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

Controle de Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) no canil da Escola de Veterinária da UFMG, Belo Horizonte, Minas Gerais, Brasil Control of Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) in the kennel of the UFMG Veterinary School, Belo Horizonte, Minas Gerais, Brazil

O presente estudo teve como proposta controlar uma infestação natural de Rhipicephalus sanguineus em um canil pertencente à Escola de Veterinária da UFMG, com uma área de 72 m² e 25 cães de diversas raças. Um teste de sensibilidade a produtos acaricidas foi aplicado em uma amostra de carrapatos capturados no canil. Dos produtos testados: Amitraz 12,5% (Produto 1); uma associação de Alfametrina 2% e Dichlorvós 60% (produto 2); Deltametrina 5% (produto 3) e uma associação de Trichlorfon 77,6%, Coumaphós 1% e Cyfluthrin 1% (produto 4); somente os produtos 1 e 4 apresentaram 100% de eficácia. O Amitraz 12,5% foi utilizado no controle dos estádios de R. sanguineus presentes no ambiente do canil, com um esquema de 4 aplicações a cada 7 dias de intervalo. Para os estádios parasitários, um único tratamento com Flumetrina 1.0% pour-on foi empregado em todos os animais. A inspeção e o monitoramento do ambiente e dos animais foram realizados durante um período de um ano. Estas medidas de controle reduziram significativamente a população de carrapatos dentro do canil. O canil não apresentou infestação pelo carrapato nos seis meses seguintes aos tratamentos. Uma infestação leve foi observada no 7º mês pós-tratamento, quando foi realizada uma nova aplicação de Amitraz 12,5% no ambiente do canil e um novo tratamento com Flumetrina 1.0% pour-on nos animais, com resultados satisfatórios.<br>The present work was aimed at proposing a control measure for Rhipicephalus sanguineus in a naturally infected kennel of 72 m² of the UFMG Veterinary School with 25 dogs of different breeds. A sensitivity test to acaricide products was applied in a sample of R. sanguineus. Out of the acaricide products tested: 12.5% Amitraz (product 1); 2% Alfamethrin and 60% Dichlorvos association (product 2); 5% Deltamethrin (product 3) and the association between 77.6% Trichlorfon, 1.0% Coumaphos and 1.0% Cyfluthrin (product 4); only 1 and 4 products showed 100% efficacy. Amitraz (12.5%) was used for controlling R. sanguineus in the surrounding of the kennel, on which four treatments every seven days were carried out in the facilities. For parasitic R. sanguineus, a single topical treatment was used: Flumetrin 1.0% pour - on on all the 25 dogs. This control measure significantly reduced the population of R. sanguineus within the kennel. A slight infestation was observed in the seventh month after treatment. A new application of 12.5% Amitraz was done in the kennel as well as a new topical treatment with Flumetrin 1.0% pour - on on the dogs. The control procedure proposed in the present study was an emergency measure and its effectiveness was checked through environmental surveys throughout a one-year period