Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Ultrahigh energy neutrinos at the Pierre Auger observatory

The observation of ultrahigh energy neutrinos (UHEνs) has become a priority in experimental astroparticle physics. UHEνs can be detected with a variety of techniques. In particular, neutrinos can interact in the atmosphere (downward-going ν) or in the Earth crust (Earth-skimming ν), producing air showers that can be observed with arrays of detectors at the ground. With the surface detector array of the Pierre Auger Observatory we can detect these types of cascades. The distinguishing signature for neutrino events is the presence of very inclined showers produced close to the ground (i.e., after having traversed a large amount of atmosphere). In this work we review the procedure and criteria established to search for UHEνs in the data collected with the ground array of the Pierre Auger Observatory. This includes Earth-skimming as well as downward-going neutrinos. No neutrino candidates have been found, which allows us to place competitive limits to the diffuse flux of UHEνs in the EeV range and above.P. Abreu ... K. B. Barber ... J. A. Bellido ... R. W. Clay ... M. J. Cooper ... B. R. Dawson ... T. A. Harrison ... A. E. Herve ... V. C. Holmes ... J. Sorokin ... P. Wahrlich ... B. J. Whelan ... et al

Caracter\uedsticas socioecon\uf3micas y aspectos relacionados con la salud de los trabajadores informales del \ue1rea de influencia del Ambulatorio Tipo I Urbano "El Olivo" Barquisimeto. Mayo-Julio 1996

La finalidad de esta investigaci\uf3n fue reconocer las caracter\uedsticas y algunos aspectos relacionados con la salud de los trabajadores informales, para ello se realiz\uf3 un estudio descriptivo transversal en el \ue1rea de influencia del Ambulatorio Urbano Tipo I "E1 Olivo" de Barquisimeto, la muestra estuvo constituida por 210 individuos seleccionados a conveniencia, a quienes se les aplic\uf3 2 encuestas que permitieron cumplir con los objetivos planteados. Se encontr\uf3 que la mayor\ueda de los sujetos pertenec\uedan al grupo masculino (70.45%), se hallaban en edades comprendidas entre 21 y 50 a\uf1os (45.22%) y estaban casados (45.24%) o eran solteros (39.05%), lo que coincide con otros autores. En lo que se refiere a las clases sociales se determin\uf3 que la mayor parte de la poblaci\uf3n se ubic\uf3 en los estratos medio - bajo u obrero (83.32%) seg\ufan la escala socioecon\uf3mica de Graffar (modificado). La principal actividad en la que se desempe\uf1aban era el comercio (46.67%); realizaban sus actividades durante 6 d\uedas a la semana (57.14%); laboraban m\ue1s de 8 horas diarias (55.71%) y generalmente no disfrutaban de per\uedodos vacacionales (76.19%). El desempleo era la primera causa que los induc\ueda a ingresar a este sector (39.19%). El ingreso semanal de estos trabajadores se situ\uf3 en menos de Bs. 20.000 (82.38%). Se verific\uf3 la tendencia a no asociarse a organizaciones laborales (97.62%). Se determin\uf3 que canalizaban sus problemas de salud a trav\ue9s de servicios m\ue9dicos p\ufablicos (62.39%). Las enfermedades por aparatos y sistemas que m\ue1s frecuentemente les afectaban eran osteomuscular, respiratorio, ORL, cardiovascular y neurol\uf3gico. Teniendo como principales signos y s\uedntomas las astralgias, las del catarro com\ufan, las cefaleas y los al\ue9rgicos. Los factores de riesgo laboral eran desconocidos por estos individuos (65.24%) y por lo tanto no empleaban medidas de protecci\uf3n. Los resultados aqu\ued mostrados reflejan la precariedad en que se desarrolla la actividad informal y las necesidades de este sector. Esta investigaci\uf3n puede ser el punto de partida a futuros estudios que contribuyan y promuevan la protecci\uf3n de la salud del trabajador informal

Rocky reef benthic assemblages in the Magellan Strait and the South Shetland Islands (Antarctica)

Subtidal reef communities from much of the world's coastline have been described in detail, but data from the world's most extensive subantarctic rocky reefs is scarce. The objective was to describe these southern coastal systems and measure the extent to which they vary in terms of fundamental measures of community structure. The Magellan Region constitutes an intermediate site between relatively well-studied temperate regions and Antarctica. Previous studies suggest that dominant canopy species may reflect different disturbance histories and associated communities may similarly be expected to vary structurally. We hypothesized that variation in subtidal sessile assemblages in the Magellan Strait, where Macrocystis pyrifera widely dominates, would be less than at Antarctic sites, where Desmarestia spp. or Himantothallus grandifolius may dominate depending on disturbance regimes. Our results showed that benthic assemblages in the Magellan Strait were similar where physical structure of the reef was similar, but differed strongly where reef form differed. At sites in South Shetland Islands, benthic assemblages differed in terms of dominant macroalgae and sessile community structure; however evidence that the Desmarestia -dominated site was more highly disturbed was equivocal. Shading produced by Macrocystis in Magellan Strait and ice effect in Antarctica are likely strong structuring factors in their respective communities, which would need to be considered when comparing community characteristics.Las comunidades submareales de arrecifes de gran parte de las costas del mundo han sido descritas en detalle, sin embargo, escasa información existe para los extensos arrecifes subantárticos. El objetivo fue describir estos sistemas costeros del sur y medir el grado en que varían en función de las medidas fundamentales de la estructura de la comunidad. La Región Magallánica constituye un sitio intermedio entre sitios relativamente bien estudiados en regiones temperadas y Antártica. Estudios previos sugieren que la especie de alga dominante (dosel) puede reflejar diferentes historias de perturbación así como diferencias en sus comunidades asociadas. Hipotetisamos que la variación en los ensambles submareales sésiles en Magallanes, donde Macrocystis pyrifera domina ampliamente, será menor a la que ocurre en sitios en Antártica, donde Desmarestia spp. o Himantothallus grandifolius dominan dependiendo de los regímenes de disturbios. Los resultados de este estudio muestran que los ensambles bentónicos en el Estrecho de Magallanes fueron similares en aquellos lugares donde la estructura física del arrecife fue similar, pero variaron fuertemente donde la forma del arrecife fue distinta. En los sitios de las Islas Shetland del Sur, los ensambles bentónicos fueron diferentes en términos del alga dominante y la estructura comunitaria. No obstante, la evidencia previa acerca de que sitios dominados por Desmarestia presentan mayor evidencia de disturbios fue incorrecta. Probablemente el efecto de sombra producido por Macrocystis en Magallanes y el efecto del hielo en Antártica son fuertes factores estructuradores en sus respectivas comunidades, situación que debe ser considerada al comparar las características comunitarias

Presencia de agregaciones reproductivas pel\ue1gicas del poliqueto Platynereis australis (Schmarda, 1861) (Nereididae) en aguas someras subant\ue1rticas de Magallanes, Chile

Se reporta la presencia de agregaciones masivas nocturnas constituidas por individuos epítocos (heteronereidos) del poliqueto Platynereis australis asociados a praderas de Macrocystis pyrifera en varias localidades (7) en la zona de canales magallánicos y fueguinos, sur de Chile (53°-55°S, 67°-73°W), en 2006 y 2007. Los especímenes adultos presentaron cambios morfológicos en 2/3 de la parte posterior del cuerpo, presentando parapodios modificados y grandes ojos coalescentes. La región pre-natatoria consiste de 19 a 22 segmentos, mientras que la zona epítoca se compone de 60 a 90 segmentos setígeros. Los especímenes se encontraban sexualmente maduros y las hembras presentaron huevos de tamaño entre 135 y 155 µm de diámetro, indicando una madurez simultánea en la cavidad celómica de cada segmento epítoco. Las agregaciones pelágicas fueron observadas en todos los lugares visitados en primavera. Observaciones efectuadas durante otoño indicaron la presencia de heteronereidos en tubos adheridos a frondas de Macrocystis, situación que podría constituir una etapa intermedia entre la fase bentónica y pelágica. Sin embargo, se requieren mayores estudios para clarificar dicho comportamiento. Se discute la estrecha asociación entre Platynereis y los bosques de M. pyrifera en las diferentes etapas de su ciclo de vida

Polystyrene nanoparticles affect the innate immune system of the Antarctic sea urchin Sterechinus neumayeri

Plastic debris has been recognised as a potential stressor for Antarctic marine organisms. In this study, the effects of surface charged polystyrene nanoparticles (PS NPs) on the immune cells (coelomocytes) of the Antarctic sea urchin Sterechinus neumayeri were assessed through in vitro short-term cultures. The behaviour of anionic carboxylated (PS-COOH) and cationic amino-modified (PS-NH2) NPs in filtered natural sea water (NSW) from King George Island (South Shetland Islands) was characterised by dynamic light scattering. Cellular morphology, NP uptake, phagocytic capacity and gene expression were evaluated after 6 and 24 h of exposure to 1 and 5 \u3bcg mL 121 PS NPs. Secondary characterisation showed an initial good dispersion of PS NPs in NSW, followed by nano-scale aggregation after 24 h. Both PS NPs affected cellular phagocytosis and generated an inflammatory response against oxidative stress and apoptosis at the molecular level. Fluorescently labelled PS-COOH aggregates were internalised by phagocytes and associated to the modulation of genes related to external challenges, antioxidant responses and cell protection against stress and apoptosis. Exposure to PS-NH2 caused a strong decrease in phagocytic capacity and the formation of cellular debris at 5 \u3bcg mL 121 after 24 h, but low gene modulation, suggesting a threshold in coelomocytes defence ability against PS-NH2. This study represents the first attempt to assess the impact of nanoplastics on Antarctic marine organisms. Our findings demonstrate that PS NPs with different surface charges constitute a challenge for S. neumayeri immune cells