60 research outputs found
Charcoal chronology of the Amazon forest: A record of biodiversity preserved by ancient fires
This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.he Amazon region holds a wide variety of ethnic groups and microclimates, enabling different interactions between humans and environment. To better understand the evolution of this region, ancient remains need to be analysed by all possible means. In this context, the study of natural and/or anthropogenic fires through the analysis of carbonized remains can give information on past climate, species diversity, and human intervention in forests and landscapes. In the present work, we undertook an anthracological analysis along with the 14 C dating of charcoal fragments using accelerator mass spectrometry (AMS). Charcoal samples from forest soils collected from seven different locations in the Amazon Basin were taxonomically classified and dated. Out of the 16 groups of charcoal fragments identified, five contained more than one taxonomic type, with the Fabaceae, Combretaceae and Sapotaceae families having the highest frequencies. 14 C charcoal dates span ∼6000 years (from 6876 to 365 yr BP) among different families, with the most significant variation observed for two fragments from the same sampling location (spanning 4000 14 C yr). Some sample sets resulted in up to five different families. These findings demonstrate the importance of the association between anthracological identification and radiocarbon dating in the reconstruction of paleo-forest composition and fire history.The authors thank the Brazilian agencies Conselho Nacional de Desenvolvimento CientÃfico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de NÃvel Superior (CAPES), and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ). KDM thanks CNPq for fellowship 305079/2014–0. CL thanks FAPEAM/FAPESP (09/53369-6, led by Flávia Regina Capellotto Costa) for financial support and Thaise EmÃlio, José Luiz Purri da Veiga Pinto, Rosineide Machado and Francislaide da Silva Costa for help with charcoal collection. TRF, BSM, and BHM acknowledge financial support from NERC (NE/N011570/1), CAPES/CNPq Science without Borders (PVE 177/2012 and PVE 401279/2014-6), CNPq/PPBio (457602/2012-0), CNPq/PELD (403725/2012-7) and the University of Exeter - College of Life and Environmental Sciences
Validation of the brazilian version of the berg balance scale for patients with parkinson's disease
Techniques to improve the maintenance of a laboratory colony of Nyssomyia neivai (Diptera: Psychodidae)
Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
Background:
Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels.
Methods:
We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level.
Findings:
In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]).
Interpretation:
The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.
Funding:
Bill & Melinda Gates Foundation
Meta-analyses including non-randomized studies of therapeutic interventions: a methodological review
Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
Summary
Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and
post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a
systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information
to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results
presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from
GBD 2016.
Methods We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence,
prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years
(DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an
ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were
generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative
records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational
attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles.
Findings In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to
stroke. The global age-standardised mortality rate decreased by 36·2% (–39·3 to –33·6) from 1990 to 2016, with
decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2%
(–37·2 to –31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in
2016. Global age-standardised incidence declined by 8·1% (–10·7 to –5·5) from 1990 to 2016 and decreased in all SDI
quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in
2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men.
Interpretation Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in
age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned
updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and
intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a
risk factor
Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Background:
The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.
Methods:
We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting.
Findings:
Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]).
Interpretation:
Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury
Meeting the Milestones. Strategies for Including High-Value Care Education in Pulmonary and Critical Care Fellowship Training
- …