Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 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

Evaluation of the effective mass of the body for helmet impacts

Currently available motorcycle helmet standards employ headforms to assess the impact absorption capability of helmets. The mass and size of the headforms are similar to those of the human head. This fact implies that the standards rely on the assumption that the effect of the rest of the body on the performance of the helmet during impact is negligible. In this study, by using validated finite element (FE) models of a commercially available helmet and of the human body, full-body helmet impacts are simulated. Even within the short duration of the impacts (less than 10 ms), the body interacts with the head, leading to further crushing of the helmet liner. To include this effect in the headform impacts, the mass of the headform is increased. The added mass is determined for various impact configurations. It is found that the added mass is not dependent on the properties of the helmet; thus, it can be adopted by the impact absorption test of standards

Book Reviews

The Intelligence Wars: Lessons from Baghdad by Steven K.O\u27Hern. Spies for Hire: The Secret World of Intelligence Outsourcing by Tim Shorrock. The Shadow Factory: The Ultra-Secret NSA from 9/11 to the Eavesdropping on America by James Bamford. Human Intelligence, Counterterrorism, and National Leadership: A Practical Guide by Gary Berntsen. Executive Measures, Terrorism, and National Security—Have the Rules of the Game Changed? by David Bonner. The Human Factor: Inside the CIA\u27s Dysfunctional Intelligence Culture by Ishmael Jones. The Lost Spy: An American in Stalin\u27s Secret Service by Andrew Meier. Threats to Homeland Security: An All-Hazards Perspective. Edited by Richard J. Kilroy, Jr

Performing age in the star body of Mickey Rourke

Ultra-high molecular weight polyethylene (UHMWPE) fibre reinforced composite materials are widely used in ballistic impact and collision scenarios due to their extremely high specific strength and stiffness. Exceptional levels of protection are provided by controlling the damage and deformation mechanisms over several length scales. In this study, the role of UHMWPE fibre architecture (cross-ply, quasi-isotropic and rotational “helicoidal” layups) is considered on the damage and deformation mechanisms arising from low velocity impacts with 150 J impact energy and clamped boundary conditions. Dyneema® panels approximately 2.2 mm thick were impacted with a fully instrumented hemi-spherical impactor at velocities of 3.38 m/s. Full field deformation of the panels was captured through digital image correlation (DIC). The results indicate that the cross-ply laminate [0°/90°] had the largest back face deflection, whilst quasi-isotropic architectures restricted and reduced the central deflection by an average of 43%. In the case of the [0°/90°] panel, the deformation mechanisms were dominated by large amounts of in-plane shear with limited load transfer from primary fibres. Conversely, the failure of the quasi-isotropic panels were dominated by large amounts of panel buckling over various length scales. The observed mechanisms of deformation with increasing length scale were; through thickness fibre compression, fibre micro-buckling, fibre re-orientation with large matrix deformation, lamina kink band formation, and laminate buckling. The helicoidal panels showed that bend-twist and extension-twist coupling were important factors in controlling clamped boundary conditions and the laminate buckling/wrinkling shape. Further examination of the impact zone indicated that the damage mechanisms appear to be fibre orientation dependent, with quasi-isotropic laminates having up to 37.5% smaller impact damage zones compared with [0°/90°]. The experimental observations highlight the importance of fibre orientation in controlling the deformation mechanisms under dynamic impact, in particular limiting the shear deformation of Dyneema® panels

Book Reviews

The Intelligence Wars: Lessons from Baghdad by Steven K.O\u27Hern. Spies for Hire: The Secret World of Intelligence Outsourcing by Tim Shorrock. The Shadow Factory: The Ultra-Secret NSA from 9/11 to the Eavesdropping on America by James Bamford. Human Intelligence, Counterterrorism, and National Leadership: A Practical Guide by Gary Berntsen. Executive Measures, Terrorism, and National Security—Have the Rules of the Game Changed? by David Bonner. The Human Factor: Inside the CIA\u27s Dysfunctional Intelligence Culture by Ishmael Jones. The Lost Spy: An American in Stalin\u27s Secret Service by Andrew Meier. Threats to Homeland Security: An All-Hazards Perspective. Edited by Richard J. Kilroy, Jr

Book Reviews

The Intelligence Wars: Lessons from Baghdad by Steven K.O\u27Hern. Spies for Hire: The Secret World of Intelligence Outsourcing by Tim Shorrock. The Shadow Factory: The Ultra-Secret NSA from 9/11 to the Eavesdropping on America by James Bamford. Human Intelligence, Counterterrorism, and National Leadership: A Practical Guide by Gary Berntsen. Executive Measures, Terrorism, and National Security—Have the Rules of the Game Changed? by David Bonner. The Human Factor: Inside the CIA\u27s Dysfunctional Intelligence Culture by Ishmael Jones. The Lost Spy: An American in Stalin\u27s Secret Service by Andrew Meier. Threats to Homeland Security: An All-Hazards Perspective. Edited by Richard J. Kilroy, Jr