organochlorides with higher levels were 4,4- DDT y α -HCH. The most common symptoms were: headache 28.7%, dizziness 29.9%, decreased strength in upper limbs 17.2% and neuropsychiatric symptoms 24%. An association between occupational exposure to DDT and neuropsychiatric symptoms were found. Conclusions: The average of DDT in blood of workers in Colombia is higher than those reported in the literature. Findings of neuropsychiatric symptoms and occupational exposure to organochloride are consistent with literature reports.Key words: DDT, chlorinated hydrocarbons, disease vectors, toxicology, occupational

Una deuda del pasado: efectos de los organoclorados en trabajadores del programa de control de vectores - Colombia

Introducción: En Colombia se supone no se usan organoclorados debido a la ratifcación de la Convención de Estocolmo y el Convenio de Rotterdam, que prohíben el uso de este tipo de sustancias. Objetivo: Evaluar la exposición a plaguicidas organoclorados empleados en salud publica en la población trabajadora del programa de control de vectores en Colombia en 2013. Métodos: Se realizó un estudio descriptivo de corte transversal en el grupo de trabajadores del programa de control de enfermedades transmitidas por vectores. A todos los participantes se aplicó un cuestionario estandarizado para recolectar variables sociodemográfcas, ocupacionales, clínicas y toxicológicas. Se determinaron los niveles de 13 organoclorados en suero mediante cromatografía de gases en el Instituto Nacional de Salud de Colombia. Resultados: El reporte de manipulación de insecticidas organoclorados fue del 39,1%. El 100% de los trabajadores que usaron organoclorados refrieron el uso DDT. El 7,5% refrieron el uso de Aldrin. El 100% de los trabajadores refrió ausencia de elementos de protección individual durante la manipulación de clorados. Los organoclorados con niveles más altos fueron 4,4- DDT y α –HCH. Los síntomas de mayor presentación fueron: cefalea 28,7%, mareo 29,9%, disminución de fuerza en miembros superiores 17,2% y síntomas neuropsiquiátricos 24%. Se encontró una asociación entre la exposición laboral a DDT y síntomas neuropsiquiátricos. Conclusiones: El promedio de DDT en sangre de los trabajadores en Colombia son superiores a los reportados en la literatura. Los hallazgos de síntomas neuropsiquiátricos y la exposición laboral a organoclorados concuerdan con los reportes de la literatura.Palabras Clave: DDT, hidrocarburos clorados, vectores de enfermedades, toxicología, salud laboral, ColombiaA debt from the past: effects of organochlorines in workers of vector control program - Colombia Introduction: It is assumed that in Colombia organochlorides are not used due to the ratifcation of the Stockholm Convention and the Rotterdam Convention, forbidding the use of those substances. Objective: To evaluate exposure to organochloride pesticides used in the working population of the vector control program in Colombia, 2013. Methods: A descriptive cross-sectional study was performed in the group of workers from the vector-borne disease management program. To all participants were applied a standardized questionnaire to collect sociodemographic, occupational, clinical and toxicological variables. Thirteen organochloride levels in serum were measured by gas chromatography at the National Institute of Health of Colombia. Results: The report show using of organochloride insecticides in the 39.1%. One hundred percent of the workers who used organochlorides reported use of DDT. 7,5% reported use of aldrin. One hundred percent or the workers referred the absence of elements of personal protection when implementing chlorinated compounds. Organochlorides with higher levels were 4,4- DDT y α -HCH. The most common symptoms were: headache 28.7%, dizziness 29.9%, decreased strength in upper limbs 17.2% and neuropsychiatric symptoms 24%. An association between occupational exposure to DDT and neuropsychiatric symptoms were found. Conclusions: The average of DDT in blood of workers in Colombia is higher than those reported in the literature. Findings of neuropsychiatric symptoms and occupational exposure to organochloride are consistent with literature reports.Key words: DDT, chlorinated hydrocarbons, disease vectors, toxicology, occupational

Caracterización de las condiciones de salud respiratoria de los trabajadores expuestos a polvo de carbón en minería subterránea en Boyacá, 2013.

Introducción: la neumoconiosis de los mineros de carbón es una enfermedad pulmonar ocupacional asociada a factores individuales y condiciones laborales específcas. Se manifesta progresiva e irreversiblemente, afectando la salud de los trabajadores y la productividad laboral. Objetivo: caracterizar las condiciones de salud respiratoria e identifcar los factores de riesgo asociados al desarrollo de neumoconiosis en trabajadores que han laborado expuestos a polvo de carbón en minas de socavón en Boyacá, 2013. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en trabajadores de minería de socavón expuestos a polvo de carbón en el departamento de Boyacá. Se llevó a cabo un registro completo de historia clínica ocupacional, examen físico completo, toma de radiografía de tórax, prueba de tuberculina y espirometría. Resultados: participaron 170 trabajadores masculinos. 75% de la población tenía antigüedad en el sector minero mayor a 12,5 años. Roncus, sibilancias y estertores predominaron en trabajadores con más de 20 años de antigüedad. Expectoración y tos se encontraron más frecuentemente en quienes realizaban la extracción mecanizada. El 15,9% de las radiografías de tórax fueron compatibles con neumoconiosis, 17,1% de las pruebas de tuberculina se encontraron positivas. 5,3% de las espirometrías mostraron alteraciones de vía aérea periférica y 2,4% mostraron patrón obstructivo. Discusión y conclusión: Los cambios radiológicos sugestivos de neumoconiosis fueron más frecuentes en trabajadores con antigüedad menor de 20 años. Los hallazgos espirométricos anormales predominaron en el grupo con antigüedad mayor a 20 años. Es necesario revisar protocolos de vigilancia epidemiológica y realizar seguimiento por medicina laboral.Palabra clave: Neumoconiosis, minería del carbón, tuberculosis, condiciones de trabajo, exposiciónocupacional, Colombia.Forma de citar: Garrote Wilches CF, Malagón Rojas JN, Morgan G, Combariza D, Varona, M. Caracterización de las condiciones de salud respiratoria de los trabajadores expuestos a polvo de carbón en minería subterránea en Boyacá, 2013. rev.univ.ind.santander.salud 2014; 46 (3): 237-247Characterization of respiratory health conditions of workers exposed to coal dust in underground mining in Boyacá, 2013. Introduction: coal miners´ pneumoconiosis is an occupational lung disease associated with individual factors and specifc working conditions. It is manifested progressively and irreversibly, affecting the health of workers and labor productivity. Objective: To characterize the respiratory health conditions and identify risk factors associated with the development of pneumoconiosis in workers that have been exposed to coal dust in the underground mines at Boyacá, 2013. Materials and Methods: A descriptive cross-sectional study was conducted among mining workers exposed to coal dust in the department of Boyacá. It was conducted a complete record of occupational medical history, physical exam, taking chest radiography, tuberculin test and spirometry. Results: 170 male workers participated. 75% of the population had worked in the mining sector for more than12.5 years old. Rhonchi, wheezing and rattling predominated in workers over 20 years old. Expectoration and cough were most frequently found in those who made mechanized extraction. 15.9% of chest X rays were compatible with pneumoconiosis, 17.1% of tuberculin tests were found positive. 5.3% of spirometries showed peripheral airway abnormalities and 2.4% showed obstructive pattern. Discussion and conclusion: Radiological changes suggestive of pneumoconiosis were more frequent in workers under 20 years old. Abnormal spirometric fndings predominated in the group with more than 20 years old. It is important to review surveillance protocols and perform monitoring through occupational medicine.Keywords: pneumoconiosis, coal mining, tuberculosis, working conditions, occupational exposure, Colombia

Caracterización de las condiciones de salud respiratoria de los trabajadores expuestos a polvo de carbón en minería subterránea en Boyacá, 2013.

Introducción: la neumoconiosis de los mineros de carbón es una enfermedad pulmonar ocupacional asociada a factores individuales y condiciones laborales específcas. Se manifesta progresiva e irreversiblemente, afectando la salud de los trabajadores y la productividad laboral. Objetivo: caracterizar las condiciones de salud respiratoria e identifcar los factores de riesgo asociados al desarrollo de neumoconiosis en trabajadores que han laborado expuestos a polvo de carbón en minas de socavón en Boyacá, 2013. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en trabajadores de minería de socavón expuestos a polvo de carbón en el departamento de Boyacá. Se llevó a cabo un registro completo de historia clínica ocupacional, examen físico completo, toma de radiografía de tórax, prueba de tuberculina y espirometría. Resultados: participaron 170 trabajadores masculinos. 75% de la población tenía antigüedad en el sector minero mayor a 12,5 años. Roncus, sibilancias y estertores predominaron en trabajadores con más de 20 años de antigüedad. Expectoración y tos se encontraron más frecuentemente en quienes realizaban la extracción mecanizada. El 15,9% de las radiografías de tórax fueron compatibles con neumoconiosis, 17,1% de las pruebas de tuberculina se encontraron positivas. 5,3% de las espirometrías mostraron alteraciones de vía aérea periférica y 2,4% mostraron patrón obstructivo. Discusión y conclusión: Los cambios radiológicos sugestivos de neumoconiosis fueron más frecuentes en trabajadores con antigüedad menor de 20 años. Los hallazgos espirométricos anormales predominaron en el grupo con antigüedad mayor a 20 años. Es necesario revisar protocolos de vigilancia epidemiológica y realizar seguimiento por medicina laboral.Palabra clave: Neumoconiosis, minería del carbón, tuberculosis, condiciones de trabajo, exposiciónocupacional, Colombia.Forma de citar: Garrote Wilches CF, Malagón Rojas JN, Morgan G, Combariza D, Varona, M. Caracterización de las condiciones de salud respiratoria de los trabajadores expuestos a polvo de carbón en minería subterránea en Boyacá, 2013. rev.univ.ind.santander.salud 2014; 46 (3): 237-247Characterization of respiratory health conditions of workers exposed to coal dust in underground mining in Boyacá, 2013. Introduction: coal miners´ pneumoconiosis is an occupational lung disease associated with individual factors and specifc working conditions. It is manifested progressively and irreversibly, affecting the health of workers and labor productivity. Objective: To characterize the respiratory health conditions and identify risk factors associated with the development of pneumoconiosis in workers that have been exposed to coal dust in the underground mines at Boyacá, 2013. Materials and Methods: A descriptive cross-sectional study was conducted among mining workers exposed to coal dust in the department of Boyacá. It was conducted a complete record of occupational medical history, physical exam, taking chest radiography, tuberculin test and spirometry. Results: 170 male workers participated. 75% of the population had worked in the mining sector for more than12.5 years old. Rhonchi, wheezing and rattling predominated in workers over 20 years old. Expectoration and cough were most frequently found in those who made mechanized extraction. 15.9% of chest X rays were compatible with pneumoconiosis, 17.1% of tuberculin tests were found positive. 5.3% of spirometries showed peripheral airway abnormalities and 2.4% showed obstructive pattern. Discussion and conclusion: Radiological changes suggestive of pneumoconiosis were more frequent in workers under 20 years old. Abnormal spirometric fndings predominated in the group with more than 20 years old. It is important to review surveillance protocols and perform monitoring through occupational medicine.Keywords: pneumoconiosis, coal mining, tuberculosis, working conditions, occupational exposure, Colombia

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023

SARs-CoV-2 and work-related transmission: Results of a prospective cohort of airport workers, 2020

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly around the globe. Even though multiple strategies are available for controlling infectious respiratory diseases, the current approach for managing this pandemic is the prevention of person-to-person transmission. Despite the quarantine strategy, some work positions must remain active, such as airport personnel. Objectives: To identify risk factors for COVID-19 transmission among workers at the El Dorado, Luis Carlos Galán Airport from March to July 2020. Methods: This is a prospective cohort study with workers of the El Dorado International Airport, in Bogotá, Colombia. A sociodemographic questionnaire was for searching for symptoms associated with COVID-19 and other risk factors. Nasopharyngeal swabs were collected for determining the presence of COVID-19. In order to identify seroconversion, we used an automated chemiluminescent immunoassay for anti-SARS-CoV-2 IgM and IgG antibodies. Patients with positive results were followed-up for 21 days. Results: We observed an incidence of infection of 7.9%; most cases were asymptomatic. The main risk factor associated with infection was the duration of daily commute (relative risk 1.02 [95% confidence interval, 1.002–1.041]). Conclusions: We observed asymptomatic infection by COVID-19 among airport workers. Future research should contribute with knowledge for developing strategies that guarantee the protection of airport workers