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V-IDENT: Enhancing Patient Safety Through PPG-Based User Identification
No full textBiometric authentication based on physiological signals offers promising potential for enhancing security in mobile patient monitoring. ‘Intelligent medical devices’, which check the identity of a patient before usage to address safety risks from device-patient mix-ups, do not yet exist. In this project, an AI-based identification system that uses vital signs for biometric authentication will be realized in order to enable the identification on the basis of biometric patterns. By integrating this component into a patient monitoring platform, a seamless and reliable method for verifying patient identity before device use is established, supporting safer and more efficient clinical workflows
DNVF Memorandum Partizipative Versorgungsforschung (Teil 1)
No full textPatient:innen als zentrale Akteur:innen der Gesundheitsversorgung sollen sich aktiv in Versorgungsforschungsprozesse einbringen können. Auch weitere Stakeholder – etwa Fachkräfte aus der Versorgungspraxis – sind für einen umfassenden partizipativen Ansatz von Bedeutung. In diesem DNVF Memorandum stehen partizipative Ansätze im Kontext der Versorgungsforschung im Mittelpunkt. Zunächst werden die Charakteristika partizipativer Versorgungsforschung beschrieben und ihr Entwicklungsstand sowie ihre Institutionalisierung in Deutschland dargestellt. Dabei werden auch das Potenzial und die Vorteile partizipativer Versorgungsforschung beleuchtet. Schließlich widmet sich das DNVF Memorandum zwei Querschnittsthemen, die für die Weiterentwicklung besonders relevant sind: der theoretisch-konzeptionellen Fundierung sowie der Erforschung von Effekten und Wirksamkeit partizipativer Ansätze.Patients, as central actors in healthcare, should be enabled to actively participate in health services research processes. In addition, other stakeholders, such as professionals from healthcare practice, are also essential for a comprehensive participatory approach. This DNVF memorandum focuses on participatory approaches in the context of health services research. It begins by outlining the key characteristics of participatory health services research and describing its current development and institutionalization in Germany. The DNVF memorandum also highlights the potential and benefits of participatory research. Finally, it addresses two cross-cutting topics that are particularly relevant for further development in this field: the theoretical and conceptual foundations, and the investigation of effects and effectiveness of participatory approaches
Relevanz der digitalen Gesundheitskompetenz (dGK) für Versorgungsforschung und -praxis – Teil II
No full textNicht alle Personen oder Bevölkerungsgruppen können aufgrund unterschiedlicher Ausprägungen ihrer (d)GK und sozioökonomischen Bedingungen gleichmäßig am digitalen Wandel teilhaben. Dieser Unterschied ist als „digital divide“, digitale Kluft, bekannt. Ausprägungen eines niedrigen sozioökonomischen Status und ein höheres Lebensalter scheinen mit geringerer dGK assoziiert zu sein. Im Sinne der Verringerung gesundheitlicher Ungleichheit ist die gezielte Förderung der dGK bei benachteiligten Gruppen anzustreben. Dieser Beitrag der Mitglieder der AG Digital Health des Deutschen Netzwerks Versorgungsforschung e.V. (DNVF) fokussiert daher die Bedeutung von digitaler Gesundheitskompetenz (dGK) für die Versorgungsforschung und -praxis in Deutschland mit Schwerpunkt auf Maßnahmen zur Steigerung der dGK. Basierend auf der in der ersten Publikation (Relevanz der digitalen Gesundheitskompetenz (dGK) für Versorgungsforschung und -praxis - Teil I) erarbeiteten theoriebasierten Definition der dGK, werden der aktuelle Stand der dGK in Deutschland sowie Auswirkungen einer geringen dGK fokussiert. Orientiert an der Delphi-Studie der AG Digital Health des DNVF und an den Vorgaben des Sachverständigenrats zur Begutachtung der Entwicklung im Gesundheitswesen und in der Pflege wird der Digital Divide adressiert und thematisiert. Es werden konkrete Vorschläge zur Steigerung der dGK gemacht. Der Fokus liegt auf theoriegeleiteten und gemeinsam mit Nutzer*innen entwickelten Interventionen zur Steigerung der dGK, wobei auch deren Evaluation und Implementierung adressiert werden.Not all individuals or population groups can participate equally in digital transformation due to varying levels of (e)HL and their socioeconomic conditions. This disparity is known as the “digital divide.” A lower socioeconomic status and older age appear to be associated with lower eHL. In the interest of reducing health inequalities, targeted efforts to promote dGK among disadvantaged groups should be pursued. This paper by the members of the working group Digital Health of the German Network for Health Services Research (Deutsches Netzwerk Versorgungsforschung e.V. (DNVF)) therefore addresses the importance of eHealth Literacy (eHL) for health services research and practice in Germany, with an emphasis on measures to enhance eHL. Building on a theory-based definition of eHL established in the first publication (Relevance of eHealth Literacy (eHL) for health services research and practice – Part I), the current state of eHL in Germany and the effects of low eHL are examined. Guided by the Delphi study conducted by the DNVF working group Digital Health and the guidelines of the German Advisory Council on Health and Care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen und in der Pflege (SVR)), the digital divide is addressed and analyzed. Specific proposals for enhancing eHL are presented, with a focus on theory-driven interventions co-developed with users. Evaluation and implementation aspects of such interventions are also considered
Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023
No full textBACKGROUND
Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging.
OBJECTIVES
We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure.
METHODS
The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023.
RESULTS
CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990.
CONCLUSIONS
CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD
Global, regional, and national burden of headache disorders, 1990–2021, with forecasts to 2050: A Global Burden of Disease study 2021
No full textHeadache disorders, especially migraines and tension-type headaches (TTHs), are major global public health concerns, as shown by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We pro vide updated global estimates of prevalence and years lived with disability (YLDs) from 1990 to 2021 across 204 countries and territories and forecasts through 2050. In 2021, there are 2.0 billion people with TTH and 1.2 billion with migraine. Although TTH is more prevalent, migraine causes higher disability. While crude prevalence and YLDs increased, age-standardized rates remained stable and are projected to continue this trend due to population growth. There is a disproportionately higher burden in women aged 30–44 and countries with higher Socio-demographic Index and Healthcare Access and Quality Index. Despite this, migraines remain underrecognized in health policies and funding. This study emphasizes the urgent need to prioritize headache disorders in global health agendas
Global burden of vision impairment due to age-related macular degeneration, 1990–2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground
Age-related macular degeneration (AMD) is a growing public health concern worldwide, as one of the leading causes of vision impairment. We aimed to estimate global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD.
Methods
Data on AMD were extracted from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990–2021. Vision impairment was defined and categorised by severity as follows: moderate to severe vision loss (visual acuity from <6/18 to 3/60) and blindness (visual acuity <3/60 or a visual field <10 degrees around central fixation). The burden of vision impairment attributable to AMD was subsequently estimated. These estimates were further stratified by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-demographic Index (SDI) levels. Additionally, the effect of tobacco use, a modifiable risk factor, on the burden of AMD was analysed, and projections of AMD burden were estimated through to 2050. These projections also included scenario modelling to assess the potential effects of tobacco elimination.
Findings
Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3·64 million (95% uncertainty inverval [UI] 3·04–4·35) in 1990 to 8·06 million (6·71–9·82) in 2021. Similarly, DALYs increased by 91% over the same period, from 0·30 million (95% UI 0·21–0·42) to 0·58 million (0·40–0·80). By contrast, age-standardised prevalence and DALY rates declined, with prevalence rates decreasing by 5·53% (99·50 per 100 000 of the population [95% UI 83·16–118·04] in 1990 to 94·00 [78·32–114·42] in 2021) and DALY rates dropping by 19·09% (8·38 [5·70–11·53] to 6·78 [4·70–9·32]). These rates showed a consistent decrease in higher SDI quintiles, reflecting the negative correlation between HAQ Index and AMD burden. A general downward trend was observed from 1990 to 2021, with the largest age-standardised reduction occurring in the low-middle SDI quintile. The global contribution of tobacco to age-standardised DALYs decreased by 20%, declining from 12·45% (95% UI 7·73–17·37) in 1990 to 9·96% (6·12–14·06) in 2021. By 2050, the number of individuals affected by AMD is projected to increase from 3·40 million males (95% UI 2·81–4·17) in 2021 to 9·02 million (5·72–14·20) and from 4·66 million females (3·88–5·65) to 12·32 million (8·88–17·08). Eliminating tobacco use could reduce these numbers to 8·17 million males (5·59–11·92) and 11·15 million females (8·58–14·48) in 2050.
Interpretation
While the total prevalence and DALYs due to AMD have steadily increased from 1990 to 2021, age-standardised prevalence and DALY rates have declined, probably reflecting the effect of population ageing and growth. The consistent decrease in age-standardised rates with higher SDI levels highlights the crucial role of health-care resources and public policies in mitigating AMD-related vision impairment. The downward trend observed from 1990 to 2021 might also be partially attributed to the reduced effect of tobacco as a modifiable risk factor, with declines in tobacco use seen globally and across all SDI quintiles. The burden of vision impairment due to AMD is projected to increase to about 21·34 million in 2050. However, effective tobacco regulation has the potential to substantially reduce AMD-related vision impairment, particularly in lower SDI quintiles where health-care resources are limited
Global, regional, and national burden of asthma and atopic dermatitis, 1990–2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021
No full textBackground
Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.
Methods
Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010–19) and during (2019–21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).
Findings
In 2021, there were an estimated 260 million (95% UI 227–298) individuals with asthma and 129 million (124–134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250–331) in 1990 to 238 million (209–272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103–112) in 1990 to 129 million (124–134) in 2021. However, age-standardised prevalence rates decreased—by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2–648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2–3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic –1·39% [–2·07 to –0·71] and during the pandemic 0·47% [–1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic –0·28% [–0·33 to –0·22] and during the pandemic –0·35% [–0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6–60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7–26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224–330) asthma cases and 148 million (140–158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (–23·2% [–44·4 to 5·3] for asthma and –1·4% [–9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.
Interpretation
Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable
Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground
Despite a substantial reduction in the use of solid fuels for cooking worldwide, exposure to household air pollution (HAP) remains a leading global risk factor, contributing considerably to the burden of disease. We present a comprehensive analysis of spatial patterns and temporal trends in exposure and attributable disease from 1990 to 2021, featuring substantial methodological updates compared with previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, including improved exposure estimations accounting for specific fuel types.
Methods
We estimated HAP exposure and trends and attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, tracheal cancer, bronchus cancer, lung cancer, stroke, type 2 diabetes, and causes mediated via adverse reproductive outcomes for 204 countries and territories from 1990 to 2021. We first estimated the mean fuel type-specific concentrations (in μg/m3) of fine particulate matter (PM2·5) pollution to which individuals using solid fuels for cooking were exposed, categorised by fuel type, location, year, age, and sex. Using a systematic review of the epidemiological literature and a newly developed meta-regression tool (meta-regression: Bayesian, regularised, trimmed), we derived disease-specific, non-parametric exposure–response curves to estimate relative risk as a function of PM2·5 concentration. We combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause by sex, age, location, and year.
Findings
In 2021, 2·67 billion (95% uncertainty interval [UI] 2·63–2·71) people, 33·8% (95% UI 33·2–34·3) of the global population, were exposed to HAP from all sources at a mean concentration of 84·2 μg/m3. Although these figures show a notable reduction in the percentage of the global population exposed in 1990 (56·7%, 56·4–57·1), in absolute terms, there has been only a decline of 0·35 billion (10%) from the 3·02 billion people exposed to HAP in 1990. In 2021, 111 million (95% UI 75·1–164) global disability-adjusted life-years (DALYs) were attributable to HAP, accounting for 3·9% (95% UI 2·6–5·7) of all DALYs. The rate of global, HAP-attributable DALYs in 2021 was 1500·3 (95% UI 1028·4–2195·6) age-standardised DALYs per 100 000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4–5104·6) age-standardised DALYs per 100 000 population. HAP-attributable burden remained highest in sub-Saharan Africa and south Asia, with 4044·1 (3103·4–5219·7) and 3213·5 (2165·4–4409·4) age-standardised DALYs per 100 000 population, respectively. The rate of HAP-attributable DALYs was higher for males (1530·5, 1023·4–2263·6) than for females (1318·5, 866·1–1977·2). Approximately one-third of the HAP-attributable burden (518·1, 410·1–641·7) was mediated via short gestation and low birthweight. Decomposition of trends and drivers behind changes in the HAP-attributable burden highlighted that declines in exposures were counteracted by population growth in most regions of the world, especially sub-Saharan Africa.
Interpretation
Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources. Such initiatives are crucial for mitigating health risks and promoting sustainable development, ultimately improving the quality of life and health outcomes for millions of people
Welche Unterschiede bestehen bei Evidenzgenerierung und -bewertung zwischen Maßnahmen auf Individual- und Populationsebene?
No full textEinleitung: Eine evidenzbasierte Praxis im Öffentlichen Gesundheitsdienst (ÖGD) ist essenziell, um fundierte Entscheidungen zum Schutz, zur Aufrechterhaltung und zur Förderung der Gesundheit von Bevölkerungsgruppen treffen zu können. Der systematische Einsatz der besten verfügbaren wissenschaftlichen Erkenntnisse trägt dazu bei, dass Maßnahmen und Interventionen gezielt auf ihre Wirksamkeit, Sicherheit und Effizienz hin bewertet werden können. Eine qualitativ hochwertige Evidenzbasis dient dabei als wichtige Grundlage, um gesundheitspolitische Entscheidungen zu legitimieren, Ressourcen bestmöglich einzusetzen und langfristig Vertrauen der Bevölkerung zu stärken. All das setzt jedoch angemessene Ansätze der Datenerhebung und methodischen Auswertung mit valider Aussagekraft voraus
Built-In Open Circuit Reference Electrodes in a PEM Water Electrolysis Cell – A Proof of Concept
No full textThis study presents a proof of concept for the integration of open circuit reference electrodes (OC-REs) in proton-exchange membrane water electrolysis (PEMWE) cells to understand electrode performance and loss mechanisms, allowing for unequivocal assignment of these losses to anode and cathode. OC-REs, which are non-invasive to cell performance and share the same environment as the working electrodes (WEs), are assessed for stability and reproducibility while their performance is investigated across varying current densities and membrane thicknesses. Results demonstrate the significant impact of hydrogen crossover on the potential of the anode RE, impact that was modeled by calculating a current-density-dependent mixed potential. When comparing half-cell and full-cell polarization, the latter shows significantly higher reproducibility, with proper electrode alignment being crucial to minimize differences in half-cell polarization curves. Conversely, no significant impact from alignment on half-cell electrochemical impedance spectroscopy (EIS) was observed, making this technique the more consistent approach. The half-cell EIS revealed a significant contribution from the cathode to the overall loss, contrary to indications from most studies lacking this half-cell insight. These findings illustrate the potential of OC-REs as effective sensors for assessing electrode contributions, paving the way for future investigations into optimizing PEMWE