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

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

Identificación de las necesidades del desarrollo de las habilidades socioemocionales

In the new educational model of the National Technology of Mexico (TecNM) an axis is established regarding the quality of the teaching and learning process, which seeks not only to improve the technical and cognitive skills of the students, but also to give them a comprehensive training in which They also develop communication skills, adaptability, critical thinking and emotional intelligence, that is, it incorporates a humanistic approach, which is incorporated into the personal and social development of students with an emphasis on the progress of social-emotional skills and stimulates cognitive development. With the purpose that students, teachers and educational service providers adopt the proposal of the educational model of the TecNM to the practice and development of human potentialities, the work that is described below is part of the identification of the needs of the development of the socioemotional skills to generate strategies for the development of well-being, with themselves and with others, through experiences, practices and routines associated with academic activities, facilitating the understanding of emotional states and sources of motivation for the achievement of goals in life .En el nuevo modelo educativo del Tecnológico Nacional de México (TecNM) se establece un eje referente a la calidad del proceso de enseñanza y aprendizaje, que busca no solo mejorar las habilidades técnicas y cognitivas de los estudiantes, sino darles una formación integral en el que también desarrollen aptitudes de comunicación, adaptabilidad, pensamiento crítico e inteligencia emocional, es decir, incorpora un enfoque humanista, que se incorpora al desarrollo personal y social de los estudiantes con énfasis en el progreso de las habilidades socioemocionales y estimula el desarrollo cognitivo. Con el propósito de que los estudiantes, docentes y prestadores de servicios educativos adopten la propuesta del modelo educativo del TecNM a la práctica y desarrollo de las potencialidades humanas, el trabajo que a continuación se describe parte de la identificación de las necesidades del desarrollo de las habilidades socioemocionales para generar las estrategias del desarrollo de bienestar, consigo mismos y hacia los demás, mediante experiencias, prácticas y rutinas asociadas a las actividades académicas, facilitando la comprensión de los estados emocionales y fuentes de motivación para el logro de las metas en la vida

Identification of mammalian noggin and its expression in the adult nervous system

The multiple roles of noggin during dorsal fate specification in Xenopus embryos, together with noggin's ability to directly induce neural tissue, inspired an effort to determine whether a similar molecule exists in mammals. Here we describe the identification of human and rat noggin and explore their expression patterns; we also localize the human NOGGIN gene to chromosome 17q22, and the mouse gene to a syntenic region of chromosome 11. Mammalian noggin is remarkably similar in its sequence to Xenopus noggin, and is similarly active in induction assays performed on Xenopus embryo tissues. In the adult mammal, noggin is most notably expressed in particular regions of the nervous system, such as the tufted cells of the olfactory bulb, the piriform cortex of the brain, and the Purkinje cells of the cerebellum, suggesting that one of the earliest acting neural inducers also has important roles in the adult nervous system

Conocimiento etnoecólogico de los hongos entre los indígenas Uitoto, Muinane y Andoke de la Amazonía Colombiana Conhecimento etnoecológico de fungos entre os indígenas Uitoto, Muinane e Andoke da Amazônia Colombiana

El presente texto es el resultado de un compartir de conocimientos acerca de los hongos y sus relaciones ecológicas con animales y plantas, con las etnias Uitoto, Andoke y Muinane que habitan la región del medio Caquetá. Gran parte de la información ecológica encontrada está contenida en la tradición oral de estas etnias, y refleja la capacidad integradora y descriptiva que tienen los indígenas sobre el medio natural circundante. En la zona de estudio la madera es un sustrato muy abundante debido principalmente al tipo de agricultura que tienen los indígenas, y por tanto se desarrollan una gran cantidad de especies de hongos lignícolas. Muinanes, Uitotos y Andokes conocen algunas de las especies vegetales que sirven de sustrato para los hongos, sobretodo aquellas utilizadas en la alimentación tales como Lentinula raphanica y Lentinus scleropus, entre otros. El conocimiento ecológico que tienen estos indígenas sobre los hongos, incluye además datos acerca de cucarrones (Coleoptera) y larvas (Diptera), mamíferos como venados (Mazama americana y M. gouazoubira) y ardillas (Microsciurus flaviventer) y tortugas que incluyen los hongos en su dieta, así como sobre especies de hongos que parasitan plantas e insectos.<br>O presente texto é o resultado de um intercâmbio de conhecimentos sobre os fungos e as suas relações ecológicas com animais e plantas, com as etnias Uitoto, Andoke e Muinane que habitam a região do Medio Caquetá. Grande parte da informação ecológica encontrada está contida na tradição oral destas etnias e reflete a capacidade integradora e descritiva que os indígenas possuem sobre o meio natural que os circunda. Na zona de estudo a madeira é um substrato abundante devido principalmente ao tipo de agricultura que os indígenas têm, portanto uma grande quantidade de espécies de fungos lignícolas se desenvolve perto dessas tribos. Os Muinanes, Uitotos e Andokes conhecem algumas das espécies vegetais que servem de subtstrato para os fungos, principalmente daquelas que eles utilizam na alimentação, como Lentinula raphanica e Lentinus scleropus, entre outros. O conhecimento ecológico que estes indígenas possuem sobre fungos inclui ainda dados de besouros (Coleoptera) e larvas (Diptera), mamíferos, como veados (Mazama americana e M. gouazoubira) e esquilos (Microsciurus flaviventer), e tartarugas que incluem fungos nas suas dietas, assim como sobre espécies de fungos que parasitam plantas e insetos