Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Psychometric Properties and Correlates of Precarious Manhood Beliefs in 62 Nations

Precarious manhood beliefs portray manhood, relative to womanhood, as a social status that is hard to earn, easy to lose, and proven via public action. Here, we present cross-cultural data on a brief measure of precarious manhood beliefs (the Precarious Manhood Beliefs scale [PMB]) that covaries meaningfully with other cross-culturally validated gender ideologies and with country-level indices of gender equality and human development. Using data from university samples in 62 countries across 13 world regions (N = 33,417), we demonstrate: (1) the psychometric isomorphism of the PMB (i.e., its comparability in meaning and statistical properties across the individual and country levels); (2) the PMB’s distinctness from, and associations with, ambivalent sexism and ambivalence toward men; and (3) associations of the PMB with nation-level gender equality and human development. Findings are discussed in terms of their statistical and theoretical implications for understanding widely-held beliefs about the precariousness of the male gender role

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Retirement Transitions among Baby Boomers: Findings from an Online Qualitative Study

Résumé En 2011, les baby-boomers canadiens ont commencé à franchir la barre des 65 ans, ou l’âge traditionnel de la retraite. Il est possible que la perception et l’expérience de la retraite s’avèrent différentes dans cette génération, comparativement aux générations précédentes. Le but de cet article est d’explorer les tendances dans la transition vers la retraite de baby-boomers en Saskatchewan, en lien avec les phases qu’ils ont traversées au cours de cette transition. Dans cette étude effectuée en ligne selon un modèle de théorie ancrée, 25 baby-boomers approchant de la retraite ou récemment retraités ont participé à un blogue multi-auteurs où ils ont partagé leurs expériences et les processus liés à leur retraite. Des données additionnelles ont été collectées dans le cadre d’entrevues et de groupes de discussion réunissant les participants après la fin de leur participation au blogue. Les participants ont adopté différents modèles dans leur processus de retraite, certains arrêtant de travailler, d’autres poursuivant leurs activités professionnelles dans le cadre de travaux occasionnels ou à temps partiel, ou en effectuant d’autres types de travaux. Les résultats ont mis en évidence 3 phases dans la transition vers la retraite : la préretraite, caractérisée à la fois par certaines craintes liées à la retraite et par l’idéalisation de la retraite parfaite, suivie de la transition initiale, au cours de laquelle les participants ont comparé la retraite à des vacances prolongées, au cours desquelles ils ont peiné à s’adapter à l’augmentation de leur temps libre, pour enfin arriver à une transition de moyen terme où ils ont appris à équilibrer structure et flexibilité. Les résultats suggèrent que bien que la transition vers la retraite présente plusieurs défis, plusieurs personnes rapportent des visions et des expériences positives de cette transition. Abstract Canadian baby boomers began turning 65 - traditional retirement age - in 2011. How this generation perceives and experiences retirement may differ from preceding generations. In this online, grounded-theory study, 25 baby boomers who were approaching retirement or had recently retired participated in a multi-author blog about their retirement experiences and processes. We collected additional data via subsequent focus groups and participant interviews. Participants retired in several ways, including ceasing work, adopting casual or part-time work, and adopting new types of work. Findings highlighted three phases of the retirement transition: pre-retirement, characterized by both apprehension about retirement and idealization of the perfect retirement; the initial transition, which participants compared to an extended vacation, but in which they also struggled to adjust to increased amounts of free time; and mid-transition, when participants learned to balance structure and flexibility. Findings suggest that despite retirement transition challenges, many people have positive experiences with this transition

School libraries, teacher-librarians and literacy at Gold Coast schools : research findings

This paper reports research about school libraries, teacher-librarians and their contribution to literacy development. It presents an evidenced based snapshot, from the principals’ perspective, of 27 school libraries in the Gold Coast area of Australia. These new Australian findings show: \ud \ud • an evidenced based snapshot of school libraries and teacher-librarians, from the principals’ perspective\ud • indications that school NAPLAN scores for reading and writing were generally higher when (a) student to library staff ratios were lower (i.e. better) and (b) the school had a teacher-librarian.\ud \ud The research responds to the Australian Government inquiry into school libraries and teacher-librarians (2010-11) which identified an urgent need for current data about provision and staffing of school libraries and their influence on student literacy and learning. In light of the National plan for school improvement (Australian Government, 2013), the findings are of potential interest to education authorities, school leadership teams, teacher-librarians, teachers and researchers. They offer evidence to inform policy development, strategic planning and advocacy about school libraries and teacher-librarians in supporting the reading, literacy and learning needs of 21st century learners

Pricing strategies and levels and their impact on corporate profitability

La definición de la política de precios es una de las decisiones más importantes en la gestión, ya que afecta a la rentabilidad de las empresas y su competitividad en el mercado. A pesar de la importancia que el precio tiene en las organizaciones, parece que este elemento no ha recibido la debida atención de muchos académicos y profesionales de marketing, dado que el tema aparece en menos del 2% de los artículos de las principales revistas del área, según estimaciones. El objetivo en este estudio es proponer y poner a prueba un modelo teórico que indique los impactos de la política de precios en la rentabilidad de las empresas. Para ello, se han estudiado 150 empresas del parque industrial metalmecánico ubicado en la región nordeste del estado de Rio Grande do Sul, Brasil, y se han integrado las estrategias de fijación de precios con base en el valor para el cliente, en la competencia y en los costos con los niveles de precios (altos y bajos) y su desempeño con respecto a la rentabilidad. Los resultados indican que la rentabilidad de las empresas es afectada positivamente por la estrategia de precios basada en el valor y niveles de precios altos, y negativamente por los niveles de precios bajos. Los hallazgos indican que las políticas de precios producen efectos en la rentabilidad de las organizaciones y que, por lo tanto, una mirada más estratégica al proceso de fijación de precios constituye un aspecto que los administradores no pueden dejar de tener en cuenta.A definição da política de preços é uma das mais importantes decisões no âmbito da gestão, pois afeta a lucratividade das empresas e sua competitividade no mercado. Apesar da importância que o preço assume nas organizações, parece que tal elemento não tem recebido a devida atenção de muitos acadêmicos e profissionais de marketing, por representar menos de 2% dos artigos das principais revistas da área, segundo estimativas. Desta forma, o objetivo deste estudo foi o de propor e testar um modelo teórico que indique os impactos da política de preços sobre a lucratividade das empresas. Para tanto, foram estudadas 150 empresas do polo metal-mecânico situadas na região Nordeste do Estado do Rio Grande do Sul, Brasil, integrando-se as estratégias de preços baseadas em valor para o cliente, na concorrência e em custos com os níveis (altos e baixos) de preços praticados e o seu desempenho no que se refere à lucratividade. Os resultados indicam que a lucratividade das empresas estudadas é afetada positivamente pela estratégia de preços baseada em valor e níveis altos de preço e negativamente pelos níveis baixos de preço. Tais achados sinalizam que as políticas de preços são impactantes na lucratividade das organizações e que, portanto, um olhar mais estratégico para o processo de formação de preços constitui um aspecto que não pode ser negligenciado pelos gestores.Price policy definition is one of the most important decisions in management as it affects corporate profitability and market competitiveness. Despite the importance that prices take in organizations, it appears that this element has not received proper attention by many academics and marketers since it represents, according to estimates, less than 2% of the papers on leading journals in the field. Thus, the aim of this study was to propose and test a theoretical model showing the impacts of pricing policy on corporate profitability. To this end, 150 companies in the metal-mechanic sector situated in the Northeast of Rio Grande do Sul State, Brazil were studied, integrating customer value-based pricing strategies, competition-based pricing strategies and cost-based pricing strategies with price levels (high and low) and performance with respect to profitability. The results indicate that the profitability of the surveyed companies is positively affected by value-based pricing strategy and high price levels while it is negatively affected by low price levels. Such findings indicate that pricing policies influence the profitability of organizations and therefore, a more strategic look at the pricing process may constitute one aspect that cannot be overlooked by managers