ALTERNATIVAS FITOTERÁPICAS NO CONTROLE DA OBESIDADE

Nos últimos anos, a obesidade vem aumentando consideravelmente entre adultos e crianças e, segundo a OMS, estima-se que em 2025 o número de obesos ultrapasse a 2,3 milhões em todo o mundo. O indivíduo obeso apresenta maiores riscos de desenvolver doenças crônicas não transmissíveis, como diabetes, doenças cardiovasculares, dislipidemias e ainda alguns tipos de cânceres. O tratamento para a obesidade é variado e inclui mudanças no estilo de vida como: hábitos alimentares e prática de atividade física, tratamento medicamentoso, cirurgia bariátrica e fitoterápicos com o potencial de auxiliar no tratamento. O objetivo deste trabalho foi realizar uma revisão bibliográfica a fim de avaliar os benefícios da utilização de medicamentos fitoterápicos como auxiliar no tratamento da obesidade, seus principais ativos, mecanismos de ação e sua utilização popular. Dentre as plantas pesquisadas e que demonstraram potencial para atuar no tratamento da obesidade encontram-se Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale e Senna alexandrina. Os principais mecanismos de ação envolvidos no potencial anti-obesidade das plantas medicinais são a capacidade de controle do apetite e ingestão de energia, estímulo da termogênese, inibição da lipase pancreática e redução da absorção de gordura, diminuição da lipogênese e aumento da lipólise. Desta forma, conclui-se que as plantas selecionadas neste estudo apresentaram efeitos positivos nos parâmetros bioquímicos e físicos, podendo ser incluídas nos protocolos como coadjuvantes nos tratamentos de emagrecimento

ASSISTÊNCIA DE ENFERMAGEM AO PACIENTE POLITRAUMATIZADO EM EMERGÊNCIA HOSPITALAR: UMA REVISÃO DA LITERATURA

Objective: To Identify nursing care for polytrauma patients in the emergency hospital environment. Method: This is a narrative review of the literature based on the analysis of scientific articles. A survey was carried out in the following databases: BDENF-BIREME, Latin American and Caribbean Literature on Health Sciences (LILACS), Scientific Electronic Library Online (Scielo). Used the crossing of Health Sciences Descriptors (Decs): “Traumatism Multiple”, “Emergency”, “Hospital Emergency Service”, “Nursing Care” and Boolean operator “AND”. The following inclusion criteria used: articles published in Portuguese, English, and Spanish, without country restrictions and publication time, and the excluded criteria were: Studies published in the form of theses, monographs, dissertations, case reports, and congress abstracts; articles were unavailable in full and did not address the proposed theme. Results: Selected 18 studies for analysis. The discussion of the articles was categorized into 3 themes: trauma dynamics; trauma victim care; nursing care for polytrauma patients. There was a need for standardized care and knowledge of ABCDE trauma for the initial care of the victim to be carried out quickly, correctly, in a comprehensive and humanized manner. Considerations: The victim of multiple traumas requires specific specific care. Thus, nurses must have technical-scientific knowledge and knowledge of the Nursing Process, as they are considered one of the main professionals responsible for the initial care and maintenance of life for polytrauma patients. KEYWORDS: Multiple trauma. Emergencies. Emergency hospital service. Nursing care.Objetivo: Identificar la atención de enfermería al paciente politraumatizado en el ámbito hospitalario de urgencias. Método: Se trata de una revisión narrativa de la literatura, basada en el análisis de artículos científicos. Se realizó una encuesta en las siguientes bases de datos: BDENF-BIREME, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca Electrónica Científica en Línea (Scielo), utilizando cruzamiento de Descriptores de Ciencias de la Salud (Decs):“Traumatismo Múltiple”, “Emergencia” Servicio de emergencia hospitalario ”y“ Atención de enfermería ”y operador booleano“Y”.Se utilizaron los siguientes criterios de inclusión: artículos publicados en portugués, inglés y español, sin restricciones de país y tiempo de publicación. Se excluyeron los estudios publicados en forma de tesis, monografías, disertaciones, informes de casos y resúmenes de congresos; artículos no disponibles en su totalidad y aquellos que no abordaron el tema propuesto. Resultados: se seleccionaron 18 estudios para su análisis.La discusión de los artículos se categorizó en 3 temas: dinámica del trauma; atención a víctimas de trauma; cuidados de enfermería para pacientes politraumatizados.Existía la necesidad de una atención y conocimiento estandarizados del ABCDE del trauma para que la atención inicial de la víctima se realizara de manera rápida, correcta, integral y humanizada. Consideraciones:La víctima de múltiples traumas requiere cuidados iniciales específicos.Así, el enfermero debe tener conocimiento técnico-científico y conocimiento del Proceso de Enfermería, por ser considerado uno de los principales profesionales responsables del cuidado inicial, cuidado y mantenimiento de la vida de los pacientes politraumatizados. PALABRAS CLAVE:Traumatismo múltiple. Emergencias. Servicio hospitalario de urgencias. Cuidado de enfermera  Objetivo: Identificar a assistência de enfermagem ao paciente politraumatizado no ambiente hospitalar de emergência. Método: Trata-se de uma revisão narrativa da literatura, realizada a partir da análise de artigos científicos. Foi realizado um levantamento nas bases de dados: BDENF-BIREME, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (Scielo), utilizando cruzamento dos Descritores de Ciências da Saúde (Decs): “Traumatismo Múltiplo”, “Emergências”, “Serviço Hospitalar de Emergência” e “Cuidados de Enfermagem” e operador booleano “AND”. Utilizou-se como critérios de inclusão: artigos publicados nos idiomas português, inglês e espanhol, sem restrição de país e tempo de publicação. Sendo excluídos os estudos publicados no formato teses, monografias, dissertações, relato de caso e resumos de congresso; artigos indisponíveis na íntegra e aqueles que não abordavam a temática proposta. Resultados: Foram selecionados 18 estudos para análise.  A discussão dos artigos foi categorizada em 3 temas: dinâmica do trauma; atendimento à vítima de trauma; assistência de enfermagem ao paciente politraumatizado. Observou-se a necessidade de uma assistência padronizada e conhecimento do ABCDE do trauma para o atendimento inicial da vítima seja realizado em tempo ágil, de maneira correta, de forma integral e humanizada. Considerações: A vítima de múltiplos traumas requer cuidados iniciais específicos. Dessa forma, o enfermeiro deve possuir conhecimento técnico-científico e conhecimento do Processo de Enfermagem, pois é considerado um dos principais profissionais responsáveis pelo atendimento inicial, o cuidado e a manutenção da vida do paciente politraumatizado. PALAVRAS-CHAVE: Traumatismo múltiplo. Emergências. Serviço hospitalar de emergência. Cuidados de enfermagem

PLANTAS ALIMENTÍCIAS NÃO CONVENCIONAIS: REVISÃO

As plantas alimentícias não convencionais (PANCs) são hortaliças nativas, normalmente encontradas em calçadas ou terrenos abandonados, sempre fizeram parte do cardápio dos antepassados. No entanto, com a modernização da agricultura e do êxodo rural, seu consumo foi esquecido de ser repassado para as gerações futuras. O objetivo deste estudo consistiu em realizar um levantamento bibliográfico sobre as plantas alimentícias não convencionais (PANCs), sua importância na alimentação e farmacológica. A metodologia consistiu na realização de levantamento bibliográfico, com as principais plantas utilizadas como alimento pelos antepassados sendo as plantas Pereskia aculeata Miller, Basella alba, Sonchus oleraceus, Stachys byzantina, Taraxacum Officinale, Xanthosoma sagittifolium, Dioscorea bulbifera, Physalis angulata, Acmella oleracea, Tropaeolum majus. Através deste estudo pode-se constatar que estas plantas são úteis, pois além de apresentar valor nutricional e a sua utilização na alimentação, também são utilizadas como como plantas medicinais, devido à presença de compostos ativos responsáveis pela ação biológica

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

Eficácia dos Protocolos de Suporte Avançado de Vida no Atendimento Pré-Hospitalar de Parada Cardiorrespiratória: Uma Revisão Integrativa

This article presents an integrative review on the effectiveness of Advanced Life Support (ALS) protocols in the pre-hospital management of cardiac arrest. The research was conducted by analyzing nine studies selected from electronic databases, published between 2018 and 2023. The results indicate that the standardization of ALS practices, according to the American Heart Association (AHA) guidelines, significantly increases the rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. Additionally, continuous education and regular training of healthcare professionals are crucial for the effectiveness of pre-hospital care. Adequate infrastructure and availability of resources are also determinants for the success of ALS interventions. The integration of educational technologies and technological advancements in the training of healthcare professionals proved to be a promising strategy to improve the application of protocols. This study contributes to the field of pre-hospital resuscitation by providing a comprehensive overview of the factors influencing the effectiveness of ALS protocols, highlighting the need for a multifaceted approach that combines standardization, continuous education, adequate resources, and technological innovations.Este artigo apresenta uma revisão integrativa sobre a eficácia dos protocolos de Suporte Avançado de Vida (SAV) no atendimento pré-hospitalar de parada cardiorrespiratória (PCR). A pesquisa foi conduzida através da análise de nove estudos selecionados em bases de dados eletrônicas, publicados entre 2018 e 2023. Os resultados indicam que a padronização das práticas de SAV, conforme as diretrizes da American Heart Association (AHA), aumenta significativamente as taxas de retorno da circulação espontânea (RCE) e a sobrevivência até a alta hospitalar. Além disso, a educação continuada e o treinamento regular dos profissionais de saúde são cruciais para a eficácia do atendimento pré-hospitalar. A infraestrutura adequada e a disponibilidade de recursos também são determinantes para o sucesso das intervenções de SAV. A integração de tecnologias educacionais e avanços tecnológicos na formação dos profissionais de saúde mostrou-se uma estratégia promissora para melhorar a aplicação dos protocolos. Este estudo contribui para o campo da ressuscitação pré-hospitalar ao fornecer uma visão abrangente sobre os fatores que influenciam a eficácia dos protocolos de SAV, destacando a necessidade de uma abordagem multifacetada que combine padronização, educação contínua recursos adequados e inovações tecnológicas

Alterações cognitivas na infecção pelo HIV: uma revisão sistemática: Cognitive changes in HIV infection: a systematic review

Provocada pelo vírus da imunodeficiência humana, com a síndrome da imunodeficiência adquirida, numa pessoa tem o seu sistema imunológico prejudicado, tornando-se suscetível a outras doenças e infecção. Tem-se a estimativa de que 50% dos infectados com o referido vírus podem sofrer alterações cognitivas. Diante disso, este estudo tem como objetivo refletir sobre mudanças estruturais cerebrais e comprometimento cognitivo em pacientes com HIV. Portanto, trata-se de uma revisão sistemática de literatura, desenvolvida a partir da seleção de estudos nas bases de dados Scielo, Pubmed e BVS/Medline a partir do uso de descritores DeCS/MeSH e aplicação de critérios de inclusão e exclusão. Após a análise e interpretação dos dados, concluiu-se que há uma significativa prevalência de HAND em adultos infectados por HIV, no que se refere a alterações cognitivas, especialmente entre pacientes do sexo feminino, de baixa escolaridade e renda, com diagnóstico tardio e baixa quantidade de linfócitos CD4 no início do tratamento. Entre essas pessoas, revelam-se comprometimentos quanto à memória, atenção, controle de impulsos, velocidade de processamento e motora, dentre outros

Uso de drogas e o aumento das infecções sexualmente transmissíveis: uma revisão sistemática: Drug use and the increase in sexually transmitted infections: a systematic review

Populações de usuários de drogas têm sido associadas a epidemias de infecções ou Infecções Sexualmente Transmissíveis, especialmente a infecção pelo HIV (que está associada a drogas injetáveis, uso de equipamentos contaminados para drogas injetáveis e sexo inseguro). A droga mais associada às DSTs é a cocaína fumável de base livre (crack), devido ao aumento dos comportamentos sexuais de risco. Diante disso, o presente estudo teve como objetivo compreender o impacto do uso de drogas no aumento das infecções sexualmente transmissíveis. Para isso, adotou-se como metodologia a revisão sistemática de literatura, realizando buscas nas bases de dados Scielo, Pubmed e BVS/Medline a partir do uso de descritores DeCS/MeSH e aplicação de critérios de inclusão e exclusão. A partir da análise e interpretação dos dados, concluiu-se que que pessoas que fazem uso abusivo de drogas lícitas ou ilícitas, sejam elas mulheres, homens, adolescentes, jovens, adultos, idosos, em situação de rua ou não, tendem a desenvolver comportamentos vulneráveis que pode resultar em IST. Somado a isso, enquanto comportamento de risco, tem-se a preferência por não usar preservativo, seja em relações sexuais com pessoas monogâmicas como com dois ou mais parceiros. Nesses casos, tanto o uso exacerbado de drogas como a falta de informação sobre comportamento sexual demonstram-se insuficientes

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of 'leaving no one behind', it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens