Carbamide peroxide gel stability under different temperature conditions: is manipulated formulation an option?

Nowadays the use of gel containing carbamide peroxide (CP) prepared in Pharmacy is a normal practice in the population. However, the quality of this product is questionable concerning its stability. The aim of this study is was to synthesize and to analyze this drug alone or associated to Carbopol gel through analytical methodology compatible with the routine of the Pharmacies. The reaction between urea and hydrogen peroxide was carried out at different resting times: 24 hours (CP 24 powder) and 48 hours (CP48 powder) after the mixture. Both products were associated with Carbopol 940® gel 1.5% (G) generating G24 and G48 samples. The stability of powders (CP24 e CP48) and the formulations (G24 and G48) were evaluated as a function of time (15, 40 and 45 days) and thermal variation (refrigeration: 8 °C±1; thermal shock 32 °C±1 /8 °C±1; stove: 32 °C±1), using a standard titration method. As a result, only under refrigeration the CP24 and CP48 contents remained stable during the period of 45 days. An interesting finding was that G24 and G48 presented greater stability for at least 45-days under refrigeration and thermal shock conditions, and up to 30 days under stove conditions. The results for the G24 and G48 were slightly higher than those obtained for the control. Therefore, we were able to conclude that association with Carbopol 940® Gel 1.5 % provided greater CP stability and that manipulated formulations containing CP may be viable for use in a period of 45 days under refrigeration conditions. The titration proved to be an effective technique for the analysis of CP with or without Carbopol 940® gel 1.5%.Atualmente, a utilização de gel contendo peróxido de carbamida manipulado em Farmácia é uma prática comum na população. No entanto, a qualidade deste produto é questionada, sobretudo no que se refere à estabilidade deste fármaco. O objetivo deste trabalho consiste na avaliação da viabilidade de sintetizar e analisar quantitativamente este fármaco associado ou não a um gel de Carbopol através de metodologia analítica compatível com a rotina das Farmácias. A reação entre a uréia e o peróxido de hidrogênio foi realizada em tempos diferentes de repouso após a mistura, 24 h para sintetizar o pó PC 24 e 48 h para o pó CP 48. Estes pós foram associados a um gel (G) de Carbopol 940® 1,5 %, originando as amostras G24 e G48. A estabilidade dos pós (PC 24 e PC 48) e das formulações (G 24 e G 48) foi avaliada em função do tempo (15, 40 e 45 dias) e da variação térmica (refrigeração: 8 °C±1; choque térmico: 32 °C±1/8 °C±1 e estufa: 32 °C±1), através da técnica de titulometria. Os resultados indicam que unicamente sob refrigeração o CP24 e o CP 48 mantiveram-se estáveis no período de 45 dias. O G24 e o G48 apresentaram estáveis por pelo menos 45 dias nas condições de refrigeração e choque térmico e por 30 dias na condição estufa. Os resultados obtidos para o G24 e G48 foram ligeiramente superiores aos obtidos para o controle. Além disso, é possível concluir que a associação do PC com o gel de Carbopol 940® 1,5 % promoveu um aumento na estabilidade do PC e que as preparações manipuladas contendo PC são viáveis para uso durante um período de 45 sob refrigeração. A titulometria mostrou-se uma técnica eficaz para a análise do PC associado ou não ao gel de Carbopol 940® 1,5%

Strategic management process design e o pensamento sistêmico: a emergência de novas metodologias de design

It is possible to attain the systemic paradigm reasoning from a historical context of increasing complexification and limitations of the analytic thought in Modern Science, by understanding non-linear processing phenomena, which are not reducible to a few variables of atomized parts. This systemic reasoning paradigm can be achieved so as to facilitate reflective thinking about design today, with its multiple marketing interactions, its strategic functions within organizations, as well as with the need for processes and management directed by design and for design. Through a short overview of the methodologies based on the analytical epistemology, the present article attempts to draw some basic guiding lines for the development of a systemic methodology for strategic design. Key words: strategic design, design management, methodology, systemic reasoning.A partir de um contexto histórico em crescente complexifi­cação e das limitações do pensamento analítico da Ciência Moderna, na compreensão de fenômenos processuais não lineares nem redutíveis a poucas variáveis de partes atomiza­das, alcança-se o paradigma do pensamento sistêmico. Com fundamento neste paradigma, reflete-se sobre o design na contemporaneidade, suas múltiplas interações mercadológi­cas, sua função estratégica nas organizações e a necessidade de processos e gestão orientados pelo e para o design. Me­diante uma revisão geral e sucinta das metodologias basea­das na epistemologia analítica, adentra-se no escopo princi­pal deste artigo, que é tentar esboçar um método sistêmico de design estratégico. Palavras-chave: design estratégico, gestão de design, meto­dologia, pensamento sistêmico

Jogos e materiais pedagógicos para leitura e escrita: Usos na clínica e na escola

El presente trabajo trata sobre el uso de juegos y materiales pedagógicos para el desarrollo de la lectura y la escritura en la clínica de logopedia y en la escuela, teniendo en cuenta las selecciones, variedades y objetivos con los que son utilizados por el docente que trabaja en alfabetización y por el logopeda que trabaja las cuestiones de lectura y escritura. Dado que la alfabetización es un período importante en la vida de los niños y los juegos facilitan el acceso al lenguaje, el objetivo general de la investigación fue verificar el uso de juegos y materiales didácticos para leer y escribir en la clínica y en la escuela. Los objetivos específicos fueron identificar cuáles de estos juegos son los más utilizados, analizar los fines con los que se utilizan y, por último, comparar las dos realidades.Para lograr los objetivos propuestos, se aplicaron cuestionarios a estas dos poblaciones, con una pregunta abierta específica sobre juegos, en la que los participantes debían indicar qué juegos y materiales utilizan y con qué finalidad. Los docentes seleccionaron más juegos y aportaron más objetivos, dando preferencia a los que exploran letras y palabras, mientras que los logopedas mostraron preferencia por la reflexión y manejo de letras y palabras a través de la conciencia fonológica. Los juegos que exploran frases y textos rara vez se mencionaron en ambas realidades. La conciencia fonológica apareció como una meta de los logopedas y profesores en varios juegos, sin embargo, esto fue más mencionado por los logopedas. Si bien la conciencia fonológica es importante para ambas realidades, se deben considerar los otros niveles lingüísticos

Carbamide peroxide gel stability under different temperature conditions: is manipulated formulation an option?

Nowadays the use of gel containing carbamide peroxide (CP) prepared in Pharmacy is a normal practice in the population. However, the quality of this product is questionable concerning its stability. The aim of this study is was to synthesize and to analyze this drug alone or associated to Carbopol gel through analytical methodology compatible with the routine of the Pharmacies. The reaction between urea and hydrogen peroxide was carried out at different resting times: 24 hours (CP 24 powder) and 48 hours (CP48 powder) after the mixture. Both products were associated with Carbopol 940® gel 1.5% (G) generating G24 and G48 samples. The stability of powders (CP24 e CP48) and the formulations (G24 and G48) were evaluated as a function of time (15, 40 and 45 days) and thermal variation (refrigeration: 8 °C±1; thermal shock 32 °C±1 /8 °C±1; stove: 32 °C±1), using a standard titration method. As a result, only under refrigeration the CP24 and CP48 contents remained stable during the period of 45 days. An interesting finding was that G24 and G48 presented greater stability for at least 45-days under refrigeration and thermal shock conditions, and up to 30 days under stove conditions. The results for the G24 and G48 were slightly higher than those obtained for the control. Therefore, we were able to conclude that association with Carbopol 940® Gel 1.5 % provided greater CP stability and that manipulated formulations containing CP may be viable for use in a period of 45 days under refrigeration conditions. The titration proved to be an effective technique for the analysis of CP with or without Carbopol 940® gel 1.5%.Atualmente, a utilização de gel contendo peróxido de carbamida manipulado em Farmácia é uma prática comum na população. No entanto, a qualidade deste produto é questionada, sobretudo no que se refere à estabilidade deste fármaco. O objetivo deste trabalho consiste na avaliação da viabilidade de sintetizar e analisar quantitativamente este fármaco associado ou não a um gel de Carbopol através de metodologia analítica compatível com a rotina das Farmácias. A reação entre a uréia e o peróxido de hidrogênio foi realizada em tempos diferentes de repouso após a mistura, 24 h para sintetizar o pó PC 24 e 48 h para o pó CP 48. Estes pós foram associados a um gel (G) de Carbopol 940® 1,5 %, originando as amostras G24 e G48. A estabilidade dos pós (PC 24 e PC 48) e das formulações (G 24 e G 48) foi avaliada em função do tempo (15, 40 e 45 dias) e da variação térmica (refrigeração: 8 °C±1; choque térmico: 32 °C±1/8 °C±1 e estufa: 32 °C±1), através da técnica de titulometria. Os resultados indicam que unicamente sob refrigeração o CP24 e o CP 48 mantiveram-se estáveis no período de 45 dias. O G24 e o G48 apresentaram estáveis por pelo menos 45 dias nas condições de refrigeração e choque térmico e por 30 dias na condição estufa. Os resultados obtidos para o G24 e G48 foram ligeiramente superiores aos obtidos para o controle. Além disso, é possível concluir que a associação do PC com o gel de Carbopol 940® 1,5 % promoveu um aumento na estabilidade do PC e que as preparações manipuladas contendo PC são viáveis para uso durante um período de 45 sob refrigeração. A titulometria mostrou-se uma técnica eficaz para a análise do PC associado ou não ao gel de Carbopol 940® 1,5%

Global, regional, and national burden of neurological disorders during 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250.7 [95% uncertainty interval (UI) 229.1 to 274.7] million, comprising 10.2% of global DALYs) and the second-leading cause group of deaths (9.4 [9.1 to 9.7] million], comprising 16.8% of global deaths). The most prevalent neurological disorders were tensiontype headache (1505 9 [UI 1337.3 to 1681.6 million cases]), migraine (958.8 [872.1 to 1055.6] million), medication overuse headache (58.5 [50.8 to 67.4 million]), and Alzheimer's disease and other dementias (46.0 [40.2 to 52.7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36.7%, and the number of DALYs by 7.4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26.1% and 29.7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services.Peer reviewe

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

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

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury