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

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Avaliações quantitativas e predição das proporções de osso, músculo e gordura da carcaça em ovinos

O objetivo deste experimento foi estudar as características da carcaça e suas correlações com a composição tecidual. Foram utilizados 22 cordeiros machos inteiros, filhos de carneiros Texel e ovelhas cruzas (Texel x Ideal). Destes, quatro foram abatidos no início do experimento (24 horas após o nascimento), como referência, e o restante, ao desmame e aos 28 e 33 kg PV. Os cordeiros foram confinados em baias individuais com suas respectivas mães até o desmame (45 dias de idade). Nesse período, a dieta fornecida, constituída de 70% de volumoso e 30% de concentrado, visava atender às necessidades nutricionais da mãe. A partir do desmame até o abate, a dieta fornecida aos cordeiros foi constituída de 60% de volumoso e 40% de concentrado. Os rendimentos de carcaça fria foram 51,20; 45,14; 42,216; e 41,73% para os pesos de abate de 20,93; 28,3; 32,57; e 4,12 kg PV, respectivamente. A relação tecido mole/osso foi de 1,74 e 4,24%, respectivamente, para os cordeiros abatidos ao nascimento e os abatidos com 32,57 kg. Os maiores coeficientes de determinação e correlação foram obtidos para a equação da porcentagem de músculo da carcaça, em função da proporção do mesmo na costela. Os valores dos coeficientes de determinação e correlação foram, respectivamente, 71,65 e 0,85. Para as equações das porcentagens de osso e gordura na carcaça, os maiores coeficientes de determinação foram obtidos para costela

Modificações na técnica de digestibilidade in vitro para avaliar forragens de baixa qualidade Modification on technique for in vitro digestibility to assess low quality forage

Dois experimentos foram desenvolvidos no Departamento de Zootecnia da Universidade Federal de Santa Maria (UFSM), para estudar modificações na técnica de digestibiüdade in vitro para avaliar forragens de baixa qualidade. O experimento I consistiu na determinação dos coeficientes de digestibilidade in vivo da matéria orgânica (MO), envolvendo 10 fenos de gramíneas tropicais e 2 palhas provenientes da colheita de grãos. No experimento II, determinaram-se os coeficientes de digestibilidade in vitro através da técnica proposta por TILLEY and TERRY (1963), tratamento M1- 48 horas de incubação com inóculo ruminal (fermentação microbiana) + 48 horas de incubação com pepsina (fermentação enzimática) e estudaram-se modificações sobre esta, denominadas: M2- prolongação no período de incubação (de 48h para 96h), com renovação do inóculo ruminal, após 48h de incubação, (adição de novo inóculo sobre a fase sólida das amostras, após centrifugação e desprezada a fase líquida); M3- 96h de incubação com inóculo ruminal, com reinoculação, após 48h de incubação, (adição de novo inóculo sobre as amostras, sem a centrifugação e retirada da fase líquida); M4- 96h de incubação com inóculo ruminal diluído, com renovação do inóculo; M5- 96h de incubação com inóculo ruminal diluído, com reinoculação; M6- 96h de incubação com inóculo ruminal, renovação do inóculo e prolongação no período de incubação com pepsina (de 48h para 72h) e M7- 96h de incubação com inóculo ruminal, reinoculação, digestão com pepsina de 72 horas. Foi efetuada a análise de correlação entre as médias dos coeficientes de digestibilidade in vivo e a digestibilidade in vitro das modificações, para todas as forragens e a análise de regressão sobre o tratamento que apresentou correlações altas e significativas. Pelos resultados obtidos, pode-se constatar que o método in vitro de TILLEY and TERRY (1963) não apresentou boa precisão para estimar a digestibilidade de forragens de baixo valor nutritivo e que, dentre as modificações testadas, a com 96h de fermentação com líquido de rúmen (LR), com reinoculação do LR após 48h de incubação + 48h com pepsina (M3), foi a que demonstrou melhor eficiência para estimativa da digestibilidade.Two experiments were undertaken at the Department of Animal Science at UFSM in arder to study in vitro digestibility technique modifications to assess low quality forages. Experiment I consisted of organic matter (OM) in vivo digestibility coefficients estimation, involving 10 tropical grass hay and two grain harvest straws. On Experiment II, one determined the in vitro digestibility coefficients through the TILLEY and TERRY technique (1963), MJ treatment - 48 hours of incubation with ruminal liquor (microbian fermentation) + 48 hours of pepsin incubation (enzymatic fermentation) and one studied the modifications over this technique named as M2 - incubation period delay (from 48h to 96h), with ruminal liquor renewal after 48h of incubation (new ruminal liquor addition over the solidphase of the samples, after centrifugation and liquid phase disregard); M3 - 96h of incubation with ruminal liquor with reinoculation after 48h of incubation (new liquor addition over the samples, without the centrifugation and liquid phase withdrawai); M4 - 96h of incubation with diluted ruminal liquor, with liquor renewal; M5 - 96h of incubation with diluted ruminal liquor with reinoculation; M6 - 96h of incubation with ruminal liquor, liquor renewal and pepsin incubation period delay (from 48 h to 72h) and M7 - 96h of incubation with ruminal liquor, reinoculation, digestion with 72h pepsin. A correlation analysis was undertaken between in vivo digestibility coefficient means and in vitro digestibility from the modifications to overall forages and a regression analysis over the treatment that presented high and significant correlations. From the results that were determined one could find that TILLEY and TERRY (1963) in vitro method does not present good precision to estimate low nutritional value forage digestibility and that among the tested modifications that one with 96h of fermentation with ruminal liquor (LR), with LR reinoculation after 48h of incubation + 48h with pepsin (M3) was the one that demonstrated to have the best efficiency to estimate the digestibility

Crescimento de cordeiros abatidos com diferentes pesos: 2. Constituintes corporais Growth of lambs slaughtered at different weights: 2. Body constituents

O experimento foi realizado no Setor de Ovinocultura do Departamento de Zootecnia da Universidade Federal de Santa Maria, com o objetivo de determinar o crescimento de órgãos e outros constituintes do corpo de cordeiros, e suas proporções em relação ao peso vivo (PV) e peso de corpo vazio (PCV). Utilizaram-se 22 cordeiros machos inteiros, filhos de carneiros Texel e ovelhas cruzas (Texel x Ideal). Desses, quatro foram abatidos ao nascimento, e os restantes ao desmame e aos 28 e 33kg. A determinação do crescimento dos constituintes corporais foi realizada através de equações alométricas, utilizando-se o logaritmo do peso de cada componente corporal, em função do logaritmo do PCV. As proporções do trato gastrintestinal (TGI), do conjunto de órgãos internos (COI), da gordura interna (GOI) e da carcaça aumentaram com a elevação do PV e PCV (P<0,05), enquanto que coração, fígado, rins, baço, (pulmão e traquéia), sangue, patas e pele diminuíram suas proporções (P<0,05). Os constituintes do corpo apresentaram diferentes ritmos de crescimento. Um grupo foi de desenvolvimento precoce (coração, rins, pulmões + traquéia, patas, sangue e cabeça), e outro tardio (rúmen, retículo, omaso e abomaso), TGI e GOI. Os restantes (fígado, baço, intestinos, pele e carcaça) cresceram na mesma velocidade que o PCV.<br>This experiment was developed at the Animal Science Department, at Federal University of Santa Maria, Brazil with the aim of determining the growth of the organs and other body constituents of lambs, and their proportion in the live weight (LW) and empty body weight (EBW). Twenty-two intact male lambs, from crossbreed Texel x Ideal dams sired by Texel males were used. Four lambs were slaughtered at the beginning of the experiment (24 hours after birth) and groups of six lambs were slaughtered at weaning and when reaching 28 or 33kg of body weight. To study the relative growth of the different body constituents, the halometric equations between the log of the weight of each component, and of the log of the EBW were fitted. The proportions of alimentary tract (AT), other internal organs (GOI), internal fat (IF) and carcass increased with increasing LW and EBW (P<0.05), whereas heart, liver, spleen, kidney, lung with trachea, blood, feet and head decreased (P<0.05). One group of constituents was early maturity (heart, kidney, lung with trachea, feet, blood and head), and another was of late maturity (rumen- reticulum- omasum and abomasum ), AT and IF). The remaining ones (liver, spleen, intestine, skin and carcass) had the same growth rate as EBW

Crescimento de regiões da carcaça de cordeiros abatidos com diferentes pesos Growth of carcass parts in slaughter lambs with different weights

O trabalho foi realizado no Setor de Ovinocultura do Departamento de Zootecnia da Universidade Federal de Santa Maria, objetivando determinar o crescimento das principais partes da carcaça e suas proporções em relação ao peso de corpo vazio e peso de carcaça fria de cordeiros abatidos com diferentes pesos. Foram utilizados 22 cordeiros machos inteiros, filhos de carneiros Texel e ovelhas cruzas (Texel x Ideal). Destes, quatro foram abatidos no início do experimento (24 horas após o nascimento), seis ao desmame (45 dias de idade) e os remanescentes aos 28 (6 animais) ou 33 kg (6 animais). Os cordeiros foram confinados em baias individuais, com suas respectivas mães, até o desmame. A determinação do crescimento dos cortes da carcaça foi realizada através de equações alométricas, utilizando-se o logaritmo do peso de cada região da carcaça, em função do logaritmo do PCF ou PCV. As proporções de quarto, paleta e pescoço, em relação ao PCV, foram semelhantes (P>0,05) nos pesos de abates estudados, no entanto, houve diferença (P<0,05) entre costela e espinhaço. Em relação ao PCF, houve diferença (P<0,05) entre os pesos de abate para as proporções de quarto, costela e pescoço. Os coeficientes de alometria encontrados demonstram que a costela é o corte de crescimento mais tardio, enquanto que as demais partes da carcaça são de crescimento precoce.<br>This work was performed at the Ovine Section of Animal Science Department, at Federal University of Santa Maria, Brazil. The purpose of this experiment was to determine the growth of the carcass cuts and percentages in relation to the empty body weight and cold carcass weight of lambs slaughtered at different weights. Twenty-two intact male lambs, sired by Texel males, from crossbreed Texel-Ideal dams were used. Four lambs were slaughtered at the beginning of the experiment (24 hours after birth) and three groups of six lambs were slaughtered at weaning and when reaching the weight of 28 and 33kg. The lambs were confined in individual stall together, with their respective mothers until weaning (45 days of age). To study the growth of the different cuts of the carcass, regression equation of the log. of the weight of each part, as a function of the log. of the empty body weight or cold carcass weight were fitted. The percentages of hindquarter, shoulder and neck in relation to the empty body weight were similar (P>0.05) in the weights studied, and of rib and backbone were different (P<0.05). In relation to the cold carcass weight the percentage of hindquarter, rib and neck showed difference (P<0.05). Among the cuts, the rib was late matured and the other cuts were early matured

Crescimento de cordeiros abatidos com diferentes pesos: osso, músculo e gordura da carcaça e de seus cortes Growth of lambs slaughtered at different weights: bone, muscle and fat of the carcass and its cuts

O trabalho foi realizado no Setor de Ovinocultura do Departamento de Zootecnia da Universidade Federal de Santa Maria, objetivando determinar as quantidades de osso, músculo e gordura da carcaça e o crescimento de osso e músculo da carcaça e dos diferentes cortes da mesma. Foram utilizados 22 cordeiros machos inteiros, filhos de carneiros Texel e ovelhas cruza (Texel x Ideal). Desses, quatro/oram abatidos no início do experimento (24 horas após o nascimento), e os restantes, ao desmame (45 dias de idade) e aos 28 e 33kg. Os cordeiros foram confinados em baias individuais, com suas respectivas mães, até o desmame (45 dias de idade). A determinação do crescimento dos tecidos da carcaça e de seus cortes (quarto, paleta, costela, espinhaço e pescoço) foi realizada através de equações alométricas, utilizando-se o logaritmo do peso de osso ou músculo, em função do logaritmo do peso de corpo vazio (PCV) ou peso de carcaça fria (PCF). As quantidades de osso e músculo aumentaram (P<0,05) com a elevação do peso de abate. A proporção de osso diminuiu (P<0,05) e a de músculo manteve-se constante (P>0,05) com a elevação do peso de carcaça fria. A proporção de gordura aumentou do nascimento ao desmame (P<0,05), e a partir daí, diminuiu (P<0,05). Com relação ao PCV e PCF, o tecido que primeiro se desenvolve é o ósseo (b=0,729l88 e b=0,673340), seguido pelo muscular (b=1,075728 e b=l,001403). Entre os cortes da carcaça, o crescimento ósseo e muscular da costela são mais tardios que os demais.<br>This experiment was developed at the Ovine Section of Animal Science Department, at Federal University of Santa Maria, Brazil- The purpose of this experiment was to determine the quantity of bone, muscle and fat of the carcass, and the growth ofbone and muscle of the carcass, and of the carcass cuts. Twenty-two intact mate lambs, sired by Texel males, from crossbreed Texel -Ideal dams were used. Four lambs were siaughtered at the beginning of the experiment (24 hours after birth) and groups of six lambs were siaughtered at weaning and when reaching 28 and 33kg. The lambs were kept in individual stalls together with their respective mothers until weaning (45 days of age). To study the growth of the carcass tissues and carcass cuts (hindquarter, shoulder, rib, backbone, neck), regression equations of the log of weight of each tissue, as a function of the log of empty body weight (EBW) or cold carcass weight (CCW) were fitted. The quantities of bone and muscle -increased (P<0.05) with the higher of siaughter weights. The proportion of bone decreased (P<0.05) and that of muscle remained constant (P>0.05) with the higher of the CCW, the proportion of fat increased from birth to weaning (P<0.05) and decreased after weaning (P<0.05). In relation to EBW and CCW, bones were early maturing (b=0.729188 and b=0.673340), followed by muscular tissue (b=1.075728 and b=1.001403). Among carcass cuts rib bone and muscle were later maturing than in other cuts