FAUNA DO SOLO AO LONGO DO PROCESSO DE SUCESSÃO ECOLÓGICA EM VOÇOROCA REVEGETADA NO MUNICÍPIO DE PINHEIRAL – RJ

The diversity, richness and composition of the soil epigeous fauna community were evaluated in a re-vegetated gully at the Instituto Federal de Educação (IFRJ) campus Nilo Peçanha, in the municipality of Pinheiral, Rio de Janeiro state. Revegetation was performed in 2000, and consisted of four different strategies involving N-fixing trees: planting Acacia mangium Willd. (PA); planting Mimosa caesalpiniifolia Benth. (PM); on the outer edges of the gully head (PTS); and planting a mix of legume tree species into the gully (IVR2000). A. mangium and M. caesalpiniifolia were planted above the gully head. A nearby 20-year secondary forest remnant was used as a reference site. Ten pitfall traps were used for the sampling of epigeous fauna at each one of the five areas (MOLDENKE, 1994). Sampling was performe in May 2000, June 2006, and April 2008. Six years after revegetation has started, fauna group richness and diversity increased both into the gully and in Mimosa caesalpiniifolia plantation. For the 2000 and 2006 samplings a PCA showed that groups were mostly associated to 2006, and completely opposite to 2000. Acacia mangium plantation had the lowest group richness. In the 2008 sampling, pasture showed the lowest group richness, and according to the PCA groups into the gully were associated to 2008, and completely opposite to 2000 and 2006. Formicidae and Collembola (Entomobryomorpha) were dominant in all sampled areas, both in 2000 and 2008, and into the gully in 2006 as well.O objetivo do trabalho foi avaliar a diversidade, riqueza e composição da comunidade da fauna do solo epígea em uma voçoroca revegetada no ano de 2000 com diferentes espécies de leguminosas arbóreas. A voçoroca está localizada no Instituto Federal de Educação (IFRJ) campus Nilo Peçanha no município de Pinheiral – RJ. Foram avaliadas as seguintes áreas: plantio de Acacia mangium Willd. (PA), plantio de Mimosa caesalpiniifolia Benth. (PM), plantio de leguminosas arbóreas no terço superior da encosta (PTS), plantio de leguminosas no interior da voçoroca (IVR2000). Os plantios de A. mangium e M. caesalpiniifolia foram realizados antes da revegetação. Para efeito comparativo também foi avaliada uma área de floresta secundária com 20 anos, próxima ao local de coleta. Na coleta da fauna do solo epígea foram utilizadas 10 armadilhas do tipo pitfall (MOLDENKE, 1994) por área. Foram realizadas três coletas, uma no início da revegetação, em maio de 2000, em junho de 2006 e abril de 2008. Houve um aumento no número de grupos e na diversidade da fauna do solo no plantio no terço superior, no interior da voçoroca, e no plantio de Mimosa caesalpiniifolia após 6 anos da intervenção. Nas coletas realizadas em 2000 e 2006, a APC mostrou que a maioria dos grupos estava associada ao ano de 2006, mostrando total antagonismo com o ano de 2000. O plantio de Acacia mangium foi a área com o menor número de grupos. Na coleta realizada em 2008, a pastagem foi a área com menor número médio de grupos coletados e na ACP do interior da voçoroca os grupos estavam associados ao ano de 2008 com total antagonismo com os anos de 2000 e 2006. Os grupos Formicidae e Collembola (Entomobryomorpha) foram os mais dominantes em todas as áreas amostradas no ano de 2000 e 2008 e no interior da voçoroca ano de 2006

Nitrogen-fixing trees and soil macrofauna in Digitaria hybrid pasture

O objetivo deste trabalho foi avaliar o efeito de três leguminosas arbóreas sobre a densidade e a diversidade de macrofauna de um Argissolo Vermelho-Amarelo, de baixa fertilidade natural. Duas espécies fixadoras de nitrogênio atmosférico, a orelha-de-negro (Enterolobium contortisiliquum) e o jacarandá-da-baía (Dalbergia nigra), e uma não-fixadora, o angico-canjiquinha (Peltophorum dubium), foram consorciadas em pastagem de capim survenola (híbrido interespecífico entre Digitaria setivalva e Digitaria valida), tendo por testemunha pasto a pleno sol. Formicidae foi o grupo mais abundante em todos os tratamentos, sendo seguido por Oligochaeta, com 47% nos tratamentos com leguminosas e 23% no pasto a pleno sol. Os maiores valores em diversidade de fauna foram obtidos nas amostragens sob as copas das leguminosas fixadoras de N2. A análise multivariada de agrupamento mostrou que o consórcio formado com orelha-de-negro apresentou grupos de fauna bastante semelhantes ao do consórcio formado com jacarandá-da-baía. De acordo com a análise multivariada de correspondência, as leguminosas arbóreas contribuíram para aumentar a densidade de alguns grupos de fauna, principalmente Oligochaeta, Coleoptera, Araneae e Formicidae.The objective of this work was to evaluate the effect of tree legume species on the density and diversity of macrofauna of a Red Yellow Argisol with low natural fertility. Two nitrogen-fixing trees, orelha-de-negro (Enterolobium contortisiliquum) and jacarandá-da-baía (Dalbergia nigra), and one non nitrogen-fixing tree, angico-canjiquinha (Peltophorum dubium), were intercropped with survenola grass (an interspecific hybrid of Digitaria setivalva and Digitaria valida), having pasture at full sun as control. Formicidae was the most abundant group, followed by Oligochaeta with 47% in the legume treatments and 23% in the pasture at full sun. The largest values for the fauna diversity were obtained in samplings under the canopy of nitrogen-fixing tree legumes. The cluster analysis showed that the intercropping with orelha-de-negro presented soil fauna groups quite similar to the ones under jacarandá-da-baía. According to the correspondence multivariate analysis, the tree legumes contributed to an increase in the density of some fauna groups, mainly Oligochaeta, Coleoptera, Araneae and Formicidae

SOIL FAUNA ALONG THE PROCESS OF ECOLOGICAL SUCCESSION IN GULLIES REVEGETATED IN THE MUNICIPALITY OF PINHEIRAL \u2013 RJ

O objetivo do trabalho foi avaliar a diversidade, riqueza e composi\ue7\ue3o da comunidade da fauna do solo ep\uedgea em uma vo\ue7oroca revegetada no ano de 2000 com diferentes esp\ue9cies de leguminosas arb\uf3reas. A vo\ue7oroca est\ue1 localizada no Instituto Federal de Educa\ue7\ue3o (IFRJ) campus Nilo Pe\ue7anha no munic\uedpio de Pinheiral \u2013 RJ. Foram avaliadas as seguintes \ue1reas: plantio de Acacia mangium Willd. (PA), plantio de Mimosa caesalpiniifolia Benth. (PM), plantio de leguminosas arb\uf3reas no ter\ue7o superior da encosta (PTS), plantio de leguminosas no interior da vo\ue7oroca (IVR2000). Os plantios de A. mangium e M. caesalpiniifolia foram realizados antes da revegeta\ue7\ue3o. Para efeito comparativo tamb\ue9m foi avaliada uma \ue1rea de floresta secund\ue1ria com 20 anos, pr\uf3xima ao local de coleta. Na coleta da fauna do solo ep\uedgea foram utilizadas 10 armadilhas do tipo pitfall (MOLDENKE, 1994) por \ue1rea. Foram realizadas tr\ueas coletas, uma no in\uedcio da revegeta\ue7\ue3o, em maio de 2000, em junho de 2006 e abril de 2008. Houve um aumento no n\ufamero de grupos e na diversidade da fauna do solo no plantio no ter\ue7o superior, no interior da vo\ue7oroca, e no plantio de Mimosa caesalpiniifolia ap\uf3s 6 anos da interven\ue7\ue3o. Nas coletas realizadas em 2000 e 2006, a APC mostrou que a maioria dos grupos estava associada ao ano de 2006, mostrando total antagonismo com o ano de 2000. O plantio de Acacia mangium foi a \ue1rea com o menor n\ufamero de grupos. Na coleta realizada em 2008, a pastagem foi a \ue1rea com menor n\ufamero m\ue9dio de grupos coletados e na an\ue1lise de componentes principais (ACP) do interior da vo\ue7oroca os grupos estavam associados ao ano de 2008 com total antagonismo com os anos de 2000 e 2006. Os grupos Formicidae e Collembola (Entomobryomorpha) foram os mais dominantes em todas as \ue1reas amostradas no ano de 2000 e 2008 e no interior da vo\ue7oroca ano de 2006.The diversity, richness and composition of the soil epigeous fauna community were evaluated in a revegetated gully at the Instituto Federal de Educa\ue7\ue3o (IFRJ) campus Nilo Pe\ue7anha, in the municipality of Pinheiral, Rio de Janeiro state. Revegetation was performed in 2000, and consisted of four different strategies involving N-fixing trees: planting Acacia mangium Willd. (PA); planting Mimosa caesalpiniifolia Benth. (PM); on the outer edges of the gully head (PTS); and planting a mix of legume tree species into the gully (IVR2000). Acacia mangium and Mimosa caesalpiniifolia were planted above the gully head. A nearby 20-year secondary forest remnant was used as a reference site. Ten pitfall traps were used for the sampling of epigeous fauna at each one of the five areas (MOLDENKE, 1994). Sampling was performe in May 2000, June 2006, and April 2008. Six years after revegetation has started, fauna group richness and diversity increased both into the gully and in Mimosa caesalpiniifolia plantation. For the 2000 and 2006 samplings a PCA showed that groups were mostly associated to 2006, and completely opposite to 2000. Acacia mangium plantation had the lowest group richness. In the 2008 sampling, pasture showed the lowest group richness, and according to the PCA groups into the gully were associated to 2008, and completely opposite to 2000 and 2006. Formicidae and Collembola (Entomobryomorpha) were dominant in all sampled areas, both in 2000 and 2008, and into the gully in 2006 as well

Database Survey of Anti-Inflammatory Plants in South America: A Review

Inflammation is a complex event linked to tissue damage whether by bacteria, physical trauma, chemical, heat or any other phenomenon. This physiological response is coordinated largely by a variety of chemical mediators that are released from the epithelium, the immunocytes and nerves of the lamina propria. However, if the factor that triggers the inflammation persists, the inflammation can become relentless, leading to an intensification of the lesion. The present work is a literature survey of plant extracts from the South American continent that have been reported to show anti-inflammatory activity. This review refers to 63 bacterial families of which the following stood out: Asteraceae, Fabaceae, Euphorbiaceae, Apocynaceae and Celastraceae, with their countries, parts used, types of extract used, model bioassays, organisms tested and their activity

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

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