What's the best way fo measure burden?
death (most common, easiest), illness, costs, time (years of life lost)
disability adjusted life year
principle 1 - the only differences in the rating of a death or disability should be due to age and sex, not to income, culture, location, social class
principle 2 - everyone in the world has right to bes life expectancy in world
DALY = YLL + YLD
What is meant by disability?
impairment - symptoms at organ level
disability - objective alteration of behavior or performance at individual level
handicap - change dinteraction at the social/environmental level
schema for assessing non-fatal health outcomes
disease -> impairment -> handicap
What is the estimated level of disability?
IHD - 28.8 (worse than below the knee amputation)
Stroke 60.9 (around the level of unipolar depression, tetanus)
What are the leading causes of death globally?
Ischemic heart disease and storke
What are some major problems with data collected for NCD mortality?
major problems with death registrations in many coutnries
ex. over 80% of countires in Africa are not registered
political reasons why NCDs might be neglected
apathy - difficult/complex to tackle, myth that risk factors only account for 50% of deaths
NCDs are invisible
What was the problem with the Denmark fat tax?
tax was levied on the carcass instead of the cut of beef
What are the top three NCD funders?
WHO, Welcome Trust, Bloomberg + Gates
five types of political incentives
political - squeaky wheel
economic - seek to shift priorities
organizational - sustaining status quo
symbolic - maintaining MDGs
Possibilities of polypill
80% reduction in CVD events
less reliance on physicians
Problems with polypill
primary vs. secondary prevention
emphasis on pills > lifestyle > policies
dose titration, side effects
What are the top three sources of salt in the US diet?
cured meat/cold cuts
Why is salt so heavily used in food?
safety - antimicrobial
processing - changes how other ingredients behave
economics - profitability
Class I treatment effect
benefit >>> risk
should be performed
Class IIa treatment effect
benefit >> risk
reasonable to perform
Class IIb treatment effect
benefit >/= risk
may be considered
Class III treatment effect
no benefit or harm
should not be performed
Level A evidence
data derived from multiple RTCs or meta-analysis
Level B evidence
data derived from a single RCT trial or non-randomized studies
Level C evidence
very limited data
expert consensus of opinion, case studies, or standard of care
What are the gaps in research and translation?
efficacy and effectiveness
moving new therapies to the bedside
making sure the quality, outcomes, and effectiveness are good
structure measures - quality of staff and equipment
process measures - the process of treatment
outcomes measures - benefit of treatment
What are performance measures used for?
attributes of satisfactory performance measures
useful in improving patient outcomes - evidence-based, interpretable, actionable
measure design - denominator precisely defined, numerator precisely defined, validity, reliability
measure implementation - feasibility
prevention of risk factors in the first place in disease free individuals
interventions geared to early detection and prompt treatment of disease, preferable before the development of clinical symptoms
interventions geared towards minimizing the effects of disease or disability by preventing complications and premature deterioration