Forest Health in the Southern Cone of America: State of the Art and Perspectives on Regional Efforts

The plantation and natural forests of South America have been highly impacted by native and exotic pests in recent decades. The interaction of emerging invasive pests, climate change, and timber markets will define the region’s forests, with significant but uncertain ecological changes and economic losses expected. The Southern Cone Forest Health Group (SCFHG), a joint ad hoc initiative run by forest health professionals from Argentina, Brazil, Chile, and Uruguay, aims to strengthen relationships between the forestry industry, stakeholders, academia, and government agencies across the region. Here, we highlight regional strengths, weaknesses, threats, and opportunities to address forest health issues in the region. A regional approach with a strong communication network is relevant for future actions. In the current global scenario of invasive species and climate change, the implementation of practices that incorporate the resilience of forest ecosystems and sustainable management needs to be prioritized in forest policy across the region. Understanding that pests and pathogens do not recognize borders, we call on governments and organizations to support joint actions with agreements and adequate resources to enhance our regional capabilities.Estación Experimental Agropecuaria BarilocheFil: Villacide, Jose Maria. Instituto Nacional de Tecnologia Agropecuaria (INTA). Estacion Experimental Agropecuaria Bariloche. Area de Recursos Forestales. Grupo de Ecologia de Poblaciones de Insectos; ArgentinaFil: Villacide, Jose Maria. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Investigaciones Forestales y Agropecuarias Bariloche; ArgentinaFil: Gomez, Demian F. Texas A&M Forest Service; Estados UnidosFil: Perez, Carlos Alberto. Universidad de la República Paysandú. Facultad de Agronomia; UruguayFil: Corley, Juan Carlos. Instituto Nacional de Tecnologia Agropecuaria (INTA). Estacion Experimental Agropecuaria Bariloche. Area de Recursos Forestales. Grupo de Ecologia de Poblaciones de Insectos; ArgentinaFil: Corley, Juan Carlos. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Investigaciones Forestales y Agropecuarias Bariloche; ArgentinaFil: Corley, Juan Carlos. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Departamento de Ecologia; ArgentinaFil: Ahumada, Rodrigo. Bioforest S.A. División de Silvicultura y Sanidad; ChileFil: Rodrigues Barbosa, Leonardo. Embrapa Florestas. Empresa Brasileira de Pesquisa Agropecuária; BrasilFil: Furtado, Edson Luiz. Universidade Estadual Paulista. Faculdade de Ciências Agronômicas Botucatu. Departamento de Proteção Vegetal; BrasilFil: Gonzalez, Andres. Universidad de la Republica. Facultad de Quimica; UruguayFil: Ramirez, Nazaret. Área Productividad de las Plantaciones. I&D.Montes del Plata; UruguayFil: Balmelli, Gustavo. Instituto Nacional de Investigacion Agropecuaria. Sistema Forestal; UruguayFil: Dias de Souza, Caroline. Instituto de Pesquisas e Estudos Florestais. Programa Cooperativo Sobre Proteção Florestal; BrasilFil: Martinez, Gonzalo. Instituto Nacional de Investigacion Agropecuaria. Sistema Forestal; Urugua

Efeitos da Redução da Gordura Epicárdica na Duração da Onda P de Obesos Mórbidos Submetidos à Cirurgia Bariátrica

Introdução: A gordura epicárdica (GE) é biologicamente ativa e, por meio de seu efeito parácrino, interage com o miocárdio atrial e pode estar envolvida no remodelamento atrial observado em obesos. A duração da onda P (DOP) é um marcador não invasivo do tempo de condução atrial e reflete alterações relacionadas ao remodelamento atrial. Os efeitos da redução da GE induzida pela cirurgia bariátrica sobre a DOP ainda não foram definidos. Métodos: Recrutamos prospectivamente 22 obesos mórbidos sem outras comorbidades na Unidade de Cirurgia Bariátrica do Hospital das Clínicas da Universidade de São Paulo. Os pacientes foram submetidos a avaliações clínica e laboratorial, além de eletrocardiograma (ECG) de 12 derivações, ecocardiograma bidimensional e Holter de 24 h. A mesma avaliação foi realizada 12 meses após a cirurgia bariátrica. A fim de que as variáveis contínuas fossem comparadas, foram utilizados os testes T pareado e de Wilcoxon. Já para avaliar a associação entre variáveis independentes foi utilizado um modelo de regressão para medidas repetidas. Resultados: Ao todo, 20 pacientes completaram o protocolo (idade: 36,35 ± 10,26 anos, 18 mulheres). Houve uma redução significativa da DOP, do índice de massa corporal (IMC) e da GE após cirurgia bariátrica (p<0,05). Houve também redução média de 11,55 ± 8,49 ms na DOP. Na análise de regressão múltipla, foi observada associação entre a redução da DOP e a redução da GE e do IMC. Conclusões: Em obesos mórbidos sem outras comorbidades, a redução da GE após cirurgia bariátrica foi associada a melhora do remodelamento atrial, indicada por uma redução significativa da DOP

Estudo da interação da radiação de microondas com sistemas biológicos e aplicações

-O objetivo do presente projeto é estudar os possíveis mecanismos da interação de radiação de microondas de baixa intensidade em sistemas biológicos. Realizamos estudos em alguns tecidos vegetais e animais. Com relação ao tecido vegetal estudamos a taxa de crescimento da semente de milho e feijão expostos a radiação de microondas. A faixa de frequencia utilizada nas sementes foi de 10GHz e com uma intensidade em torno de 0,003 microwatts por centímetro quadrado. Pode-se observar um aumento da taxa de germinação nas sementes expostas à radiação de microondas quando comparada com o controle. Também estão sendo realizados experimentos de radiação de microondas proveniente de um telefone celular (GSM 1.8GHz) em ratos. As análises estão focadas nas alterações das proteínas de stress encontradas na glandula pineal dos ratos. Sabe-se que a via de sinalização de MAPKs é a mais importante na regulação transcricional induzida por estímulo extracelular (YOON e SEGER, 2006). ERK1 e ERK2 estão entre as proteínas que atuam nesta via de sinalização, sendo que culturas de Células Rat1 e HeLa apresentaram aumento da expressão de ERK1 e ERK2 (in vitro) quando expostas à radiação de aparelhos celulares (FRIENDMAN et al. 2007). Deste modo, nossos estudos visam avaliar a influência da radiação emitida por celulares sobre ERK1 e 2, além de outras proteínas, como AKT (que atua no ciclo celular), PKC (relacionada com o desenvolvimento de câncer) e TH (muito importante no sistema nervoso central). Para o presente estudo foi desenvolvido no Laboratório de Óptica da UFJF um dispositivo capaz de realizar ligações de um aparelho de celular sem influenciar na radiação emitida. O equipamento é controlado por um micorcontrolador PIC12F675 e usa um motor de passo PM55L-048 para pressionar as teclas

Perfil periodontal de puérperas que geraram recém-nascidos prematuros e de baixo peso ao nascer

Estudos são realizados referente ao perfil periodontal e possíveis associações da doença periodontal com desfechos adversos na gravidez. As alterações hormonais que ocorrem nesse período podem intensificar as doenças periodontais e assim gerar implicações para a gestante e para o feto. Desde forma, o objetivo deste estudo foi avaliar o perfil periodontal e características gestacionais de puérperas que tiveram parto prematuro e recém-nascidos com baixo peso ao nascer (BPN) em uma unidade de saúde pública de referência no Norte do Brasil. O estudo observacional foi realizado por meio de amostra de conveniência, com 50 puérperas no período de agosto e setembro de 2017, por meio de uma anamnese criteriosa e exame clínico intraoral, que constavam a avaliação dos principais parâmetros clínicos periodontais. O perfil periodontal foi classificado como saudável ou com doença periodontal (DP), considerando a presença de gengivite ou periodontite. Foi realizada a associação dos dados materno com o perfil periodontal. Nos resultados, observou-se que 54% (27) das puérperas apresentam DP, dessas, 12 relataram apresentar alguma doença sistêmica. Não houve associação estatística do perfil periodontal com a idade materna, doença sistêmica e uso do fio dental. Houve associação da presença de DP com a escovação diária inferior ou igual a 2 vezes e houve associação da ausência da DP com a escovação diária de 3 vezes ou mais, durante a gestação. Por meio dos resultados foi possível observar que o perfil periodontal com a presença de DP foi encontrado na maior parte de puérperas com RN prematuros e BPN e que a quantidade de escovação diária está associada com o perfil periodontal de mulheres que tiveram parto prematuro e bebês de BPN

Efeito da radiação emitida por telefones móveis na via de sinalização das MAPK de células da hipófise de ratos

Nos últimos anos, o sistema de telecomunicação móvel tem crescido significativamente, de modo que um sexto da população mundial utiliza telefones móveis. Tais aparelhos e estações de base emitem rádio-frequência ou micro-ondas. Sabe-se que a exposição a esses tipos de radiação pode afetar diretamente a saúde, modificando, por exemplo, a cascata de sinalização das MAPK’s (proteínas quinases ativadas por mitógeno). Essa cascata atua no controle de vários processos celulares, incluindo diferenciação, proliferação, apoptose, síntese e secreção de hormônios. Neste trabalho, foram avaliados, por western blotting, os níveis de expressão das enzimas ERK 1 e ERK 2 (quinase regulada por sinais extracelulares) da hipófise de ratos wistar machos de 60 dias, expostos à radiação emitida por aparelhos celulares (1800MHz), e constatamos um aumento significativo da expressão destas enzimas. Estes resultados demonstram que este tipo de radiação é capaz de alterar a cascata de sinalização das MAPK’s, o que pode afetar o funcionamento das células hipofisárias de ratos Wistar

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

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

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks 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 (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning