Showing papers by "Mohsen Naghavi published in 2011"

Japan: Universal Health Care at 50 Years 1 What has made the population of Japan healthy?

Abstract: People in Japan have the longest life expectancy at birth in the world. Here, we compile the best available evidence about population health in Japan to investigate what has made the Japanese people healthy in the past 50 years. The Japanese population achieved longevity in a fairly short time through a rapid reduction in mortality rates for communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates. Japan had moderate mortality rates for non-communicable diseases, with the exception of stroke, in the 1950s. The improvement in population health continued after the mid-1960s through the implementation of primary and secondary preventive community public health measures for adult mortality from non-communicable diseases and an increased use of advanced medical technologies through the universal insurance scheme. Reduction in health inequalities with improved average population health was partly attributable to equal educational opportunities and fi nancial access to care. With the achievement of success during the health transition since World War 2, Japan now needs to tackle major health challenges that are emanating from a rapidly ageing population, causes that are not amenable to health technologies, and the eff ects of increasing social disparities to sustain the improvement in population health.

Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys

Abstract: OBJECTIVE: To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors. METHODS: We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management. FINDINGS: A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States. CONCLUSION: There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.

Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards

Abstract: Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. Results show that physician coding for cause of death assignment may not be as robust as previously thought. The time and cost required to initially collect the verbal autopsies must be considered in addition to the analysis, as well as the impact of diverting physicians from servicing immediate health needs in a population to review VAs. All of these considerations highlight the importance and urgency of developing better methods to more reliably analyze past and future verbal autopsies to obtain the highest quality mortality data from populations without reliable death certification.

Improving the public health utility of global cardiovascular mortality data: the rise of ischemic heart disease

Abstract: High-quality, cause-specific mortality data are critical for effective health policy. Yet vague cause of death codes, such as heart failure, are highly prevalent in global mortality data. We propose an empirical method correcting mortality data for the use of heart failure as an underlying cause of death. We performed a regression analysis stratified by sex, age, and country development status on all available ICD-10 mortality data, consisting of 142 million deaths across 838 country-years. The analysis yielded predicted fractions with which to redistribute heart failure-attributed deaths to the appropriate underlying causes of death. Age-adjusted death rates and rank causes of death before and after correction were calculated. Heart failure accounts for 3.1% of all deaths in the dataset. Ischemic heart disease has the highest redistribution proportion for ages 15-49 and 50+ in both sexes and country development levels, causing gains in age-adjusted death rates in both developed and developing countries. COPD and hypertensive heart disease also make significant rank gains. Reproductive-aged women in developing country-years yield the most diverse range of heart failure causes. Ischemic heart disease becomes the No. 1 cause of death in several developed countries, including France and Japan, underscoring the cardiovascular epidemic in high-income countries. Age-adjusted death rate increases for ischemic heart disease in low- and middle-income countries, such as Argentina and South Africa, highlight the rise of the cardiovascular epidemic in regions where public health efforts have historically focused on infectious diseases. This method maximizes the use of available data, providing better evidence on major causes of death to inform policymakers in allocating finite resources.

Optimal vitamin A and suboptimal vitamin D status are common in Iranian infants

Abstract: Aim: Investigation of serum concentrations of vitamins A and D in Iranian infants. Methods: A descriptive cross-sectional study, investigating 7112 infants (1523 months of age) from all regions of ...

The prevention and control of road traffic injuries in rural communities: input from community health workers in rural Twiserkan, Iran

Abstract: Background: Preventing road traffic injuries (RTIs) in rural areas poses particular challenges. This study highlights potential countermeasures and barriers as identified by health workers (known as Behvarzes) responsible for local community health and safety matters. Methods: The study enrolled the rural health workers of Twiserkan district (Iran), all of whom (n= nearly 100) were trained for the purpose of prospectively gathering data on any severe injury occurring in their catchment population over a six-month period, proposing preventive measures and identifying potential barriers. The data collection finished with a questionnaire session covering similar issues but addressed in more general terms. Results: The Health workers reported a total of 59 persons who were severely injured in 41 crashes during the 6 month follow-up. Of those, 14 (24%) died in or as a consequence of the crash. A total of 28 people were injured in a “one victim” crash, 18 in a “two victim” crash and 13 in a “three or more victims” crash. The health workers emphasized the adoption of safe behavior/practice as an important means for RTI prevention (90%), with a focus on the use of motorcycle helmet and compliance with traffic rules. Their suggestions covered the three “Es” – education, engineering and enforcement. They saw their own contribution as being health and safety educators and promoters. The barriers they identified dealt with both individual and environmental factors. Conclusion: Health workers are in a good position to identify both a variety of context-relevant countermeasures for RTI control and prevention and potential barriers to their implementation and uptake. They can help to bridge the knowledge-practice gap in the field of safety promotion among rural community.

Fall safety promotion in rural communities: input from injury data and community health workers in Twiserkan, Iran

Abstract: Background: Falls are one of important cause of injury morbidity. Knowledge is limited about fall-related injuries in low- and middle-income countries in general and in Iran in particular. This study aims to document the epidemiology of injuries among rural community and to determine how fall injury control and prevention are conceived by community health workers (known as Behvarzes), given the role that they are expected to done for promotion of local people health and safety. Methods: The study was a six-month prospective injury data collection (from July 15th 2007 to January 15th 2008) that took place in one of the Iranian district and focused on severe injuries (leading to hospitalization over six hours or death). About 100 community health workers (Behvarzes) collected data according to a special assignment. They used a pre-determined form (a logbook) for data collection on injuries of various causes, including falls. At the end of data collection Behvarzes were asked, by questionnaire, about injury prevention measures and barriers in the community. Results: A total of 23 severe fall injuries (two fatal) were reported during the follow-up period with an annual estimated incidence rate of 8/10 000 (95% CI: 6-11). The incidence rate of severe falls was significantly higher among males than females (12/10 000 vs. 3/10 000 person-years). Fall incidence rates was also higher among people 65 years and over (24/10 000 person-years). Severe falls led commonly to fractures and lower limb was the most common single body region. Most falls were from height, mainly from roof and tree, and about half were work-related. The injury analyses revealed that the Behvarzes often considered that the adoption of safe behavior/practice could help preventing fall injuries (17 out of 23). Their post follow-up reflection on fall prevention indicates that education, provided by them could help prevent fall injuries (71 out of 87) and so could environmental improvement, people training, instruction, cooperation and consultation by other performers in this field. Also the barriers or risk factors for fall injury prevention identified related mostly to human factors (for all 23 cases) followed by physical environmental factors. At the end of the follow-up, however, they identified several physical environmental factors (44 out of 87), followed by social and legal environmental factors, and then, individual factors. Conclusion: Community health workers can provide a variety of suggestion for fall injury prevention and highlight potential barriers to their implementation among their catchment area.