Browsing by Subject "DISABILITY"

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  • Ronimus, Miia; Eklund, Kenneth; Westerholm, Jari; Ketonen, Ritva; Lyytinen, Heikki (2020)
    We used a randomized controlled trial to investigate if a mobile game, GraphoLearn (GL), could effectively support the learning of first graders (N = 70), who have severe difficulties in reading and spelling. We studied the effects of two versions of the game: GL Reading, which focused on training letter-sound correspondence and word reading; and GL Spelling, which included additional training in phonological skills and spelling. During the spring of first grade, the children trained with tablet computers which they could carry with them during the six-week intervention. The average exposure time to training was 5 hr 44 min. The results revealed no differences in the development of reading or spelling skills between GL players and the control group. However, pre-training self-efficacy moderated the effect among GL Reading players: children with high self-efficacy developed more than the control group in word reading fluency, whereas children with low self-efficacy developed less than the control group in spelling.
  • Kortelainen, Simon; Curtze, Sami; Martinez-Majander, Nicolas; Raj, Rahul; Skrifvars, Markus B. (2022)
    Background and purpose Little is currently known about the cost-effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1-year costs and outcome for patients with AIS treated in the intensive care unit (ICU). Materials and methods A single-center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12-month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO). Results The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87-0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97-0.99) per added year. The ECPS and ECPFO were 115,628euro and 291,210euro, respectively. Conclusions Treatment of AIS in the ICU is resource-intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost-efficacy of ICU care for AIS patients.
  • Halonen, Jaana; Lallukka, Tea; Virtanen, Marianna; Rod, Naja H.; Hanson, Linda L. Magnusson (2019)
    Objectives Bi-directional associations between perceived effort-reward imbalance (FRI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI. Methods We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876-3239). Results ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.22, 95% confidence interval (CI) 1.00-1.48] and 41% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.34 (95% CI 1.09-1.64), but the mediating role of depressive symptoms was less consistent. Conclusions Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain.
  • Mikkola, Tuija M.; Kautiainen, Hannu; von Bonsdorff, Mikaela B.; Salonen, Minna K.; Wasenius, Niko; Kajantie, Eero; Eriksson, Johan G. (2020)
    Purpose Most studies examining the associations between body composition and health-related quality of life (HRQoL) in older age have been cross-sectional and analyzed only fat or lean mass. Hence, it is poorly known whether fat and lean mass are independently associated with subsequent changes in HRQoL. We investigated whether baseline lean and fat mass are associated with changes in HRQoL over a 10-year period in older adults. Methods We studied 1044 men and women from the Helsinki Birth Cohort Study (age 57-70 years at baseline). Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height(2)) and lean mass index (lean mass/height(2)), dichotomized at sex-specific medians. HRQoL was assessed using RAND 36-item Health Survey at baseline and follow-up 10 years later. Results When controlled for lean mass and adjusted for potential confounders, high baseline FMI was associated with a greater decline in general health (standardized regression coefficient [beta] = - 0.13, p = 0.001), physical functioning (beta = - 0.11, p = 0.002), role physical (beta = - 0.13, p = 0.003), vitality (beta = - 0.08, p = 0.027), role emotional (beta = - 0.12, p = 0.007), and physical component score (beta = - 0.14, p <0.001). High baseline FMI was also associated with low HRQoL in all physical domains at baseline (beta: from - 0.38 to - 0.10). Lean mass was not strongly associated with HRQoL at baseline or change in HRQoL. Conclusion In older community-dwelling adults, higher fat mass is, independent of lean mass, associated with lower physical HRQoL and greater decline in HRQoL. Prevention of adiposity may contribute to preservation of a good quality of life in older age.
  • Stenholm, S.; Head, J.; Aalto, V.; Kivimaki, M.; Kawachi, I.; Zins, M.; Goldberg, M.; Platts, L. G.; Zaninotto, P.; Hanson, L. L. Magnusson; Westerlund, H.; Vahtera, J. (2017)
    BACKGROUND: While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies. METHODS: Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9 kg m(-2)) to obesity class II (>= 35 kg m(-2)). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category. RESULTS: The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts. CONCLUSIONS: Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.
  • Lundberg, Johan; Cars, Thomas; Lööv, Sven-Åke; Söderling, Jonas; Tiihonen, Jari; Leval, Amy; Gannedahl, Anna; Björkholm, Carl; Själin, Mikael; Hellner, Clara (2022)
    Objective Major depressive disorder (MDD) is a highly prevalent condition and a significant contributor to global disability. The vast majority of MDD is handled by primary care, but most real-life studies on MDD only include data from secondary care. The aim of this study was therefore to estimate the total clinical and societal burden of incident MDD including data from all healthcare levels in a large well-defined western European healthcare region. Methods Population-wide observational study included healthcare data from Region Stockholm, Sweden's largest region with approximately 2.4 million inhabitants. All patients in Region Stockholm having their first unipolar MDD episode between January 1, 2012, and December 31, 2018, were included. The sample also included matched study population controls. Outcomes were psychiatric and non-psychiatric comorbid conditions, antidepressant therapy use, healthcare resource utilization, work loss, and all-cause mortality. Results In the study period, 137,822 patients in Region Stockholm were diagnosed with their first unipolar MDD episode. Compared with matched controls, MDD patients had a higher burden of non-psychiatric and psychiatric comorbid conditions, 3.2 times higher outpatient healthcare resource utilization and 8.6 times more work loss. MDD was also associated with a doubled all-cause mortality compared with matched controls (HR: 2.2 [95% CI: 2.0-2.4]). Conclusions The high mortality, morbidity, healthcare resource utilization, and work loss found in this study confirms that MDD is associated with individual suffering and low functioning leading to substantial costs for patients and society. These findings should motivate additional efforts in improving outcomes for MDD patients.
  • Kaartinen, Sara; Korhonen, Tellervo; Rottensteiner, Mirva; Kujala, Urho M.; Kaprio, Jaakko; Aaltonen, Sari (2020)
    Leisure-time physical activity has a complex relationship with low back pain (LBP). Thus, we aimed to investigate whether the diversity of sport activities is associated with the type of LBP. In the FinnTwin16 study, 4246 (55% females) Finnish twins at mean age 34.1 years replied to a health behaviour survey in 2010-2012. Based on the participation in different sport activities, we created two measures of diversity: quantity (i.e. the number of sport activities: 1, 2, 3, 4 and >= 5) and quality (i.e. the type of sport activity: endurance, strength, body care, etc.). Based on the frequency, duration and type of LBP, we created three groups: no history of LBP lasting more than one day, radiating LBP and non-radiating LBP. The associations between the quantity and quality of sport activities and the type of LBP were investigated with logistic regression analyses. Participation in >= 5 sport activities associated with less radiating and non-radiating LBP in analyses pooled across sex (odds ratio 0.46, 95% CI 0.30-0.69 and 0.66, 0.44-0.99, respectively). However, the associations attenuated after adjusting for several confounders. Participation in endurance sports was associated with less radiating (0.58, 0.43-0.76) and non-radiating (0.60, 0.44-0.81) LBP, whereas strength sports and body care only with less radiating LBP (0.76, 0.58-1.00 and 0.26, 0.09-0.74, respectively) adjusted for all sport types. On a sport-specific level, running and cycling were associated with less radiating and non-radiating LBP. In adulthood, the diversity of sport activities, particularly participation in endurance sports, may be associated with less radiating and non-radiating LBP.
  • Pérez, Alejandro Garcia; Nieminen, Heikki J.; Finnilä, Mikko; Salmi, Ari; Pritzker, Kenneth P. H.; Lampsijärvi, Eetu; Paulin, Tor; Airaksinen, Anu J.; Saarakkala, Simo; Haeggström, Edward (2018)
    Localized delivery of drugs into articular cartilage (AC) may facilitate the development of novel therapies to treat osteoarthritis (OA). We investigated the potential of spark-gap-generated sound to deliver a drug surrogate, i.e., methylene blue (MB), into AC. In vitro experiments exposed bovine AC samples to either simultaneous sonication and immersion in MB (Treatment 1; n = 10), immersion in MB after sonication (Control 1; n = 10), solely immersion in MB (Control 2; n = 10), or neither sonication nor immersion in MB (Control 3; n = 10). The sonication protocol consisted of 1,000 spark-gap -generated pulses. Delivery of MB into AC was estimated from optical absorbance in transmission light microscopy. Optical absorbance was significantly greater in the treatment group up to 900 mu m depth from AC surface as compared to all controls. Field emission scanning electron microscopy (FESEM), histological analysis, and digital densitometry (DD) of sonicated (n = 6) and non-sonicated (n = 6) samples showed no evidence of sonication-induced changes in proteoglycan content or collagen structure. Consequently, spark-gap -generated sound may offer a solution for localized drug delivery into AC in a non-destructive fashion. Further research on this method may contribute to OA drug therapies.
  • Wikstrom, Miia; Anttila, Heidi; Savinainen, Minna; Kouvonen, Anne; Joensuu, Matti (2020)
    BackgroundThe unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position.MethodsThe Abilitator was developed in 2014-2017. Its construct was assessed by members of academic expert panels (n=30), practical expert panels of professionals (n=700) and target group clients (n=28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels' feedback. The Abilitator was also implemented among target group clients (n=3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel.ResultsThe construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator's 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively.ConclusionThe Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.
  • Niemi, Anna-Maija; Laaksonen, Linda Maria (2020)
    After basic education, the Finnish educational system divides into separate types of upper secondary schools – general and vocational. Vocational schools have long traditions of educating young people with support needs and arranging special education. General upper secondary schools are instead considered to serve ‘academically orientated’ students, and these schools do not necessarily have established support practices. In this article, we examine how the needs of support are discussed in general upper secondary education, and what kinds of meanings they get in a school’s everyday practices. The article is based on an ethnographic study of educational support, study counselling and societal inclusion. Our analysis highlights the school’s study culture as strongly academic, where diverse support practices are not part of the picture. The current resources shape support as an individual and separate addition to general teaching, even though, according to education policy aims, support should be communal and inclusive.
  • Russo, Fabrizio; De Salvatore, Sergio; Ambrosio, Luca; Vadalà, Gianluca; Fontana, Luca; Papalia, Rocco; Rantanen, Jorma; Iavicoli, Sergio; Denaro, Vincenzo (2021)
    Low back pain (LBP) is currently the leading cause of disability worldwide and the mostcommon reason for workers’ compensation (WC) claims. Studies have demonstrated that receivingWC is associated with a negative prognosis following treatment for a vast range of health conditions.However, the impact of WC on outcomes after spine surgery is still controversial. The aim of thismeta-analysis was to systematically review the literature and analyze the impact of compensationstatus on outcomes after lumbar spine surgery. A systematic search was performed on Medline,Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patientsundergoing lumbar spine surgery in which compensation status was reported. Methodologicalquality was assessed through ROBINS-I and quality of evidence was estimated using the GRADErating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patientshad higher post-operative pain and disability, as well as lower satisfaction after surgery whencompared to those without WC. Furthermore, WC patients demonstrated to have a delayed return towork. According to our results, compensation status is associated with poor outcomes after lumbarspine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helpsunderstand the multifactorial nature of the phenomenon.
  • Haapanen, M. J.; Perälä, M. M.; Salonen, M. K.; Kajantie, E.; Simonen, M.; Pohjolainen, P.; Pesonen, A. K.; Räikkönen, K.; Eriksson, J. G.; von Bonsdorff, M. B. (2018)
    Background: Evidence suggests that early life stress (ELS) may extend its effect into adulthood and predispose an individual to adverse health outcomes. We investigated whether wartime parental separation, an indicator of severe ELS, would be associated with frailty in old age. Methods: Of the 972 participants belonging to the present sub-study of the Helsinki Birth Cohort Study, 117 (12. 0%) had been evacuated abroad unaccompanied by their parents in childhood during World War II. Frailty was assessed at a mean age of 71 years according to Fried's criteria. Results: Thirteen frail men (4 separated and 9 non-separated) and 20 frail women (2 separated and 18 non-separated) were identified. Compared to the non-separated men, men who had been separated had an increased relative risk ratio (RRR) of frailty (age-adjusted RRR 3.93, 95% CI 1.02, 15.11) that persisted after adjusting for several confounders. No associations were observed among women (RRR 0.62; 95% CI 0.13, 2.94). Conclusions: These preliminary results suggest that ELS might extend its effects not just into adulthood but also into old age, and secondly, that men may be more vulnerable to the long-term effects of ELS.
  • Jokinen, Hanna; Goncalves, Nicolau; Vigario, Ricardo; Lipsanen, Jari; Fazekas, Franz; Schmidt, Reinhold; Barkhof, Frederik; Madureira, Sofia; Verdelho, Ana; Inzitari, Domenico; Pantoni, Leonardo; Erkinjuntti, Timo; LADIS Study Grp (2015)
    White matter lesions (WML) are the main brain imaging surrogate of cerebral small-vessel disease. A new MRI tissue segmentation method, based on a discriminative clustering approach without explicit model based added prior, detects partial WML volumes, likely representing very early-stage changes in normal-appearing brain tissue. This study investigated how the different stages of WML, from a "pre-visible" stage to fully developed lesions, predict future cognitive decline. MRI scans of 78 subjects, aged 65-84 years, from the Leukoaraiosis and Disability (LADIS) study were analyzed using a self supervised multispectral segmentation algorithm to identify tissue types and partial VVML volumes. Each lesion voxel was classified as having a small (33%), intermediate (66%), or high (100%) proportion of lesion tissue. The subjects were evaluated with detailed clinical and neuropsychological assessments at baseline and at three annual follow-up visits. We found that voxels with small partial WML predicted lower executive function compound scores at baseline, and steeper decline of executive scores in follow-up, independently of the demographics and the conventionally estimated hyperintensity volume on fluid-attenuated inversion recovery images. The intermediate and fully developed lesions were related to impairments in multiple cognitive domains including executive functions, processing speed, memory, and global cognitive function. In conclusion, early-stage partial WML, still too faint to be clearly detectable on conventional MRI, already predict executive dysfunction and progressive cognitive decline regardless of the conventionally evaluated WML load. These findings advance early recognition of small vessel disease and incipient vascular cognitive impairment.
  • Rintala, Aki; Päivärinne, Ville; Hakala, Sanna; Paltamaa, Jaana; Heinonen, Ari; Karvanen, Juha; Sjögren, Tuulikki (2019)
    Objective: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke. Data Sources: A systematic literature search was conducted in 6 databases from January 2000 to May 2018. Study Selection: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (0) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies. Data Extraction: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable. Data Synthesis: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low. Conclusions: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke. (C) 2018 by the American Congress of Rehabilitation Medicine
  • Soukkio, Paula; Suikkanen, Sara; Kääriä, Sanna; Kautiainen, Hannu; Sipilä, Sarianna; Kukkonen-Harjula, Katriina; Hupli, Markku (2018)
    Background: Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. Methods: This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age >= 65) and 300 persons with a recent hip fracture (age >= 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Discussion: Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.
  • Liimatta, Heini; Lampela, Pekka; Laitinen-Parkkonen, Pirjo; Pitkälä, Kaisu H. (2019)
    Objective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. Design: A randomised controlled trial. Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. Setting: Hyvinkaa town municipality, Finland. Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.
  • Taponen, Saara; Lehtimäki, Lauri; Karvala, Kirsi; Luukkonen, Ritva; Uitti, Jukka (2018)
    Background: Asthmatics confront inconveniences in working life that make it more difficult to pursue a sustainable career, such as unemployment and work disability. Ways of dealing with these inconveniences may be career changes. More needs to be known about the backgrounds and consequences of career changes among asthmatics, especially their relation to asthma or a change in asthma symptoms. The aim of this study was to compare earlier career changes of adults with asthma who are working full time to those who have drifted away from active working life because of work disability, unemployment or early retirement. The frequency of having changed tasks, work place or occupation, whether the changes had been driven by asthma and furthermore, whether the changes had affected their asthma symptoms were investigated. Methods: In this population-based survey study, all patients with reimbursement rights for asthma aged 20-65 years in the city of Tampere (total population 190,000), Finland (n = 2613) were recruited. The questionnaire was sent in October 2000 and the response rate was 79%. The questionnaire included questions e.g. on changing tasks, work place and occupation, whether these changes were driven by asthma or associated with change of asthma symptoms. The respondents were divided into four groups: working full-time, work disability, unemployed and retired due to age. We applied ANOVA with Dunnet's post-test (variances were not equal between the groups) for a continued variable age and Chi-squared tests for categorical variables. Logistic regression models were built using unemployed vs. full-time work or work disability vs. full-time work as an outcome variable. A p-value of Results: Adults with asthma working full time had more often made changes in their career, but not as often driven by asthma as those with current work disability. The reason for changing work place compared to full-time workers (24.9%) was more often mainly or partly due to asthma among those with work disability (47.9%, p <0.001) and the unemployed (43.3%, p = 0.006). Of those who made career changes because of asthma, a major proportion (over 67%) reported relief in asthma symptoms. Changing tasks (OR 5.8, 95% CI 1.9-18.0, for unemployment vs. full-time work), work place (OR 2.8, 95% CI 1.1-7.0, for work disability vs. full-time work and OR 2.6, 95% CI 1.3-5.4, for unemployment vs. full-time work) or occupation (OR 2.7, 95% CI 1.2-6.0, for unemployment vs. full-time work) mainly because of asthma was associated with an elevated risk for undesirable employment status even after adjusting for age, gender, smoking and professional status. Conclusions: Career changes that were made mainly because of asthma were associated with undesirable employment status in this study. However, asthma symptoms were relieved after career changes especially among those who reported asthma to be the reason for the change. In addition to proper treatment and counselling of asthma patients towards applicable area of work or study, it may be beneficial to support early career changes in maintaining sustainable working careers among adults with asthma.
  • Hakulinen, Christian; Elovainio, Marko; Arffman, Martti; Lumme, Sonja; Suokas, Kimmo; Pirkola, Sami; Keskimäki, Ilmo; Manderbacka, Kristiina; Böckerman, Petri (2020)
    Objective: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder. Methods: All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015. Results: Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis. Conclusions: The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.
  • James, Spencer L.; Lucchesi, Lydia R.; Bisignano, Catherine; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Henry, Nathaniel J.; McCracken, Darrah; Roberts, Nicholas L. S.; Sylte, Dillon O.; Ahmadi, Alireza; Ahmed, Muktar Beshir; Alahdab, Fares; Alipour, Vahid; Andualem, Zewudu; Antonio, Carl Abelardo T.; Arabloo, Jalal; Badiye, Ashish D.; Bagherzadeh, Mojtaba; Banstola, Amrit; Baernighausen, Till Winfried; Barzegar, Akbar; Bayati, Mohsen; Bhaumik, Soumyadeep; Bijani, Ali; Bukhman, Gene; Carvalho, Felix; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Nasab, Mostafa Dianati; Hoa Thi Do; Huyen Phuc Do; Endries, Aman Yesuf; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Fukumoto, Takeshi; Gebremedhin, Ketema Bizuwork Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gilani, Syed Amir; Haagsma, Juanita A.; Hamidi, Samer; Hostiuc, Sorin; Househ, Mowafa; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Jayatilleke, Achala Upendra; Kahsay, Amaha; Kapoor, Neeti; Kasaeian, Amir; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Ejaz Ahmad; Khazaee-Pool, Maryam; Kokubo, Yoshihiro; Lopez, Alan D.; Madadin, Mohammed; Majdan, Marek; Maled, Venkatesh; Malekzadeh, Reza; Manafi, Navid; Manafi, Ali; Mangalam, Srikanth; Massenburg, Benjamin Ballard; Meles, Hagazi Gebre; Menezes, Ritesh G.; Meretoja, Tuomo J.; Miazgowski, Bartosz; Miller, Ted R.; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Morrison, Shane Douglas; Negoi, Ionut; Trang Huyen Nguyen; Son Hoang Nguyen; Cuong Tat Nguyen; Nixon, Molly R.; Olagunju, Andrew T.; Olagunju, Tinuke O.; Padubidri, Jagadish Rao; Polinder, Suzanne; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rahimi-Movaghar, Vafa; Rawaf, Salman; Rawaf, David Laith; Rezapour, Aziz; Rickard, Jennifer; Roro, Elias Merdassa; Roy, Nobhojit; Safari-Faramani, Roya; Salamati, Payman; Samy, Abdallah M.; Satpathy, Maheswar; Sawhney, Monika; Schwebel, David C.; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Shigematsu, Mika; Soheili, Amin; Stokes, Mark A.; Tohidinik, Hamid Reza; Bach Xuan Tran; Valdez, Pascual R.; Wijeratne, Tissa; Yisma, Engida; Zaidi, Zoubida; Zamani, Mohammad; Zhang, Zhi-Jiang; Hay, Simon; Mokdad, Ali H. (2020)
    Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
  • James, Spencer L.; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Bertolacci, Gregory J.; Cunningham, Matthew; Henry, Nathaniel J.; LeGrand, Kate E.; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abedi, Aidin; Abegaz, Kedir Hussein; Abosetugn, Akine Eshete; Abushouk, Abdelrahman; Adebayo, Oladimeji M.; Adsuar, Jose C.; Advani, Shailesh M.; Agudelo-Botero, Marcela; Ahmad, Tauseef; Ahmed, Muktar Beshir; Ahmed, Rushdia; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alanezi, Fahad Mashhour; Alema, Niguse Meles; Alemu, Biresaw Wassihun; Alghnam, Suliman A.; Ali, Beriwan Abdulqadir; Ali, Saqib; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi-Hashiani, Amir; Almasri, Nihad A.; Altirkawi, Khalid; Amer, Yasser Sami Abdeldayem; Andrei, Catalina Liliana; Ansari-Moghaddam, Alireza; Antonio, Carl Abelardo T.; Anvari, Davood; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Arab-Zozani, Morteza; Arefi, Zohreh; Aremu, Olatunde; Ariani, Filippo; Arora, Amit; Asaad, Malke; Ayala Quintanilla, Beatriz Paulina; Ayano, Getinet; Ayanore, Martin Amogre; Azarian, Ghasem; Badawi, Alaa; Badiye, Ashish D.; Baig, Atif Amin; Bairwa, Mohan; Bakhtiari, Ahad; Balachandran, Arun; Banach, Maciej; Banerjee, Srikanta K.; Banik, Palash Chandra; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Baernighausen, Till Winfried; Barzegar, Akbar; Bayati, Mohsen; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Behzadifar, Masoud; Belete, Habte; Bennett, Derrick A.; Bensenor, Isabela M.; Berhe, Kidanemaryam; Bhagavathula, Akshaya Srikanth; Bhardwaj, Pankaj; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhutta, Zulfiqar A.; Bibi, Sadia; Bijani, Ali; Boloor, Archith; Borges, Guilherme; Borschmann, Rohan; Borzi, Antonio Maria; Boufous, Soufiane; Braithwaite, Dejana; Briko, Nikolay Ivanovich; Brugha, Traolach; Budhathoki, Shyam S.; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Castaldelli-Maia, Joao Mauricio; Castaneda-Orjuela, Carlos A.; Castelpietra, Giulio; Catala-Lopez, Ferran; Cerin, Ester; Chandan, Joht S.; Chapman, Jens Robert; Chattu, Vijay Kumar; Chattu, Soosanna Kumary; Chatziralli, Irini; Chaudhary, Neha; Cho, Daniel Youngwhan; Choi, Jee-Young J.; Chowdhury, Mohiuddin Ahsanul Kabir; Christopher, Devasahayam J.; Dinh-Toi Chu; Cicuttini, Flavia M.; Coelho, Joao M.; Costa, Vera M.; Dahlawi, Saad M. A.; Daryani, Ahmad; Alberto Davila-Cervantes, Claudio; De Leo, Diego; Demeke, Feleke Mekonnen; Demoz, Gebre Teklemariam; Demsie, Desalegn Getnet; Deribe, Kebede; Desai, Rupak; Nasab, Mostafa Dianati; da Silva, Diana Dias; Forooshani, Zahra Sadat Dibaji; Hoa Thi Do; Doyle, Kerrie E.; Driscoll, Tim Robert; Dubljanin, Eleonora; Adema, Bereket Duko; Eagan, Arielle Wilder; Elemineh, Demelash Abewa; El-Jaafary, Shaimaa; El-Khatib, Ziad; Ellingsen, Christian Lycke; Zaki, Maysaa El Sayed; Eskandarieh, Sharareh; Eyawo, Oghenowede; Faris, Pawan Sirwan; Faro, Andre; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Ferrara, Pietro; Fischer, Florian; Folayan, Morenike Oluwatoyin; Fomenkov, Artem Alekseevich; Foroutan, Masoud; Francis, Joel Msafiri; Franklin, Richard Charles; Fukumoto, Takeshi; Geberemariyam, Biniyam Sahiledengle; Gebremariam, Hadush; Gebremedhin, Ketema Bizuwork; Gebremeskel, Leake G.; Gebremeskel, Gebreamlak Gebremedhn; Gebremichael, Berhe; Gedefaw, Getnet Azeze; Geta, Birhanu; Getenet, Agegnehu Bante; Ghafourifard, Mansour; Ghamari, Farhad; Gheshlagh, Reza Ghanei; Gholamian, Asadollah; Gilani, Syed Amir; Gill, Tiffany K.; Goudarzian, Amir Hossein; Goulart, Alessandra C.; Grada, Ayman; Grivna, Michal; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Gaurav; Haagsma, Juanita A.; Hall, Brian James; Hamadeh, Randah R.; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haro, Josep Maria; Hasanzadeh, Amir; Hassan, Shoaib; Hassanipour, Soheil; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hendrie, Delia; Heydarpour, Fatemeh; Hijar, Martha; Ho, Hung Chak; Chi Linh Hoang; Hole, Michael K.; Holla, Ramesh; Hossain, Naznin; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hu, Guoqing; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Inbaraj, Leeberk Raja; Irvani, Seyed Sina Naghibi; Islam, M. Mofizul; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Jahani, Mohammad Ali; Jakovljevic, Mihajlo; Jalilian, Farzad; Jayaraman, Sudha; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; John-Akinola, Yetunde O.; Jonas, Jost B.; Jones, Kelly M.; Joseph, Nitin; Joukar, Farahnaz; Jozwiak, Jacek Jerzy; Jungari, Suresh Banayya; Jurisson, Mikk; Kabir, Ali; Kahsay, Amaha; Kalankesh, Leila R.; Kalhor, Rohollah; Kamil, Teshome Abegaz; Kanchan, Tanuj; Kapoor, Neeti; Karami, Manoochehr; Kasaeian, Amir; Kassaye, Hagazi Gebremedhin; Kavetskyy, Taras; Kayode, Gbenga A.; Keiyoro, Peter Njenga; Kelbore, Abraham Getachew; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalil, Ibrahim A.; Khalilov, Rovshan; Khan, Maseer; Khan, Ejaz Ahmad; Khan, Junaid; Khanna, Tripti; Khazaei, Salman; Khazaie, Habibolah; Khundkar, Roba; Kiirithio, Daniel N.; Kim, Young-Eun; Kim, Yun Jin; Kim, Daniel; Kisa, Sezer; Kisa, Adnan; Komaki, Hamidreza; Kondlahalli, Shivakumar K. M.; Koolivand, Ali; Korshunov, Vladimir Andreevich; Koyanagi, Ai; Kraemer, Moritz U. G.; Krishan, Kewal; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kugbey, Nuworza; Kumar, Nithin; Kumar, Manasi; Kumar, Vivek; Kumar, Narinder; Kumaresh, Girikumar; Lami, Faris Hasan; Lansingh, Van C.; Lasrado, Savita; Latifi, Arman; Lauriola, Paolo; La Vecchia, Carlo; Leasher, Janet L.; Lee, Shaun Wen Huey; Li, Shanshan; Liu, Xuefeng; Lopez, Alan D.; Lotufo, Paulo A.; Lyons, Ronan A.; Machado, Daiane Borges; Madadin, Mohammed; Abd El Razek, Muhammed Magdy; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Maled, Venkatesh; Malta, Deborah Carvalho; Manafi, Navid; Manafi, Amir; Manda, Ana-Laura; Manjunatha, Narayana; Mansour-Ghanaei, Fariborz; Mansournia, Mohammad Ali; Maravilla, Joemer C.; Mason-Jones, Amanda J.; Masoumi, Seyedeh Zahra; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Mehndiratta, Man Mohan; Melketsedik, Zeleke Aschalew; Memiah, Peter T. N.; Mendoza, Walter; Menezes, Ritesh G.; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Meretoja, Atte; Merie, Hayimro Edemealem; Mestrovic, Tomislav; Miazgowski, Bartosz; Miazgowski, Tomasz; Miller, Ted R.; Mini, G. K.; Mirica, Andreea; Mirrakhimov, Erkin M.; Mirzaei-Alavijeh, Mehdi; Mithra, Prasanna; Moazen, Babak; Moghadaszadeh, Masoud; Mohamadi, Efat; Mohammad, Yousef; Darwesh, Aso Mohammad; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohebi, Farnam; Bandpei, Mohammad A. Mohseni; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Lakeh, Maziar; Moradzadeh, Rahmatollah; Morawska, Lidia; Moreno Velasquez, Ilais; Morrison, Shane Douglas; Mossie, Tilahun Belete; Muluneh, Atalay Goshu; Musa, Kamarul Imran; Mustafa, Ghulam; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naik, Gurudatta; Naimzada, Mukhammad David; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Naserbakht, Morteza; Nayak, Vinod; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Ngunjiri, Josephine W.; Trang Huyen Nguyen; Cuong Tat Nguyen; Diep Ngoc Nguyen; Huong Lan Thi Nguyen; Nikbakhsh, Rajan; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oghenetega, Onome Bright; Oh, In-Hwan; Olagunju, Andrew T.; Olagunju, Tinuke O.; Bali, Ahmed Omar; Onwujekwe, Obinna E.; Orpana, Heather M.; Ota, Erika; Otstavnov, Nikita; Otstavnov, Stanislav S.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pakshir, Keyvan; Panda-Jonas, Songhomitra; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Pati, Sanghamitra; Paulos, Kebreab; Peden, Amy E.; Pepito, Veincent Christian Filipino; Pereira, Jeevan; Phillips, Michael R.; Polibin, Roman; Polinder, Suzanne; Pourmalek, Farshad; Pourshams, Akram; Poustchi, Hossein; Prakash, Swayam; Pribadi, Dimas Ria Angga; Puri, Parul; Syed, Zahiruddin Quazi; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafay, Anwar; Rafiee, Ata; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahman, Muhammad Aziz; Rajabpour-Sanati, Ali; Rajati, Fatemeh; Rakovac, Ivo; Rao, Sowmya J.; Rashedi, Vahid; Rastogi, Prateek; Rathi, Priya; Rawaf, Salman; Rawal, Lal; Rawassizadeh, Reza; Renjith, Vishnu; Resnikoff, Serge; Rezapour, Aziz; Ribeiro, Ana Isabel; Rickard, Jennifer; Rios Gonzalez, Carlos Miguel; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Saddik, Basema; Safarpour, Hamid; Safdarian, Mahdi; Sajadi, S. Mohammad; Salamati, Payman; Salem, Marwa R. Rashad; Salem, Hosni; Salz, Inbal; Samy, Abdallah M.; Sanabria, Juan; Riera, Lidia Sanchez; Milicevic, Milena M. Santric; Sarker, Abdur Razzaque; Sarveazad, Arash; Sathian, Brijesh; Sawhney, Monika; Sayyah, Mehdi; Schwebel, David C.; Seedat, Soraya; Senthilkumaran, Subramanian; Seyedmousavi, Seyedmojtaba; Sha, Feng; Shaahmadi, Faramarz; Shahabi, Saeed; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Sheikh, Aziz; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Siabani, Soraya; Sigfusdottir, Inga Dora; Singh, Jasvinder A.; Singh, Pankaj Kumar; Sinha, Dhirendra Narain; Soheili, Amin; Soriano, Joan B.; Sorrie, Muluken Bekele; Soyiri, Ireneous N.; Stokes, Mark A.; Sufiyan, Mu'awiyyah Babale; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Taddele, Biruk Wogayehu; Tefera, Yonatal Mesfin; Tehrani-Banihashemi, Arash; Tekulu, Gebretsadkan Hintsa; Tesema, Ayenew Kassie Tesema; Tesfay, Berhe Etsay; Thapar, Rekha; Titova, Mariya Vladimirovna; Tlaye, Kenean Getaneh; Tohidinik, Hamid Reza; Topor-Madry, Roman; Khanh Bao Tran; Bach Xuan Tran; Tripathy, Jaya Prasad; Tsai, Alexander C.; Tsatsakis, Aristidis; Car, Lorainne Tudor; Ullah, Irfan; Ullah, Saif; Unnikrishnan, Bhaskaran; Upadhyay, Era; Uthman, Olalekan A.; Valdez, Pascual R.; Vasankari, Tommi Juhani; Veisani, Yousef; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vlassov, Vasily; Waheed, Yasir; Wang, Yuan-Pang; Wiangkham, Taweewat; Wolde, Haileab Fekadu; Woldeyes, Dawit Habte; Wondmeneh, Temesgen Gebeyehu; Wondmieneh, Adam Belay; Wu, Ai-Min; Wyper, Grant M. A.; Yadav, Rajaram; Yadollahpour, Ali; Yano, Yuichiro; Yaya, Sanni; Yazdi-Feyzabadi, Vahid; Ye, Pengpeng; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Yoon, Seok-Jun; Youm, Yoosik; Younis, Mustafa Z.; Yousefi, Zabihollah; Yu, Chuanhua; Yu, Yong; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zarei, Fatemeh; Zhang, Zhi-Jiang; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Dandona, Rakhi; Dharmaratne, Samath Dhamminda; Hay, Simon; Mokdad, Ali H.; Pigott, David M.; Reiner, Robert C.; Vos, Theo (2020)
    Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.