Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Supply Chain Management y Logística en la empresa MECÁNICOS ASOCIADOS S.A.S

Con este trabajo buscamos dar desarrollo al proyecto final del diplomado de profundización supply Chain management y logística, donde mediante el aporte de cada participante se da desarrollo a la guía de trabajo, se mostrará el resultado de la caracterización de una empresa que se escoge, en este caso MECÁNICOS ASOCIADOS S.A.S, dando caracterización de la logística enfocándonos principalmente en el archivo modelo referencial logístico. Aplicar los trece elementos del Modelo Referencial en Logística, que hipotéticamente se encuentran presentes en una Red Adaptativa o Supply Chain: concepto sobre logística, organización logística, tecnología de manipulación, tecnología de almacenaje, tecnología de transporte interno, tecnología de transporte externo, tecnología de información, tecnología de software, talento humano, integración del Supply Chain, barreras logísticas, logística reversa y, medida del desempeño logístico.With this work we seek to develop the final project of the deepening diploma supply chain management and logistics, where through the contribution of each participant development is given to the work guide, the result of the characterization of a company that is chosen, in this case MECÁNICOS ASOCIADOS SAS, giving characterization of logistics focusing mainly on the logistic reference model file. Apply the thirteen elements of the Reference Model in Logistics, which hypothetically are present in an Adaptive Network or Supply Chain: concept on logistics, logistics organization, handling technology, storage technology, internal transport technology, external transport technology, technology information, software technology, human talent, supply chain integration, logistic barriers, reverse logistics and, logistic performance measurement

Infectología Clínica

Infections are one of the main reasons for consultation in daily practice, as well as being the cause of multiple hospital admissions. The world faces a serious crisis with antimicrobial resistance; During the last decade, the creation of new antibiotics has been elusive against multiresistant pathogens, so the mortality rate has increased due to this situation.Health not only faces this problem with antimicrobials, it also suffers from antivirals, especially with patients with HIV, the various mutations at the viral level condition the therapeutic response.The facts mentioned in therapeutics have suggested the creation of new approaches to solve them and these are phage therapy and nanotechnology, alternatives not only used for autoimmune or cancer diseases, their clinical use against persistent infections and against multi-resistant strains.The early recognition of sepsis becomes one of the main objectives when caring for a patient; the establishment of early treatment represents the opportunity to obtain a higher survival rate.Las infecciones constituyen uno de los principales motivos de consulta en la práctica diaria, además de ser la causa de múltiples ingresos a nivel hospitalario. El mundo enfrenta una grave crisis con la resistencia antimicrobiana; durante la última década la creación de nuevos antibióticos ha sido esquivo frente a patógenos multirresistentes, por lo que la tasa de mortalidad aumento por esta situación. La salud no solo enfrenta este problema con los antimicrobianos también lo sufre con los antivirales en especial con los pacientes con VIH, las diversas mutaciones a nivel viral condicionan la respuesta terapéutica. Los hechos mencionados en la terapéutica han sugerido la creación de nuevos abordajes para resolverlos y estos son la fagoterapía y la nanotecnología, alternativas no solo utilizadas para enfermedades autoinmunes o cancerígenas, su uso clínico frente a infecciones persistentes y contra cepas multirresistentes. El reconocimiento temprano de la sepsis se convierte en uno de los principales objetivos en el momento de la atención de un paciente, la instauración del tratamiento temprano representa la oportunidad para obtener una mayor tasa de supervivencia

Infectología Clínica

Infections are one of the main reasons for consultation in daily practice, as well as being the cause of multiple hospital admissions. The world faces a serious crisis with antimicrobial resistance; During the last decade, the creation of new antibiotics has been elusive against multiresistant pathogens, so the mortality rate has increased due to this situation.Health not only faces this problem with antimicrobials, it also suffers from antivirals, especially with patients with HIV, the various mutations at the viral level condition the therapeutic response.The facts mentioned in therapeutics have suggested the creation of new approaches to solve them and these are phage therapy and nanotechnology, alternatives not only used for autoimmune or cancer diseases, their clinical use against persistent infections and against multi-resistant strains.The early recognition of sepsis becomes one of the main objectives when caring for a patient; the establishment of early treatment represents the opportunity to obtain a higher survival rate.Las infecciones constituyen uno de los principales motivos de consulta en la práctica diaria, además de ser la causa de múltiples ingresos a nivel hospitalario. El mundo enfrenta una grave crisis con la resistencia antimicrobiana; durante la última década la creación de nuevos antibióticos ha sido esquivo frente a patógenos multirresistentes, por lo que la tasa de mortalidad aumento por esta situación. La salud no solo enfrenta este problema con los antimicrobianos también lo sufre con los antivirales en especial con los pacientes con VIH, las diversas mutaciones a nivel viral condicionan la respuesta terapéutica. Los hechos mencionados en la terapéutica han sugerido la creación de nuevos abordajes para resolverlos y estos son la fagoterapía y la nanotecnología, alternativas no solo utilizadas para enfermedades autoinmunes o cancerígenas, su uso clínico frente a infecciones persistentes y contra cepas multirresistentes. El reconocimiento temprano de la sepsis se convierte en uno de los principales objetivos en el momento de la atención de un paciente, la instauración del tratamiento temprano representa la oportunidad para obtener una mayor tasa de supervivencia

Infectología Clínica

Infections are one of the main reasons for consultation in daily practice, as well as being the cause of multiple hospital admissions. The world faces a serious crisis with antimicrobial resistance; During the last decade, the creation of new antibiotics has been elusive against multiresistant pathogens, so the mortality rate has increased due to this situation.Health not only faces this problem with antimicrobials, it also suffers from antivirals, especially with patients with HIV, the various mutations at the viral level condition the therapeutic response.The facts mentioned in therapeutics have suggested the creation of new approaches to solve them and these are phage therapy and nanotechnology, alternatives not only used for autoimmune or cancer diseases, their clinical use against persistent infections and against multi-resistant strains.The early recognition of sepsis becomes one of the main objectives when caring for a patient; the establishment of early treatment represents the opportunity to obtain a higher survival rate.Las infecciones constituyen uno de los principales motivos de consulta en la práctica diaria, además de ser la causa de múltiples ingresos a nivel hospitalario. El mundo enfrenta una grave crisis con la resistencia antimicrobiana; durante la última década la creación de nuevos antibióticos ha sido esquivo frente a patógenos multirresistentes, por lo que la tasa de mortalidad aumento por esta situación. La salud no solo enfrenta este problema con los antimicrobianos también lo sufre con los antivirales en especial con los pacientes con VIH, las diversas mutaciones a nivel viral condicionan la respuesta terapéutica. Los hechos mencionados en la terapéutica han sugerido la creación de nuevos abordajes para resolverlos y estos son la fagoterapía y la nanotecnología, alternativas no solo utilizadas para enfermedades autoinmunes o cancerígenas, su uso clínico frente a infecciones persistentes y contra cepas multirresistentes. El reconocimiento temprano de la sepsis se convierte en uno de los principales objetivos en el momento de la atención de un paciente, la instauración del tratamiento temprano representa la oportunidad para obtener una mayor tasa de supervivencia

Infectología Clínica

Infections are one of the main reasons for consultation in daily practice, as well as being the cause of multiple hospital admissions. The world faces a serious crisis with antimicrobial resistance; During the last decade, the creation of new antibiotics has been elusive against multiresistant pathogens, so the mortality rate has increased due to this situation.Health not only faces this problem with antimicrobials, it also suffers from antivirals, especially with patients with HIV, the various mutations at the viral level condition the therapeutic response.The facts mentioned in therapeutics have suggested the creation of new approaches to solve them and these are phage therapy and nanotechnology, alternatives not only used for autoimmune or cancer diseases, their clinical use against persistent infections and against multi-resistant strains.The early recognition of sepsis becomes one of the main objectives when caring for a patient; the establishment of early treatment represents the opportunity to obtain a higher survival rate.Las infecciones constituyen uno de los principales motivos de consulta en la práctica diaria, además de ser la causa de múltiples ingresos a nivel hospitalario. El mundo enfrenta una grave crisis con la resistencia antimicrobiana; durante la última década la creación de nuevos antibióticos ha sido esquivo frente a patógenos multirresistentes, por lo que la tasa de mortalidad aumento por esta situación. La salud no solo enfrenta este problema con los antimicrobianos también lo sufre con los antivirales en especial con los pacientes con VIH, las diversas mutaciones a nivel viral condicionan la respuesta terapéutica. Los hechos mencionados en la terapéutica han sugerido la creación de nuevos abordajes para resolverlos y estos son la fagoterapía y la nanotecnología, alternativas no solo utilizadas para enfermedades autoinmunes o cancerígenas, su uso clínico frente a infecciones persistentes y contra cepas multirresistentes. El reconocimiento temprano de la sepsis se convierte en uno de los principales objetivos en el momento de la atención de un paciente, la instauración del tratamiento temprano representa la oportunidad para obtener una mayor tasa de supervivencia

Infectología Clínica

Infections are one of the main reasons for consultation in daily practice, as well as being the cause of multiple hospital admissions. The world faces a serious crisis with antimicrobial resistance; During the last decade, the creation of new antibiotics has been elusive against multiresistant pathogens, so the mortality rate has increased due to this situation.Health not only faces this problem with antimicrobials, it also suffers from antivirals, especially with patients with HIV, the various mutations at the viral level condition the therapeutic response.The facts mentioned in therapeutics have suggested the creation of new approaches to solve them and these are phage therapy and nanotechnology, alternatives not only used for autoimmune or cancer diseases, their clinical use against persistent infections and against multi-resistant strains.The early recognition of sepsis becomes one of the main objectives when caring for a patient; the establishment of early treatment represents the opportunity to obtain a higher survival rate.Las infecciones constituyen uno de los principales motivos de consulta en la práctica diaria, además de ser la causa de múltiples ingresos a nivel hospitalario. El mundo enfrenta una grave crisis con la resistencia antimicrobiana; durante la última década la creación de nuevos antibióticos ha sido esquivo frente a patógenos multirresistentes, por lo que la tasa de mortalidad aumento por esta situación. La salud no solo enfrenta este problema con los antimicrobianos también lo sufre con los antivirales en especial con los pacientes con VIH, las diversas mutaciones a nivel viral condicionan la respuesta terapéutica. Los hechos mencionados en la terapéutica han sugerido la creación de nuevos abordajes para resolverlos y estos son la fagoterapía y la nanotecnología, alternativas no solo utilizadas para enfermedades autoinmunes o cancerígenas, su uso clínico frente a infecciones persistentes y contra cepas multirresistentes. El reconocimiento temprano de la sepsis se convierte en uno de los principales objetivos en el momento de la atención de un paciente, la instauración del tratamiento temprano representa la oportunidad para obtener una mayor tasa de supervivencia