The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

S’approprier son genre entre pathologie et résistance. La transidentité après la Révolution islamique en Iran

La question du changement de sexe en Iran après la révolution islamique de 1979 revêt une certaine originalité. Chaque culture a sa manière propre d’appréhender la question de la transgression du genre. Elle peut être déviance pour les uns, pathologie ou choix identitaire pour les autres. La reconnaissance légale de l’identité trans est rendue possible dans certains pays mais, en majorité, la transgression de genre est ignorée voire sanctionnée. En Iran la spécificité de cette reconnaissance ..

Gender transition after islamic revolution in Iran : trans subjectivity between pathology and resistance

L'histoire de l'identité trans et sa légalisation après la Révolution islamique de 1979 en Iran laisse souvent perplexe les observateurs étrangers. Chaque pays a sa propre façon d'accepter, d'ignorer ou de réprimer la demande de la transition de genre. Le rôle important du discours religieux sur la transition de genre en Iran est lié à la fatwa de l'ayatollah Khomeini, qui a sanctionné la réassignation sexuelle dans une société où toute identité non binaire et toute orientation non hétérosexuelle est un acte criminel. La fatwa a été publiée pour la première fois en 1967 et, après la révolution de 1979, dans les années 1980, cette fatwa a acquis soutien, financement et force dans la loi. Le discours juridique de la République islamique admet la possibilité d'une inadéquation entre le sexe et le genre et met à disposition les moyens médicaux pour guérir la souffrance de la personne trans. La catégorisation psychiatrique et le protocole médico-légal du changement de sexe constituent une réponse légitime à la « souffrance » chez les personnes trans. La souffrance en question fait référence aux sentiments d'un individu trans qui croit que son âme est « piégée dans le mauvais corps ». La légalisation de l'identité trans en Iran renvoie à des processus de biopouvoir où les technologies de genres sont au service d'un processus de normalisation de l'individu non binaire. Néanmoins, les individus trans utilisent leurs corps comme un outil de pouvoir pour actualiser leur propre définition du genre et de l'être genré. Nous analysons la construction iranienne des subjectivités trans dans une approche foucaldienne du pouvoir, du savoir et du sujet, dans trois domaines : (i) Le discours religieux qui légalise le changement de sexe, (ii) Le discours psychiatrique et légal qui catégorise l'identité trans en tant que « trouble de l'identité de genre » et (iii) Les réactions des individus trans au système. La corporéité du genre est un processus de « devenir » entre une autoconstruction identitaire de l'individu trans et la construction politico-légale des identités trans dans chaque société. Nous avons cherché à critiquer l'assujettissement du sujet en proposant d'autres modalités de l'interpellation non institutionnelles et non idéologique de l'individu trans en sujet trans. Ainsi nous avons essayé de redéfinir la transition de genre comme un « passage » dans un paradigme non pathologique inspiré par le concept de rhizome développé par Deleuze et Guattari et nous utilisons ce concept pour analyser la transition de genre et la possibilité de multiple forme d'identification. Le statut des personnes trans iraniennes se situe entre la pathologie et la résistance. L'individu trans construit son identité et transgresse les normes du genre. En s'orientant, en changeant, en choisissant, l'individu modifie inévitablement ce qu'il devient. Le corps dans cette transition est au cœur de la résistance trans dans son parcours de subjectivation. Les individus trans iraniens réagissent différemment au discours protocolaire de changement de sexe. Nous avons distingué les différentes modalités de réaction au protocole de changement de sexe que nous avons décrit en trois typologies de réactions chez les personnes trans. Le contexte sociopolitique de la société iranienne limite le transactivisme et les mouvements collectifs trans. Nous essayons d'introduire un type de résistance des individus trans iraniens qui ne soit ni une résistance révolutionnaire ou rebelle ni une résistance publique et collective. Nous développons le concept de « résistance quotidienne » qui décrit comment les personnes trans agissent dans leur quotidien de manière à porter atteinte au pouvoir. Pour enrichir notre analyse, nous avons suivi les activités théâtrales d'un acteur et metteur en scène trans qui sensibilise le public à travers ses performances.The history of trans identity in Iran and its legalization after the Islamic Revolution of 1979 often seems perplexing to outside observers. Each country has its own way of accepting, ignoring or repressing the gender transition. The important role of religious discourse on gender transition in Iran is related to the famous fatw' of Ayatollah Khomeini, which sanctioned sex change, in a society where any non-binary identity and non-heterosexual orientation is a criminal act. The fatwa was published first in 1967 and after the 1979 Revolution, in the 1980s, his fatwa gained support, finance and force of law. The legal discourse of the Islamic Republic, which accepts the possibility of inadequation between sex and gender and the medical means of remedying trans suffering, remains beholden to the binary notion of gender. Psychiatric labeling and the medico-legal protocol of sex change are a legitimating reply to trans individual "suffering". Here, the suffering in question refers to the feelings of an Iranian trans individual who believes that his/her soul is "trapped in the wrong body". A biopolitical analysis shows how mandatory sterilization manage bodies and their productive and reproductive capacities and roles in society by putting in concrete territories, the non-binaire bodies as threats to heterocentrist hegemony. Nevertheless, trans individuals use theirs bodies as a site of power, to actualize their own definition of gender binary and being. We analyze the Iranian construction of trans subjectivities by Foucault's concept of power, knowledge and subject in three domains: (i) The religious discourse which legalizes sex change, (ii) The power-knowledge discourse which categorizes trans identity as "gender identity disorder", and (iii) The trans individual reactions to the system. Embodying gender is a process of "becoming" between a trans self-construction and the politico-legal construction of trans identities in each society. The "wrong body narrative" then depends on the conversion of body and self-gender identity and the discursive production of gender binary norms in each society. We try to redefine gender transition as a "passage" in a non-pathological paradigm inspired by Deleuze and Guattari's concept of "rhizome" that we use for analyzing gender transition. Iranian trans individual's status is located beyond resistance and pathology. The trans individual builds his identity and intervenes, in addition, on the norms of the gender. By orienting oneself, by changing, by choosing, the individual inevitably modifies what they become. Bodies in this transition are the center of trans resistance as a process of subjectivisation. Iranian trans individuals react differently to the dominant gender discourse of the society. We made three typologies of trans subjectivities in reaction to legal protocol of sex change. The socio-political context of the society limits all kinds of transactivisme and trans movements. We try to introduce a special kind of resistance of Iranian trans individuals that is not a revolutionary or rebellious resistance, nor is it a public and collective one; it is closer to the concept of "everyday resistance" that describes how people act in their everyday lives in ways that might undermine power. We observed the activities of a trans performer who attempts to sensibilize society about trans identity

Les trans-subjectivités en Iran : une méconnaissance épistémique

Gender Affirmation Surgery (GAS), or Amali Tasdigi Jinsiyat in Persian, was permitted by Ayatollah Khomeini’s fatwa in 1982. Although GAS is allowed under Islamic law, trans subjectivities in Iran are misrecognized. Here we investigate the construction of trans subjectivities in Iranian society through an intersectional analysis of different power relations. We analyse discourses and practices of gender at structural, institutional and individual levels. We build on the concept of ‘epistemic misrecognition’ to explain how Iranian trans people’s status is misrecognized both inside and outside Iran, which has made Iranian trans people and their experience invisible in society. Furthermore, we employ the notion of ‘subjectivation’ to describe the multiplicities of trans subjectivation in Iranian society. We apply Critical Discourse Analysis to analyse forty-six semi-structured face-to-face interviews conducted during 2015–2018

Alpha oscillatory activity during attentional control in children with Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and ASD+ADHD

BACKGROUND: Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) share impairments in top-down and bottom-up modulation of attention. However, it is not yet well understood if co-occurrence of ASD and ADHD reflects a distinct or additive profile of attention deficits. We aimed to characterise alpha oscillatory activity (stimulus-locked alpha desynchronisation and prestimulus alpha) as an index of integration of top-down and bottom-up attentional processes in ASD and ADHD. METHODS: Children with ASD, ADHD, comorbid ASD+ADHD, and typically-developing children completed a fixed-choice reaction-time task (‘Fast task’) while neurophysiological activity was recorded. Outcome measures were derived from source-decomposed neurophysiological data. Main measures of interest were prestimulus alpha power and alpha desynchronisation (difference between poststimulus and prestimulus alpha). Poststimulus activity linked to attention allocation (P1, P3), attentional control (N2), and cognitive control (theta synchronisation, 100–600 ms) was also examined. ANOVA was used to test differences across diagnostics groups on these measures. Spearman’s correlations were used to investigate the relationship between attentional control processes (alpha oscillations), central executive functions (theta synchronisation), early visual processing (P1), and behavioural performance. RESULTS: Children with ADHD (ADHD and ASD+ADHD) showed attenuated alpha desynchronisation, indicating poor integration of top-down and bottom-up attentional processes. Children with ADHD showed reduced N2 and P3 amplitudes, while children with ASD (ASD and ASD+ADHD) showed greater N2 amplitude, indicating atypical attentional control and attention allocation across ASD and ADHD. In the ASD group, prestimulus alpha and theta synchronisation were negatively correlated, and alpha desynchronisation and theta synchronisation were positively correlated, suggesting an atypical association between attentional control processes and executive functions. CONCLUSIONS: ASD and ADHD are associated with disorder-specific impairments, while children with ASD+ADHD overall presented an additive profile with attentional deficits of both disorders. Importantly, these findings may inform the improvement of transdiagnostic procedures and optimisation of personalised intervention approaches

Resting-State Neurophysiological Activity Patterns in Young People with ASD, ADHD, and ASD + ADHD

Altered power of resting-state neurophysiological activity has been associated with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), which commonly co-occur. We compared resting-state neurophysiological power in children with ASD, ADHD, co-occurring ASD + ADHD, and typically developing controls. Children with ASD (ASD/ASD + ADHD) showed reduced theta and alpha power compared to children without ASD (controls/ADHD). Children with ADHD (ADHD/ASD + ADHD) displayed decreased delta power compared to children without ADHD (ASD/controls). Children with ASD + ADHD largely presented as an additive co-occurrence with deficits of both disorders, although reduced theta compared to ADHD-only and reduced delta compared to controls suggested some unique markers. Identifying specific neurophysiological profiles in ASD and ADHD may assist in characterising more homogeneous subgroups to inform treatment approaches and aetiological investigations.<br/