Consumo alimentar e balanço de nitrogênio de fisiculturistas em Cuité, Paraíba, Brasil

Background: Sports nutrition has grown substantially. Considering that as compared to sedentary or moderately active individuals, athletes have distinct nutritional requirements, it is important to reflect on the adequacy of food intake as compared to the established recommendations. Thus, the present study evaluated food consumption and nitrogen balance in bodybuilders’ from Cuité-Paraíba, aiming to learn their food and nutritional profiles. Methods: Data were collected using structured questionnaires and 24-hour dietary recalls. Anthropometric evaluations were performed. The analyses were performed on Avanutri®. For both urea determination and nitrogen balance calculations, twenty-four (24) hour urine processing was also performed. Results: The sample consisted of 6 amateur bodybuilders, with a mean age of 22.83 ± 4.53 (standard deviation), weight 72.37 ± 14.34 kg, height 1.68 ± 0.10 meters, and fat percentage of 11.81 ± 2.84%. The majority (5 athletes) was in the hypertrophy period (off-session), and 1 athlete was in definition (pre-contest). The food consumption results indicated that according to established recommendations for the sports modality, the athletes (with high intake of protein, and low carbohydrate consumption) were practicing inadequate eating habits. Testing showed that zinc, and vitamins D, B1, B2, and B6 intake was adequate. It was also observed that 66.67% (n = 4) used dietary supplements. The mean nitrogen balance was 19.15 ± 22.09. Conclusion: The bodybuilders’ diets were hyper-proteic, normo-lipid and hypo-glycemic; being inadequate in magnesium, iron, sodium and vitamins A, B3, C and E. The positive nitrogen balance found for the athletes correlated to their high protein intakes. RESUMO Consumo alimentar e balanço de nitrogênio de fisiculturistas em Cuité, Paraíba, BrasilObjetivos: avaliar o consumo alimentar e o balanço nitrogenado de fisiculturistas da cidade de Cuité-Paraíba, visando conhecer o perfil alimentar e nutricional. Métodos: Para coleta dos dados foram aplicados questionários estruturados, recordatórios alimentares de 24 horas e realizada avaliação antropométrica. As análises foram feitas no Avanutri®. O processamento da urina de 24 horas para determinação da ureia e cálculo do balanço nitrogenado também foi realizado. Resultados: A amostra foi composta por 6 atletas amadores do fisiculturismo, com médias de idade de 22,83 ± 4,53 anos (desvio-padrão), peso de 72,37 ± 14,34 Kg, altura de 1,68 ± 0,10 metros e percentual de gordura de 11,81 ± 2,84 %. A maioria (5 atletas) encontrava-se em período de hipertrofia (off-session) e 1 em período de definição (pré-contest). Os resultados do consumo alimentar indicaram que os hábitos alimentares dos atletas encontram-se inadequados frente às recomendações estabelecidas para a modalidade esportiva, com ingestão elevada de proteína com baixo consumo de carboidratos. Quanto aos micronutrientes, contatou-se que o zinco e as vitaminas D, B1, B2, B6, encontravam-se adequadas. Observou-se ainda que 66,67% (n=4) dos entrevistados fazem uso de suplementos alimentares. O balanço nitrogenado foi de 19,15 ± 22,09. Conclusão: A dieta dos fisiculturistas estava hiperprotéica, normolipídica e hipoglicídica, com inadequação de magnésio, ferro, sódio e das vitaminas A, B3, C e E. O balanço nitrogenado positivo dos atletas acompanhou o alto consumo de proteínas.Objetivos: avaliar o consumo alimentar e o balanço nitrogenado de fisiculturistas da cidade de Cuité-Paraíba, visando conhecer o perfil alimentar e nutricional. Métodos: Para coleta dos dados foram aplicados questionários estruturados, recordatórios alimentares de 24 horas e realizada avaliação antropométrica. As análises foram feitas no Avanutri®. O processamento da urina de 24 horas para determinação da ureia e cálculo do balanço nitrogenado também foi realizado. Resultados: A amostra foi composta por 6 atletas amadores do fisiculturismo, com médias de idade de 22,83 ± 4,53 anos (desvio-padrão), peso de 72,37 ± 14,34 Kg, altura de 1,68 ± 0,10 metros e percentual de gordura de 11,81 ± 2,84 %. A maioria (5 atletas) encontrava-se em período de hipertrofia (off-session) e 1 em período de definição (pré-contest). Os resultados do consumo alimentar indicaram que os hábitos alimentares dos atletas encontram-se inadequados frente às recomendações estabelecidas para a modalidade esportiva, com ingestão elevada de proteína com baixo consumo de carboidratos. Quanto aos micronutrientes, contatou-se que o zinco e as vitaminas D, B1, B2, B6, encontravam-se adequadas. Observou-se ainda que 66,67% (n=4) dos entrevistados fazem uso de suplementos alimentares. O balanço nitrogenado foi de 19,15 ± 22,09. Conclusão: A dieta dos fisiculturistas estava hiperprotéica, normolipídica e hipoglicídica, com inadequação de magnésio, ferro, sódio e das vitaminas A, B3, C e E. O balanço nitrogenado positivo dos atletas acompanhou o alto consumo de proteínas. ABSTRACTDietary intake and nitrogen balance of bodybuilders in Cuité, Paraíba, BrazilBackground: Sports nutrition has grown substantially. Considering that as compared to sedentary or moderately active individuals, athletes have distinct nutritional requirements, it is important to reflect on the adequacy of food intake as compared to the established recommendations. Thus, the present study evaluated food consumption and nitrogen balance in bodybuilders’ from Cuité-Paraíba, aiming to learn their food and nutritional profiles. Methods: Data were collected using structured questionnaires and 24-hour dietary recalls. Anthropometric evaluations were performed. The analyses were performed on Avanutri®. For both urea determination and nitrogen balance calculations, twenty-four (24) hour urine processing was also performed. Results: The sample consisted of 6 amateur bodybuilders, with a mean age of 22.83 ± 4.53 (standard deviation), weight 72.37 ± 14.34 kg, height 1.68 ± 0.10 meters, and fat percentage of 11.81 ± 2.84%. The majority (5 athletes) was in the hypertrophy period (off-session), and 1 athlete was in definition (pre-contest). The food consumption results indicated that according to established recommendations for the sports modality, the athletes (with high intake of protein, and low carbohydrate consumption) were practicing inadequate eating habits. Testing showed that zinc, and vitamins D, B1, B2, and B6 intake was adequate. It was also observed that 66.67% (n = 4) used dietary supplements. The mean nitrogen balance was 19.15 ± 22.09. Conclusion: The bodybuilders’ diets were hyper-proteic, normo-lipid and hypo-glycemic; being inadequate in magnesium, iron, sodium and vitamins A, B3, C and E. The positive nitrogen balance found for the athletes correlated to their high protein intakes

Anthropometric characteristics, dietary profile and nitrogen balance of Brazilian Jiu Jitsu athletes

Objetivos: analisar a composição corporal, consumo alimentar e o balanço nitrogenado de atletas amadores do jiu jitsu brasileiro. Métodos: foram investigadas as variáveis idade, estatura, dobras cutâneas, percentual de gordura corporal, consumo alimentar e balanço nitrogenado de 11 atletas amadores do jiu jitsu brasileiro, adultos de ambos os sexos. Para isto, foram aplicados questionários estruturados, recordatórios alimentares de 24 horas e realizada avaliação antropométrica, além da dosagem de ureia em urina de 24 horas para determinação do balanço nitrogenado. Resultados e discussão: os atletas tinham idade média de 23,20 ± 5,70 anos (desvio-padrão), peso de 79,89 ± 20,67 kg, altura de 1,75 ± 0,09 m e percentual de gordura de 14,51 ± 6,02%. Apresentaram ingestão de energia (2.887,00 ± 940,60 kcal/dia) e de carboidratos (54,78 ± 5,67%) abaixo do nível recomendado pela literatura; ingestão adequada de proteínas (1,62 ± 0.60 g/kg), lipídeos (27,54 ± 5,91%) e alguns micronutrientes, como o zinco e as vitaminas D, E, B1, B2, B3, B6, C e B12; o consumo alimentar de vitaminas A e B5, bem como o de cálcio, magnésio, potássio, ferro e sódio apresentou-se inadequado. Não houve diferença entre os atletas, em relação à energia e macronutrientes (Kruskal Wallis test). O balanço nitrogenado mostrou-se positivo em todos os atletas. Não se observou relação entre consumo de proteínas e positividade do balanço nitrogenado (Fischer test). Conclusão: a ingestão inadequada de energia, carboidratos, vitaminas A e B5, assim como de cálcio, magnésio, potássio, ferro e sódio ocorre nos atletas deste estudo, apresentando um fator preocupante e prejudicial em termos de desempenho e saúde. ABSTRACT Anthropometric characteristics, dietary profile and nitrogen balance of Brazilian Jiu Jitsu athletesObjectives: to analyze body mass, food intake and nitrogen balance of Brazilian Jiu Jitsu amateur athletes. Methods: Age, stature, skinfolds, percentage of body fat, food intake and nitrogen balance of 11 Brazilian jiu jitsu amateur athletes, adults of both sexes, were investigated. For this, structured questionnaires, 24-hour food records and anthropometric evaluation were applied, in addition to the 24-hour urea dosage for determination of the nitrogen balance. Results and discussion: mean weight of 23.20 ± 5.70 years (standard deviation), weight of 79.89 ± 20.67 kg, height of 1.75 ± 0.09 m and fat percentage of 14.51 ± 6.02%. They presented the amount of energy (2,887.00 ± 940.60 kcal / day) and carbohydrates (54.78 ± 5.67%) below the original level of the literature; (1.62 ± 0.60 g / kg), lipids (27.54 ± 5.91%) and some micronutrients, such as zinc and vitamins D, E, B1, B2, B3, B6, C and B12; the dietary intake of vitamins A and B5, as well as calcium, magnesium, potassium, iron and sodium being inadequate. There was no difference between athletes in relation to energy and macronutrients (Kruskal Wallis test). Nitrogen balance was positive in all athletes. Neutral content between protein and nitrogen balance positivity (Fischer's test). Conclusion: An inadequate intake of energy, carbohydrates, vitamins A and B5, as well as calcium, magnesium, potassium, iron and sodium, present themselves as protagonists of this study, presenting a worrying and detrimental factor in terms of performance and health.Objectives: to analyze body mass, food intake and nitrogen balance of Brazilian Jiu Jitsu amateur athletes. Methods: Age, stature, skinfolds, percentage of body fat, food intake and nitrogen balance of 11 Brazilian jiu jitsu amateur athletes, adults of both sexes, were investigated. For this, structured questionnaires, 24-hour food records and anthropometric evaluation were applied, in addition to the 24-hour urea dosage for determination of the nitrogen balance. Results and discussion: mean weight of 23.20 ± 5.70 years (standard deviation), weight of 79.89 ± 20.67 kg, height of 1.75 ± 0.09 m and fat percentage of 14.51 ± 6.02%. They presented the amount of energy (2,887.00 ± 940.60 kcal / day) and carbohydrates (54.78 ± 5.67%) below the original level of the literature; (1.62 ± 0.60 g / kg), lipids (27.54 ± 5.91%) and some micronutrients, such as zinc and vitamins D, E, B1, B2, B3, B6, C and B12; the dietary intake of vitamins A and B5, as well as calcium, magnesium, potassium, iron and sodium being inadequate. There was no difference between athletes in relation to energy and macronutrients (Kruskal Wallis test). Nitrogen balance was positive in all athletes. Neutral content between protein and nitrogen balance positivity (Fischer's test). Conclusion: An inadequate intake of energy, carbohydrates, vitamins A and B5, as well as calcium, magnesium, potassium, iron and sodium, present themselves as protagonists of this study, presenting a worrying and detrimental factor in terms of performance and health

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe