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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation
Teleo-logía y teo-logía en Edmund Husserl
The problem of God is tackled by E. Husserl and can be found in some passages of his phenomenological analysis. Though he is interested more to perform his method of research than to discuss that particular topic, it is possible to pinpoint that for him teo-logy –in the sense of the rational way to deal with the problem of the Absolute– is linked up with teleo-logy. As in Kant's speculation, but more under the influence of Leibnitz and Fichte, in Husserl's inquiry we find that the finality of natural processes and the ultimate meaning of human being's behavior compelles us to admit an absolute aim and a goal of all things. And that can be nothing else than God
Religion and Spirituality: the Perspective of Health Professionals Religión y espiritualidad: una perspectiva de profesionales de la salud Religião e espiritualidade: um olhar de profissionais de saúde
This study examined how health professionals signify the religiosity and faith of patients under cancer treatment and how they themselves experience such phenomena. This is a qualitative-descriptive study, using the phenomenological framework as set out by Stein and Ales Bello, as a way of understanding the human being in its totality - physical, mental and spiritual. Most professionals report they are spiritualists, two are Catholics, one physician is a Buddhist and another is a Spiritist. They believe that religion is inherent to all human beings. Professionals convicted of their religion (less than half) believe in divine protection and recognize religiosity as a support and comfort for patients and their families in coping with illness. They expect patients to live their faith with prudence, never losing sight of reality.<br>Este estudio tuvo por objetivo comprender como los profesionales de la salud le dan significado a la religiosidad y a la fe de los pacientes en tratamiento de cáncer, y como ellos experimentan ese fenómeno. Se refiere a una investigación cualitativa-descriptiva, bajo el referencial del análisis fenomenológico de Stein y Ales Bello, un modo de comprender al ser humano en su totalidad - física, psíquica y espiritual. La mayoría de los profesionales de la salud se declaró Espiritualista, dos son Católicos, un médico se dice Budista y una médica Espírita. Creen que la religión es inherente a todo ser humano. Los convictos de sus religiones creen en la protección divina y reconocen la religiosidad como sustento y confort para el paciente y sus familiares, también para que puedan enfrentar la situación de enfermarse. Ellos esperan que esos enfermos vivan su fe con prudencia y siempre adhiriendo a la realidad.<br>O estudo teve por objetivos compreender como profissionais de saúde significam religiosidade e fé dos pacientes em tratamento de câncer, e como experienciam esse fenômeno. Trata-se de pesquisa qualitativa-descritiva, sob o referencial de análise fenomenológica em Stein e Ales Bello, um modo de compreender o ser humano na sua totalidade - física, psíquica e espiritual. A maioria dos profissionais de saúde se diz espiritualista, dois são católicos, um médico se diz budista e uma médica espírita. Acreditam que a religião é inerente a todo ser humano. Os convictos de suas religiões creem na proteção divina e reconhecem a religiosidade como sustento e conforto para o paciente e seus familiares enfrentarem a situação de adoecimento. Eles esperam que esses enfermos vivam a sua fé com prudência e sempre aderindo à realidade
Presentazione del libro "L'apparire del mondo" di Leonardo Messinese
REDAZIONE DELLA TAVOLA ROTONDA DI PRESENTAZIONE DEL VOLUME, TENUTASI PRESSO LA SEDE DELLA "SOCIETA' FENOMENOLOGICA ITALIANA", Roma, dicembre 200
Disseminazioni fenomenologiche.A partire dalla fenomenologia della vita
Dall\u2019antica esigenza di \uabsalvare i fenomeni\ubb, molti semi fenomenologici sono stati gettati sul terreno della riflessione filosofica. Da tale ibridazione disseminante si sta costituendo sotto i nostri occhi una rete teoretica originale, alla quale come ad una \u201cfilosofia prima\u201d si annodano i nuovi saperi scientifico-tecnologici, finora tendenzialmente autoreferenziali e si connette il pensiero filosofico tradizionale, di cui la nuova teoresi fenomenologica intende rappresentare l\u2019approfondimento e la continuazione, oltre la crisi.
Opportuno \ue8 sembrato, pertanto, descrivere il farsi della nuova trama di senso, utilizzando il modello della \u201cdisseminazione\u201d, che in botanica indica il processo mediante il quale i semi delle Spermatofite pervengono in un terreno adatto alla germinazione, veicolati o dal vento o dall\u2019acqua o da un animale.
L\u2019autentica disseminazione fenomenologica \ue8 infatti prioritariamente volta alla nuova germinazione, e tuttavia produce uno sviluppo continuo dell\u2019origine stessa: questa si trova immessa in una vasta e imprevedibile rete genealogica, dove la fedelt\ue0 per parentela genetica al senso del seme primitivo si coniuga con la libera variet\ue0 del nuovo germinare che, sui terreni geografici e storici pi\uf9 disparati, fiorisce e fruttifica in una pluralit\ue0 evolutiva, impensabile per la logica e inadeguabile persino dalla dialettica. La teoresi fenomenologica \ue8, del resto, pensiero vivente: ciascun seme porta con s\ue9 la potenza poietico-creativa dell\u2019origine, che nella nuova germinazione si sprigiona, conducendo a maturazione il frutto, per la nuova disseminazione, come la riflessione di Anna-Teresa Tymieniecka ampiamente documenta
Riflessioni sulla famiglia a partire da Michel Henry
Il contributo affronta il tema della famiglia a partire dall’approccio del grande filosofo francese Michel Henry, che superando la prospettiva fenomenologica, propone una filosofia dell’assoluta origine: quella della Vita, condizione di ogni esperienza ‘patica’ e di intellegibilità.The contribution deals with the theme of the family moving from the approach of the great French philosopher Michel Henry, who, overcoming the phenomenological perspective, proposes a theoretical reflection about the absolute origin: that of Life, which is the condition of all experiences, both 'pathic' and of intelligibility