INCIDÊNCIA DE DEPRESSÃO E ANSIEDADE ENTRE CRIANÇAS E ADOLESCENTES DURANTE O ISOLAMENTO SOCIAL DECORRENTE DA PANDEMIA PELO SARS-COV-2: UMA REVISÃO DE ESCOPO.

INTRODUCTION: Since the decree by the World Health Organization (WHO) of a worldwide pandemic caused by SARS-CoV-2, social isolation measures impact children and adolescents mainly due to factors such as the importance of peers and group interaction for this population. Therefore, the aim of this study was to investigate in the literature the impact of the new coronavirus pandemic on the mental health of children and adolescents. METHODS: This is a scope review, covering articles in English or Portuguese produced between 2019 and 2021, which addressed the mental health of children and adolescents in the pandemic context. RESULTS: A search was carried out for articles addressing the topic on the PubMed, SciELO and BVS platforms. From a total of 15 articles initially, six were selected. All selected studies show an evidenced relationship between symptoms of anxiety and depression and the COVID-19 pandemic. CONCLUSIONS: Studies indicate that the pandemic was a potential aggravating factor in the development of mental health disorders among children and adolescents, indicating a need to develop preventive actions, prepare health professionals and develop government strategies for reversal this experienced scenario and its consequences.INTRODUCCIÓN: Desde que la Organización Mundial de la Salud (OMS) decretó una pandemia mundial por el SARS-CoV-2, las medidas de aislamiento social han impactado a los niños y adolescentes, principalmente por factores como la importancia de los pares y la convivencia grupal para esta población. Por lo tanto, este estudio tuvo como objetivo investigar en la literatura el impacto de la nueva pandemia de coronavirus en la salud mental de los niños y adolescentes. MÉTODOS: Se trata de una revisión de alcance, que incluye artículos en inglés o portugués producidos en el último año, que abordan la salud mental de niños y adolescentes en el contexto de la pandemia. RESULTADOS: Se realizó una búsqueda de artículos sobre el tema en las plataformas PubMed, SciELO y BVS. De un total de 15 artículos iniciales, se seleccionaron seis. Todos los estudios seleccionados mostraron una clara relación entre los síntomas de ansiedad y depresión y la pandemia de COVID-19. CONCLUSIONES: Los estudios indican que la pandemia fue un factor potencial de agravamiento en el desarrollo de trastornos de salud mental entre niños y adolescentes, indicando la necesidad de desarrollo de acciones preventivas, preparación de los profesionales de la salud y elaboración de estrategias gubernamentales para la reversión de este escenario y sus consecuencias.INTRODUÇÃO: Desde o decreto pela Organização Mundial da Saúde (OMS) de uma pandemia mundial pelo SARS-CoV-2, as medidas de isolamento social impactam crianças e adolescentes principalmente por fatores como a importância dos pares e do convívio em grupo para essa população. Logo, objetivou-se por meio desse estudo investigar na literatura o impacto da pandemia pelo novo coronavírus na saúde mental das crianças e adolescentes. MÉTODOS: Trata-se de uma revisão de escopo, abrangendo artigos em inglês ou português produzidos no último ano, que abordassem saúde mental de crianças e adolescentes no contexto pandêmico. RESULTADOS: Realizou-se uma busca por artigos que abordassem o tema nas plataformas PubMed, SciELO e BVS. De um total de 15 artigos inicialmente, foram selecionados seis. Todos os trabalhos selecionados apresentam relação evidenciada entre sintomas de ansiedade e depressão e a pandemia de COVID-19. CONCLUSÕES: Os estudos indicam que a pandemia foi um fator potencial de agravo no desenvolvimento de transtornos de saúde mental entre as crianças e os adolescentes, indicando uma necessidade de desenvolvimento de ações preventivas, preparação dos profissionais de saúde e elaboração de estratégias governamentais para a reversão desse cenário vivenciado e de suas consequências.INTRODUÇÃO: Desde o decreto pela Organização Mundial da Saúde (OMS) de uma pandemia mundial pelo SARS-CoV-2, as medidas de isolamento social impactam crianças e adolescentes principalmente por fatores como a importância dos pares e do convívio em grupo para essa população. Logo, objetivou-se por meio desse estudo investigar na literatura o impacto da pandemia pelo novo coronavírus na saúde mental das crianças e adolescentes. MÉTODOS: Trata-se de uma revisão de escopo, abrangendo artigos em inglês ou português produzidos no último ano, que abordassem saúde mental de crianças e adolescentes no contexto pandêmico. RESULTADOS: Realizou-se uma busca por artigos que abordassem o tema nas plataformas PubMed, SciELO e BVS. De um total de 15 artigos inicialmente, foram selecionados seis. Todos os trabalhos selecionados apresentam relação evidenciada entre sintomas de ansiedade e depressão e a pandemia de COVID-19. CONCLUSÕES: Os estudos indicam que a pandemia foi um fator potencial de agravo no desenvolvimento de transtornos de saúde mental entre as crianças e os adolescentes, indicando uma necessidade de desenvolvimento de ações preventivas, preparação dos profissionais de saúde e elaboração de estratégias governamentais para a reversão desse cenário vivenciado e de suas consequências

Promoção De Qualidade De Vida Para Pacientes Hemodialíticos / Promotion Of Quality Of Life For Hemodialytic Patients

RESUMEA doença renal crônica é caracterizada pela incapacidade do rim em remover produtos da degradação metabólica e realizar funções reguladoras.  No Brasil, há cerca de 12 milhões de pessoas acometidas pela doença renal, desses 10% tem conhecimento de sua situação; esse número tem crescido no país, a tal ponto que já se considera a nova epidemia do século XXI. O objetivo desse trabalho é realizar ações para melhoria na qualidade de vida de pacientes em tratamento para doenças renais crônicas em uma unidade de tratamento no estado de São Paulo. Durante oito semanas, foram realizadas ações buscando orientar pacientes abordando temas como ingestão de água, alimentação, exercícios físicos, relaxamento mental e autoestima. Para nos permitir realizá-lo os pacientes responderam um questionário adaptado a partir do SF-36 O Medical Outcomes Study 36-item Short-Form Health Survey traduzido e validado para a cultura brasileira na primeira e última visita, e um termo de consentimento livre e esclarecido aceitando participar do projeto. Como resultado, foram obtidos relatos sobre melhorias em conhecimentos acerca da alimentação, quantidade de água que pode ser ingerida, humor e significativa concordância sobre alunos universitários estarem ali promovendo qualidade de vida durante as aulas práticas de Integração Ensino-Comunidade IV ser importante. Não foram obtidos bons resultados relacionados ao exercício físico. Pode-se concluir que tais atividades são de fundamental importância, pois além de promover qualidade de vida, os pacientes relataram alegria com nossa presença as terças-feiras e um ambiente de tratamento mais calmo. Palavras chaves: qualidade de vida, pacientes hemodialíticos, hemodiális

Implante mamário de silicone e Síndrome ASIA: uma revisão de literatura Silicone / Breast Implant and ASIA Syndrome: A Literature Review

OBJETIVO: O estudo objetiva indicar a correlação entre os implantes mamários e a ocorrência da Síndrome ASIA. METODOLOGIA: Os artigos foram selecionados na base de dados PubMed, publicados entre os anos de 2016 e 2021. A pesquisa utilizou os Descritores em Ciência da Saúde (DeCS) e seus sinônimos, em inglês: breast implants, silicones, autoimmune diseases e rheumatic diseases. RESULTADOS: Apesar dos resultados divergentes entre os estudos analisados, em sua maioria a correlação é evidente entre o implante mamário e a ocorrência de doenças autoimunes. DISCUSSÃO: A síndrome ASIA envolve-se como fator adjuvante para o desenvolvimento de autoimunidade, visto que há exacerbação da resposta imunológica, com liberação de citocinas e células de defesa do organismo com a presença dos implantes mamários. O diagnóstico é feito pela sintomatologia e história pregressa da paciente, em que há sintomas característicos. Sendo o principal tratamento a extração das próteses mamárias. Há uma correlação importante entre os baixos níveis de vitamina D com a síndrome ASIA, além da presença de outras doenças autoimunes. CONCLUSÃO: O implante mamário pode ser adjuvante para a ocorrência da síndrome ASIA, sendo reafirmado pelos fatores de melhora após a retirada do silicone

A evolução clínica do paciente portador de abscesso pulmonar: Clinical evolution of patients with lung abscess

Atualmente, com a era da antibioticoterapia e demais meios terapêuticos, o abscesso pulmonar decaiu em termos de morbimortalidade, mas ainda permanece como um desafio em termos diagnósticos e manejo clínico. O abscesso pulmonar corresponde a uma cavidade com pus no pulmão, envolvido por tecido inflamado e geralmente oriunda de uma infecção. O artigo objetivou descrever de modo narrativo a evolução clínica do portador de abscesso pulmonar, ressaltando os principais dados para a compreensão deste fenômeno. Um abscesso pulmonar é causado principalmente por bactérias existentes na boca ou garganta, a qual são aspiradas até os pulmões. A sintomatologia é inespecífica, abordando fadiga, inapetência, sudorese noturna, febre, perda ponderal e tosse com expectoração. O quadro clínico geralmente necessita do complemento de exames de imagem, principalmente a radiografia torácica para diagnóstic

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1.49 million deaths (95% uncertainty interval 1.39-1.59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1.3% in males and 1.6% in females, almost half that of males aged 1-4 years (2.4%), and around a third less than in females aged 1-4 years (2.5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9.5% to 21.6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

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