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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Investigation of accessory Allanite, Monazite and Rutile of the Barrovian sequence of the Central Alps (Switzerland)

Accessory Allanite, Monazite and Rutile from amphibolite facies rocks across the Barrovian sequence of the Central Alps (Switzerland) were investigated for textural relationships, composition and U-Th-Pb ages. The crystallisation ages of these minerals record multiple stages of prograde and peak metamorphism, which are notoriously difficult to date at these relatively low temperatures. Synkinematic allanite preserves prograde ages of 26-33 Ma, determined by ion microprobe (SHRIMP). This age is interpreted to record a pressure-dominated phase of metamorphism related to nappe stacking in the Central Alps on the basis of textural relationships, trace element composition, Zr-in-rutile thermometry of rutiles associated with allanite, and likely stability of Allanite in metapelites. The timing of amphibolite facies metamorphism (575-650 degC) is recorded in monazite, rutile and, in one sample, allanite rims. Two samples yield monazite ages of 22.1 +/- 0.4 Ma and 21.6 +/- 0.3 Ma. Monazite grew at the expense of allanite and after the first stage of garnet growth. 19.7 +/- 1.3 Ma Allanite rims in one metapelite crystallised on older (26.8 +/- 1.3 Ma) cores, and are interpreted to reflect the timing of maximum temperature to retrograde conditions. Isotope dilution Rutile ages that contribute to this metamorphic history are the result of an improved Pb separation protocol developed specifically for rutile geochronology. The need for a new protocol was highlighted by poor chemistry yields of standard HBr-based procedures. The new HBr+HF protocol consistently returns higher chemistry yields, suggesting a more complete Pb separation by this procedure. The high chemistry yields are especially important for young samples or small fractions. The potential of Allanite to record fluid-rock interaction has been explored using oxygen isotope analysis of distinct growth stages by ion microprobe (SHRIMP). Magmatic Allanite yielded delta 18O values between 6.8 and 7.8 per mil, when standardised against a reference allanite. Metamorphic allanite show a variation in delta 18O from 4.3 to 13 per mil but much of the variation observed is likely to be biased by matrix effects. A preliminary study into matrix effects in oxygen isotope analysis by SHRIMP suggests an increase in delta 18O with decreasing Allanitic component (Th + LREE) in allanite. Oxygen isotopes in mosaic allanite from an orthogneiss show variation (delta 18O between 4.3 and 7.6) that is larger than is expected from matrix effects, is not correlated with composition and may indicate equilibration with a low delta 18O fluid. The unique mosaic Allanite, which are present in one sample from the Central Alps, are aggregates of multiple subgrains that formed due to deformation and dissolution-precipitation of the high-Th pre-Alpine Allanite grains (preserved as relics in some subgrains). Subgrains have core-rim zoning and subgrain cores record an age of 31.3 +/- 1.1 Ma; subgrain rims range from 26 to 29 Ma. Regularly-zoned allanite from the same sample returns allanite dates between 27 and 32 Ma. The overlap of ages suggests that both mosaic and regularly-zoned allanite grew either at the same time or at different times but within the precision of age determination

Voter Responsiveness to the Spatial Distribution of Goods

How do inequalities in the spatial distribution of public goods shape the way people think about government? Are voters more responsive to particular kinds of public investmentfor instance, in infrastructure? We examine the effect of a sudden influx of government spending, the 2009 American Recovery and Reinvestment Act (ARRA), on support for the President's party. We find that stimulus spending had a positive effect on Democratic vote share, but only in counties that were already Democratic-leaning. Contrary to our theoretical expectations, however, more visible investments did not appear to have a more significant effect than their less visible counterparts regardless of the partisan valence of the county. We discuss possible reasons for these results and directions for future research

Sustainable Biomass Supply from Forest Health and Fire Hazard Reduction Treatments

This report focuses on the translation of potential silvicultural treatments implemented at various levels across the dry-forest landscapes of the interior West to meet feedstock needs for potential biomass processing locations and sizes

Yo-yo subduction recorded by accessory minerals in the Italian Western Alps

High-pressure metamorphic rocks form during subduction of Earth's crust to mantle depths at convergent plate margins. Their exposure at the surface of Earth today provides a record of the subduction zone process. In general, such metamorphic rocks recor

Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi

Objectives Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population.Design and setting Retrospective cross-sectional analysis of facility data from the 2013–2014 Malawi Service Provision Assessment and individual data from the 2015–2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.Participants 2740 children aged 12–23 months living in rural areas.Outcome measures Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.Findings 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).Conclusion Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage

Blueberries Improve Endothelial Function, but Not Blood Pressure, in Adults with Metabolic Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Blueberry consumption has been shown to have various health benefits in humans. However, little is known about the effect of blueberry consumption on blood pressure, endothelial function and insulin sensitivity in humans. The present study investigated the role of blueberry consumption on modifying blood pressure in subjects with metabolic syndrome. In addition, endothelial function and insulin sensitivity (secondary measurements) were also assessed. A double-blind and placebo-controlled study was conducted in 44 adults (blueberry, n = 23; and placebo, n = 21). They were randomized to receive a blueberry or placebo smoothie twice daily for six weeks. Twenty-four-hour ambulatory blood pressure, endothelial function and insulin sensitivity were assessed pre- and post-intervention. The blood pressure and insulin sensitivity did not differ between the blueberry and placebo groups. However, the mean change in resting endothelial function, expressed as reactive hyperemia index (RHI), was improved significantly more in the group consuming the blueberries versus the placebo group (p = 0.024). Even after adjusting for confounding factors, i.e., the percent body fat and gender, the blueberry group still had a greater improvement in endothelial function when compared to their counterpart (RHI; 0.32 ± 0.13 versus −0.33 ± 0.14; p = 0.0023). In conclusion, daily dietary consumption of blueberries did not improve blood pressure, but improved (i.e., increased) endothelial function over six weeks in subjects with metabolic syndrome