Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Responsabilidade civil do Estado por omissão estatal Civil liability of the State for environmental neglect

Constituição Federal de 1988 é um divisor de águas ao assumir-se como Constituição Ambiental, provocando uma ruptura em relação ao conceito de responsabilidade civil. Partindo de uma abordagem qualitativa, dialética e jurisprudencial, este artigo analisa o Princípio Responsabilidade desenvolvido por hans jonas e realiza um diálogo com o instituto da responsabilidade civil ambiental, identificando, com apoio na legislação constitucional e infraconstitucional, as controvérsias doutrinárias acerca da natureza da responsabilidade estatal (objetiva ou subjetiva) frente a casos de omissão da administração pública e à ocorrência de dano ambiental. Conclui-se que o Superior Tribunal de Justiça assume uma dimensão mais alargada do conceito de responsabilidade civil do Estado, demonstrando uma tendência pela responsabilidade civil objetiva com base no risco. Assim, o Brasil, salvo algumas divergências doutrinárias, adota a responsabilidade civil objetiva do Estado pela teoria do risco administrativo alicerçada no ato ilícito e na aceitação do risco.<br>The Federal Constitution of 1988 is a 'water divisor' since it assumes the role of Environmental Constitution, causing a rapture of the concept of civil liability. Starting from a qualitative, dialectical and jurisprudential approach, this article analyzes the Principle of Liability according to Hans Jonas in order to dialogue with the Institute of Civil Environmental Liability, identifying, with the support of the constitutional and infraconstitutional legislation, the doctrinary controversies about the nature of state liability (objective or subjective) towards cases of neglect by the public administration and the event of environmental damage. It is possible to conclude that the Higher Court of Justice assumes a larger dimension of the civil liability of the State, thus showing the tendency towards the objective civil liability based on the risk. Therefore, Brazil, regarded some doctrinary differences, adopts the objective civil liability for the State through the theory of administrative risk based on the illicit act and the acceptance of the risk