Showing papers by "Christopher J L Murray published in 1995"

The Health of Adults in the Developing World: A Summary

Abstract: This booklet summarizes the main points of the full length publication of the same name. It provides the salient points discussed concerning health sector resources in developing countries. The concept of adult health, as discussed, includes all major health conditions, communicable, noncommunicable, or injuries. It includes the poor, wealthy, urban, rural, employed, unemployed, men and women. The booklet defines adults as those aged between fifteen through fifty-nine years. The booklet summarizes the key findings based on already available data and identifies areas for further research and makes recommendations for action. The recommendations are that governments reduce expenditures on inefficient and inequitable adult health care and free resources for the implementation of cost effective interventions, many of which are preventive.

Burden of disease assessment and health system reform: Results of a study in Mexico

Abstract: This paper describes in broad terms the first national assessment of the burden of disease using Disability Adjusted Life Years, which formed part of an overall study of health system reform in Mexico. The overall project, ‘Health and the Economy: proposals for improving the Health System in Mexico’, is one of the first experiences of applying the analytical tools featured in the World Development Report 1993: Investing in Health. The Mexican National Burden of Disease (NBD) study was a critical component of the analysis of health system reform in Mexico. It provided a strong analytical basis for the identification of epidemiological priorities. The results of the study document the heterogeneous nature of the epidemiological transition in different parts of Mexico, and included both premature mortality and disability in the analysis. The results of this study were employed along with information on the cost-effectiveness of major health interventions in Mexico to design a package of essential health services for all Mexicans. Not only was the NBD study useful in identifying health needs and interventions that may have a major health impact, but the exercise itself had a number of other benefits. Through the careful review of all available sources of information on the incidence, prevalence, duration and severity of disability and mortality by age, sex and cause, the strengths and gaps in the current information system were identified. The process by which a large number of Mexican experts were involved in the estimation of the burden of each disease encouraged broad participation of health experts in the discussions about health reform in Mexico.

Distinct patterns of minimal residual disease associated with graft-versus-host disease after allogeneic bone marrow transplantation for chronic myelogenous leukemia.

Abstract: PURPOSEAllogeneic bone marrow transplantation (BMT) has been shown to provide effective therapy for chronic myelogenous leukemia (CML), but previous reports have also demonstrated the persistence of bcr-abl-positive cells for months to years after BMT in the majority of patients. To evaluate the biologic significance of persistent bcr-abl-positive cells, we examined the relationship between clinical parameters known to affect the risk of relapse and the ability to detect bcr-abl-positive cells post-BMT.PATIENTS AND METHODSWe analyzed 480 samples from 92 patients at two transplant centers for the presence of bcr-abl-positive cells by polymerase chain reaction (PCR). Two different BMT preparative regimens and protocols for prevention of graft-versus-host disease (GVHD) were used. One center used cyclophosphamide plus total-body irradiation (CY/TBI) and T-cell-depleted marrow; the second center used busulfan plus cyclophosphamide (Bu/CY) and untreated marrow with cyclosporine and methotrexate (Csp/MTX) as GV...

Cuantificación de la carga de enfermedad: la base técnica del cálculo de los años de vida ajustados en función de la discapacidad

Abstract: Se presentan detalladamente los supuestos empleados para construir un nuevo indicador de la carga de enfwmedad: los afios de vida ajustados en funcion de la discapackiad CAVAD). Se examinan con detenimiento cuatro opciones sociales importantes para cualquier indicador de esta imiole. Primero, se comentan las ventajas y los inconvenientes de varios metodos para calcular la duracion de la vida perdida por defuncion en cada edad. Para calcular los AVAD se emplea una vida esperada estandar perdida a partir del nivel 26 de la tabla de mortalidad modelo de West. Segundo, el valor del tiempo vivido a difwentes edades se expresa en AVAD mediante una funcion exponencial que r@eja la depemiencia de jovenes y ancianos respecto a los adultos. Tucero, el tiempo vivido con discapacti se compara con el tiempo perdido por mortalidad prematura, definiendo seis clases de gravedad de la discapacidad. Para ponderar la gravedad, a cada clase se le asigna un peso cuyos valores oscilan entre 0 y 1. Por ultimo, para calcular los AVAD se aplica una tasa & actualizacion de 3% y se presenta la formula para calcular los AVAD atendiendo a esas suposiciones.

Global and regional cause-of-death patterns in 1990

Abstract: Demographic estimation techniques suggest that worldwide about 50 million deaths occur each year, of which about 39 million are in the developing countries. In countries with adequate registration of vital statistics, the age at death and the cause can be reliably determined. Only about 30-35% of all deaths are captured by vital registration (excluding sample registration schemes); for the remainder, cause-of-death estimation procedures are required. Indirect methods which model the cause-of-death structure as a function of the level of mortality can provide reasonable estimates for broad cause-of-death groups. Such methods are generally unreliable for more specific causes. In this case, estimates can be constructed from community-level mortality surveillance systems or from epidemiological evidence on specific diseases. Some check on the plausibility of the estimates is possible in view of the hierarchical structure of cause-of-death lists and the well-known age-specific patterns of diseases and injuries. The results of applying these methods to estimate the cause of death for over 120 diseases or injuries, by age, sex and region, are described. The estimates have been derived in order to calculate the years of life lost due to premature death, one of the two components of overall disability-adjusted life years (DALYs) calculated for the 1993 World development report. Previous attempts at cause-of-death estimation have been limited to a few diseases only, with little age-specific detail. The estimates reported in detail here should serve as a useful reference for further public health research to support the determination of health sector priorities.

Patrones de distribucion mundial y regional de las causas de defuncion en 1990

Abstract: Global and regional cause-of-death patterns in 1990 Demographic estimation techniques suggest that worldwide about 50 million deaths occur each year, of which about 39 million are in the developing countries. In countries with adequate registration of vital statistics, the age at death and the cause can be reliably determined. Only about 30-35% of all deaths are captured by vital registration (excluding sample registration schemes); for the remainder, causeof-death estimation procedures are required. Indirect methods which model the cause-ofdeath structure as a function of the leve1 of mortality can provide reasonable estimates for broad cause-of-death groups. Such methods are generally unreliable for more spec&c causes. In this case, estimates can be constructed from community-leve1 mortality surveillance systems or from epidemiological evidente on specific diseases. Some check’on the plausibility of the estimates is possible in view of the hierarchical structure of cause-of-death lists and the wellknown age-specific patterns of diseases and injuries. The results of applying these methods to estimate the causes of death for over 120 diseases or injuries, by age, sex and region, are described. The estimates have been derived in order to calculate the years of life lost due to premature death, one of the two components of overall disability-adjusted life years (DALYs) calculated for the 1993 World akuelopment report. Previous attempts at cause-of-death estimation have been limited to a few diseases only, with little age-specik detail. The estimates reported in detail here should serve as a useful referente for further public health research to support the determination of health sector priorities. Abastecimiento de agua en las ciudades La mala gestion y los procedimientos inadecuados de operacion y mantenimiento hacen que en muchas grandes ciudades de los pafses en desarrollo no se registre en contadores mas de la mitad del agua abastecida. En las zonas con abastecimiento publico de esas ciudades hay gran desperdicio de agua y las tarifas a menudo estan subsidiadas. Por el contrario, los que viven en las afueras en su mayor parte no tienen abastecimiento publico y se ven obligados a pagara proveedores privados precios de mercado por cantidades insuficientes de agua de calidad cuestionable. Esos precios a menudo son de 10 a 20 veces mayores que la tarifa que se carga a los usuarios del sistema de abastecimiento publico. (World Health Organization, Operation and maintenance of urban watersupply and sanitafian systems: a guide formanagers. Ginebra, WHO, 1994, p. vii.)

El análisis de la efectividad en función del costo y la elección de políticas: la inversión en los sistemas de salud

Abstract: Se examina la funcion de la infraestructura de los sistemas de salud en los estudios analiticos de efectividad en funcion del costo y asignacion de recursos de salud, y se revisan algunos analisis de efectividad en funcion del costo en el sector salud realizados con anterioridad. Se senalan dos d(ficultades importantes relacionadas con la naturaleza de los costos del sistema de salud y la eleccion de las politicas. En primer lugal; el problema de la infraestructura del sistema de salud puede abordarse recurriendo a modelos computadorizados comn el Modelo para Asignar Recursos de Salud (MARS), desarrollado en hkroard, que integra datos sobre la efectividad en funcion del costo y de la carga de enfermeakd. Se observo que un modelo que considera la expansion de la infraestructura de salud produce casi $O% mas de anos de vida ajustados en funcion de la discapacidad totales para un hipotetico pais del Africa subsahariana que un modelo que soslaya dicha expansion. Si se desea difundir la utilizacion de las bases de datos sobre la efectividad en funcion del costo para asignar los recursos en el sector salud, sera preciso que los analisis de la efectividad en funcion akl costo pasen de aportar informacion sobre costosa notificar funciones de produccion. En segundo lugal; con estos instrumentos es posible analizar tres interrogantes concretos sobre politicas, cada uno de ellos con sus propios insumos y restricciones: la asignacion cuando el presupuesto y la infraestructura de salud son fijos, cuando hay recursos para una expansion marginal y cuando existen restricciones politicas para expandir los recursos. Para que no se confunda el interrogante que se esta abordando, es necesario desarrollar un metodo congruente y riguroso destinado a utilizar los datos de efictividad en funcion del costo para orientar la asignacion de recursos.

Cuantificacion de la discapacidad : datos , metodos y resultados

Abstract: Los metodos convencionales de recopilacion, analisis y diseminacion de injkmacion sobre discapacidad en las poblaciones se basan en censos y encuestas transversales que miden la prevalencia en un periido determinado. Si bien pueakn servir para definir el alcance y el patron almografico de las discapacidades en una poblacion e indicar asi la necesidad de disponer de servicios de rehabilitacion, la prevencion exige injurmacion detallada sobre las enjermeedades y los traumatismos subyacentes que causan discapacihd. Los metodos empleados para calcular la carga global de enfermedad descritos en el presente documento proporcionan un mecanismo para cuantificar las consecuencias para la salud de los arios vividos con discapacidad estimando primero las tasas de incidencia especificas por edad y sexo y luego incorporandolas a un indice de discapacti simple que rejleja colectivamente la probabilidad de llegara padecer discapacidad, la duracion de la vida vivida con discapacidad y la gravedad aproximada de la discapac idad en terminos de restriccion riela actividad. En este documento se presentan estimaciones detalladas del numero de anos de vida ajustados en funcion de la discapacidad CAVAD) vividos en ocho regiones geograficas. Los resultados akben ser utiles para los interesados en planificar servicios de salud para discapacitados y, mas concretamente, en elaborar politiw para prevenir las afecciones subyacentes que ocasionan graves secuelas discapacitantes.