22 research outputs found

    Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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    Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

    Platform for Plasmodium vivax vaccine discovery and development

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    Plasmodium vivax is the most prevalent malaria parasite on the American continent. It generates a global burden of 80-100 million cases annually and represents a tremendous public health problem, particularly in the American and Asian continents. A malaria vaccine would be considered the most cost-effective measure against this vector-borne disease and it would contribute to a reduction in malaria cases and to eventual eradication. Although significant progress has been achieved in the search for Plasmodium falciparum antigens that could be used in a vaccine, limited progress has been made in the search for P. vivax components that might be eligible for vaccine development. This is primarily due to the lack of in vitro cultures to serve as an antigen source and to inadequate funding. While the most advanced P. falciparum vaccine candidate is currently being tested in Phase III trials in Africa, the most advanced P. vivax candidates have only advanced to Phase I trials. Herein, we describe the overall strategy and progress in P. vivax vaccine research, from antigen discovery to preclinical and clinical development and we discuss the regional potential of Latin America to develop a comprehensive platform for vaccine development

    Ambiente letrado y estrategias didácticas en la educación preescolar chilena

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    This study analyzes the quality of literate environment and didactic strategies used by preschool teachers in 147 establishments of different socioeconomic environments in Chile. For data collection, the ELLCO (Early Language and Literacy Observation Tool) was used, which includes self-reports, checklists, surveys and rating scales. The results show that the quality of literate environment is low and that there are significant differences between establishments of different socioeconomic level.Cette étude analyse la qualité de l´environnement lettré et des stratégies didactiques utilisés par les éducatrices de préscolaire en 147 salles de préscolaire de différents niveaux socioéconomiques au Chili. Pour réunir les données on a utilisé l´outil ELLCO (Early Language and Literacy Observation Tool), qui inclut auto-rapports, listes de confrontation, entretiens et échelles d´évaluation. Les résultats montrent que la qualité de l´environnement lettré et des stratégies didactiques employées est baisse et qu´existent différences significatives entre les établissements de différent niveau socioéconomique.O presente estudo analisa a qualidade do ambiente letrado e das estratégias didáticas usadas por educadoras em 147 salas de educação infantil de diferentes níveis socioeconômicos no Chile. Para reunir os dados se usou a ferramenta ELLCO (Early Language and Literacy Observation Tool), que inclui autorrelatórios, listas de cotejo, entrevistas e escalas de avaliação. Os resultados mostram que a qualidade do ambiente letrado e das estratégias didáticas empregadas é baixa e que existem diferenças significativas entre estabelecimentos de diferentes níveis socioeconômicos.El presente estudio analiza la calidad del ambiente letrado y de las estrategias didácticas usadas por educadoras de párvulos en 147 salas de preescolar de distintos niveles socioeconómicos en Chile. Para recopilar los datos se usó la herramienta ELLCO (Early Language and Literacy Observation Tool), que incluye autoinformes, listas de cotejo, entrevistas y escalas de valoración. Los resultados muestran que la calidad del ambiente letrado y de las estrategias didácticas empleadas es baja y que existen diferencias significativas entre establecimientos de distinto nivel socioeconómico

    Ambiente letrado y estrategias didácticas en la educación preescolar chilena

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    El presente estudio analiza la calidad del ambiente letrado y de las estrategias didácticas usadas por educadoras de párvu- los en 147 salas de preescolar de distintos niveles socioeconó- micos en Chile. Para recopilar los datos se usó la herramienta ELLCO (Early Language and Literacy Observation Tool), que incluye autoinformes, listas de cotejo, entrevistas y escalas de valoración. Los resultados muestran que la calidad del am- biente letrado y de las estrategias didácticas empleadas es baja y que existen diferencias significativas entre estableci- mientos de distinto nivel socioeconómico

    Ambiente letrado e estratégias didáticas na educação infantil chilena

    No full text
    This study analyzes the quality of literate environment and didactic strategies used by preschool teachers in 147 establishments of different socioeconomic environments in Chile. For data collection, the ELLCO (Early Language and Literacy Ob- servation Tool) was used, which includes self-reports, checklists, surveys and rating scales. The results show that the quality of literate environment is low and that there are significant differences between establishments of different socioeconomic level.El presente estudio analiza la calidad del ambiente letrado y de las estrategias didácticas usadas por educadoras de párvulos en 147 salas de preescolar de distintos niveles socioeconómicos en Chile. Para recopilar los datos se usó la herramienta ELLCO (Early Language and Literacy Observation Tool), que incluye autoinformes, listas de cotejo, entrevistas y escalas de valoración. Los resultados muestran que la calidad del ambiente letrado y de las estrategias didácticas empleadas es baja y que existen diferencias significativas entre establecimientos de distinto nivel socioeconómico.Cette étude analyse la qualité de l’environnement lettré et des stratégies didactiques utilisés par les éducatrices de préscolaire en 147 salles de préscolaire de différents niveaux socioéconomiques au Chili. Pour réunir les données on a utilisé l’outil ELLCO (Early Language and Literacy Observation Tool), qui inclut auto-rapports, listes de confrontation, entretiens et échelles d’évaluation. Les résultats montrent que la qualité de l’environnement lettré et des stratégies didactiques employées est baisse et qu’existent différences significatives entre les établissements de différent niveau socioéconomique.O presente estudo analisa a qualidade do ambiente letrado e das estratégias didáticas usadas por educadoras em 147 salas de educação infantil de diferentes níveis socioeconômicos no Chile. Para reunir os dados se usou a ferramenta ELLCO (Early Language and Literacy Observation Tool), que inclui autorrelatórios, listas de cotejo, entrevistas e escalas de avaliação. Os resultados mostram que a qualidade do ambiente letrado e das estratégias didáticas empregadas é baixa e que existem diferenças significativas entre estabelecimentos de diferentes níveis socioeconômicos

    Literate Environment and Didactic Strategies in Chilean Preschool Education

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    El presente estudio analiza la calidad del ambiente letrado y de las estrategias didácticas usadas por educadoras de párvulos en 147 salas de preescolar de distintos niveles socioeconómicos en Chile. Para recopilar los datos se usó la herramienta ELLCO (Early Language and Literacy Observation Tool), que incluye autoinformes, listas de cotejo, entrevistas y escalas de valoración. Los resultados muestran que la calidad del ambiente letrado y de las estrategias didácticas empleadas es baja y que existen diferencias significativas entre establecimientos de distinto nivel socioeconómico.Cette étude analyse la qualité de l’environnement lettré et des stratégies didactiques utilisés par les éducatrices de préscolaire en 147 salles de préscolaire de différents niveaux socioéconomiques au Chili. Pour réunir les données on a utilisé l’outil ELLCO (Early Language and Literacy Observation Tool), qui inclut auto-rapports, listes de confrontation, entretiens et échelles d’évaluation. Les résultats montrent que la qualité de l’environnement lettré et des stratégies didactiques employées est baisse et qu’existent différences significatives entre les établissements de différent niveau socioéconomique.O presente estudo analisa a qualidade do ambiente letrado e das estratégias didáticas usadas por educadoras em 147 salas de educação infantil de diferentes níveis socioeconômicos no Chile. Para reunir os dados se usou a ferramenta ELLCO (Early Language and Literacy Observation Tool), que inclui autorrelatórios, listas de cotejo, entrevistas e escalas de avaliação. Os resultados mostram que a qualidade do ambiente letrado e das estratégias didáticas empregadas é baixa e que existem diferenças significativas entre estabelecimentos de diferentes níveis socioeconômicos.This study analyzes the quality of literate environment and didactic strategies used by preschool teachers in 147 establishments of different socioeconomic environments in Chile. For data collection, the ELLCO (Early Language and Literacy Ob- servation Tool) was used, which includes self-reports, checklists, surveys and rating scales. The results show that the quality of literate environment is low and that there are significant differences between establishments of different socioeconomic level
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