Evolução da magnetotaxia: predição, isolamento e caracterização de bacteriófagos potencialmente transdutores de genes de biomineralização

Bactérias magnetotáticas (BMs) compõem um grupo de bactérias Gram-negativas que possuem diversidade morfológica, filogenética e metabólica, apresentando a capacidade sintetizar nanocristais ferromagnéticos envoltos por uma membrana biológica, os magnetossomos. Magnetossomos são organelas que auxiliam na navegação destes microrganismos em colunas d’agua ou sedimentos quimicamente estratificados, utilizando o campo magnético da Terra como guia. Esse comportamento é conhecido como magnetotaxia. A biomineralização do magnetossomo é altamente regulada a nível genético e um conjunto específicos de genes é responsável por esse processo. Embora os genes de biomineralização sejam conhecidos, sua origem e distribuição ao longo da evolução de BMs ainda é desconhecida. Eventos de transferência horizontal de genes (THG) podem explicar o espalhamento da magnetotaxia entre os representantes magnetotáticos dos filos Proteobacteria, Nitrospirae e Omnitrophica. Fagos são a entidade biológica mais abundante no planeta Terra e participam diretamente de processos de transferência de genes, assim como em ciclos biogeoquímicos, controle populacional e ciclagem de matéria orgânica nos oceanos. Nesse trabalho, foram preditos profagos em BMs bem como o isolamento e caracterização de fagos produzidos por Magnetofaba. australis cepa IT-1. Fagos já foram evidenciados em culturas de Mf. australis cepa IT-1 por microscopia eletrônica de varredura e citometria de fluxo (Toledo, 2016). Nossos resultados mostram profagos preditos em genomas de BMs descritas na literatura encontrando-se o predomínio de sequências correspondentes a fagos das famílias Myo-, Sipho- e Podoviridae. Análises filogenéticas permitiram inferir que profagos de Mf. australis cepa IT-1 estão distantes filogeneticamente dos fagos preditos na BM mais próxima descrita, Mc. marinus cepa MC-1. Populações de fagos produzidos por Mf. australis cepa IT-1 foram quantificados durante o cultivo e após a purificação destas partículas obtendo-se a ordem de 107 bacteriófagos e 105 bactérias por mililitro. Bacteriófagos envelopados com diâmetro médio em torno de 100 nm foram observados por microscopia eletrônica de transmissão (MET) e genes de biomineralização foram amplificados por PCR usando o genoma fágico como molde. Estes dados demonstram que fagos são produzidos em cultura por Mf. australis cepa IT-1 são potenciais transdutores de genes de biomineralização

Faciologia, quimioestratigrafia e interação fluido-rocha em carbonatos neoproterozoicos da formação salitre na região de Irecê, Bahia

Dissertação (mestrado)—Universidade de Brasília, Instituto de Geociências, Programa de Pós-Graduação em Geologia, 2020.Neste trabalho são apresentados dados de faciologia, petrografia e geoquímica isotópica obtidos em carbonatos Neoproterozoicos da Formação Salitre em afloramento localizado no povoado Achado, localizado 5 km a leste da cidade de Irecê, Bahia. O objetivo principal foi verificar a relação entre as litofácies e a migração de fluidos utilizando dados de δ13C, δ18O e 87Sr/86Sr dos carbonatos. O levantamento faciológico se deu em uma seção de exposição contínua, com níveis faciológicos bem preservados, resultando na confecção de uma coluna estratigráfica com espessura de 345 metros. As fácies identificadas foram agrupadas em três associações de fácies distribuídas em um sistema de rampa carbonática: rampa carbonática interna dominada por maré e microbialitos (FA1); rampa carbonática interna dominada por ondas (FA2); e, rampa carbonática média dominada por ondas de tempestade (FA3). Apesar da boa preservação das estruturas sedimentares, toda a sequência apresenta feições de deformação, tais como: brechas hidráulicas, veios, fraturas e falhas. Com base na litologia, nas feições sedimentares e nas variações isotópicas, a coluna foi dividida em três seções, a saber: 1) Basal; 2) Intermediária; e, 3) Superior. A seção inferior é caracterizada por calcários com valores de δ13C entre -0.46‰ e +3.17‰ que reflete deposição quando da conexão da bacia com oceanos Neoproterozoicos. As seções média e superior são caracterizadas por dolomitos e apresentam valores de δ13C variando de -3.41‰ a +13.69‰ representando deposição em bacia restrita. A evolução diagenética da sucessão é caracterizada por seis estágios diagenéticos distintos, sendo eles: diagênese marinha, autigênese, reflux, meteórica, soterramento e hidrotermal. As condições paleoambientais e diagenéticas foram fundamentais para o estabelecimento do fluxo de fluidos na sucessão estudada. Os dolomitos da seção média e superior são caracterizados por grandes ocorrências de veios, sugerindo um controle litológico sobre a distribuição de fraturas e falhas - tais estruturas foram os principais condutos para a migração de fluidos, que tiveram espalhamento lateral devido ao controle faciológico. Nos dolomitos, dois grupos de veios foram identificados e que representam diferentes fontes de fluidos. O primeiro é caracterizado por apresentar valores muito negativos de δ13C (entre -8.99‰ e +0.61‰) e δ18O (-4.24‰ a -9.29‰) e valores radiogênicos de 87Sr/86Sr (variando de 0.71056 a 0.73854), representando fluidos hidrotermais externos. O segundo grupo foi formado em sistema fechado como resultado da interação fluido-rocha devido aos mecanismos de dissolução por pressão - os valores semelhantes de δ13C e δ18O para os veios e a rocha encaixante suportam tal interpretação. O estudo multidisciplinar envolvendo a análise de fácies, diagênese e geoquímica isotópica permitiu identificar as prováveis fontes de fluidos que percolaram a bacia, bem como a assinatura isotópica que esses fluidos deixam ao interagir com a rocha encaixante. A identificação de zonas de percolação de fluidos em reservatórios carbonáticos é de extrema importância, uma vez que estes podem causar modificações na qualidade dos reservatórios, principalmente em relação à porosidade e permeabilidade.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).In this work, we show our new data, including facies analysis, petrography and isotope geochemistry obtained in Neoproterozoic carbonates of the Salitre Formation, in an outcrop located in the Achado village, 5 km east of the city of Irecê, Bahia. The main objective was to verify the relationship between lithofacies and fluid-rock migration using δ 13C and δ 18O carbonate data. Facies analysis was carried out in a section of continuous exposure, with well- preserved facies layers, resulting in a stratigraphic column with 345m. The facies identified were grouped into three facies associations, distributed on a carbonate ramp system: (FA1) inner carbonate ramp dominated by tidal process and microbialites, (FA2) inner carbonate ramp dominated by waves and (FA3) mid carbonate ramp dominated by storm waves. Despite well- preserved sedimentary structures, the entire sequence presents deformation features, such as veins, fractures and faults. Based on lithology, sedimentary features and isotope variations, the column was divided into three sections, namely: 1) lower; 2) middle; and 3) upper. The lower section is characterized by limestones, where δ 13C ranges from -0.46‰ to +3.17, which reflects deposition when the basin was connected to the Neoproterozoic open ocean. The middle and upper sections are characterized by dolostones, and have δ 13C values ranging from -3.41‰ to +13.69‰, representing deposition in a restricted basin. The diagenetic evolution of the succession is characterized by six distinct diagenetic stages: marine, authigenic, reflux, meteoric, burial and hydrothermal. The paleoenvironmental and diagenetic conditions were fundamental to establish the fluid flow in the studied carbonate succession. The dolostones of the middle and upper sections are characterized by frequent occurrences of veins, which suggests a lithological control of the distribution of fractures and faults. Such structures were the main conduits for fluid migration, which presented lateral spread due to facies control. In the dolostones, two groups of veins were identified which represent different sources of fluids. The first one is characterized by very negative δ13C (ranging from -8.99‰ to +0.61‰) and δ18O (ranging from - 4.24 ‰ to -9.29‰) values, and radiogenic 87Sr/86Sr values (ranging from 0.71056 to 0.73854), representing external hydrothermal fluids. The other group was formed in a closed system as a result of the fluid-rock interaction through a pressure-solution mechanism. Similar δ13C and δ18O values for veins and host rock support this interpretation. The multidisciplinary study involving facies analysis, diagenesis and isotope geochemistry allowed for the identification of the probable sources of fluids that percolated the basin, as well as of the isotopic changes in the host rock due to fluid-rock interaction. The identification of fluid flow zones in carbonate reservoirs is extremely important, since such fluids may cause changes in the quality of the reservoirs, especially in relation to porosity and permeability

Biomineralization of Magnetosomes: Billion-Year Evolution Shaping Modern Nanotools

Biomineralization in the microbial realm usually gives origin to finely structured inorganic nanomaterials. Perhaps, one of the most elegant bioinorganic processes found in nature is the iron biomineralization into magnetosomes, which is performed by magnetotactic bacteria. A magnetosome gene cluster within the bacterial genome precisely regulates the mineral synthesis. The spread and evolution of this ability among bacteria are thought to be a 2,7-billion-year process mediated by horizontal gene transfers. The produced magnetite or greigite nanocrystals coated by a biological membrane have a narrow diameter dispersibility, a highly precise morphology, and a permanent magnetic dipole due to the molecular level control. Approaches inspired by this bacterial biomineralization mechanism can imitate some of the biogenic nanomagnets characteristics in the chemical synthesis of iron oxide nanoparticles. Thus, this chapter will give a concise overview of magnetosome synthesis’s main steps, some hypotheses about the evolution of magnetosomes’ biomineralization, and approaches used to mimic this biological phenomenon in vitro

Delivering beneficial microorganisms for corals: rotifers as carriers of probiotic bacteria

The use of Beneficial Microorganisms for Corals (BMCs) to increase the resistance of corals to environmental stress has proven to be effective in laboratory trials. Because direct inoculation of BMCs in larger tanks or in the field can be challenging, a delivery mechanism is needed for efficient transmission of the BMC consortium. Packaged delivery mechanisms have been successfully used to transmit probiotics to other organisms, including humans, lobsters, and fish. Here, we tested a method for utilizing rotifers of the species Brachionus plicatilis for delivery of BMCs to corals of the species Pocillopora damicornis. Epifluorescence microscopy combined with a live/dead cell staining assay was used to evaluate the viability of the BMCs and monitor their in vivo uptake by the rotifers. The rotifers efficiently ingested BMCs, which accumulated in the digestive system and on the body surface after 10 min of interaction. Scanning electron microscopy confirmed the adherence of BMCs to the rotifer surfaces. BMC-enriched rotifers were actively ingested by P. damicornis corals, indicating that this is a promising technique for administering coral probiotics in situ. Studies to track the delivery of probiotics through carriers such as B. plicatilis, and the provision or establishment of beneficial traits in corals are the next proof-of-concept research priorities

Parkinson's disease: neurological manifestations and possibilities for neurosurgery

Parkinson's disease is caused by the progressive degeneration of nerve cells that produce dopamine, a neurotransmitter essential for motor coordination. The most common symptoms of Parkinson's disease are resting tremors, muscle rigidity, slow voluntary movements and postural instability. Furthermore, the disease can cause cognitive, emotional, sensory and autonomic changes. There are two main types of neurosurgery for Parkinson's disease: ablative surgery and deep brain stimulation (DBS). Objective: to evaluate the impact of neurosurgery for Parkinson's disease in improving motor symptoms, reducing medication side effects, preserving cognitive functions and improving patients' quality of life. Methodology: followed the PRISMA checklist. The databases used were PubMed, Scielo, Web of Science and Google Scholar. The descriptors used were: “Parkinson's disease”, “neurosurgery”, “ablation”, “deep brain stimulation” and “outcome”. The inclusion criteria were: articles that compared the two types of neurosurgery for Parkinson's disease (ablative surgery and deep brain stimulation), that evaluated clinical outcomes (motor symptoms, medication side effects, cognitive functions and quality of life) and that used standardized scales to measure these outcomes. The exclusion criteria were: articles that did not compare the two types of neurosurgery for Parkinson's disease, that did not evaluate the clinical outcomes of interest, that used non-validated or inadequate scales to measure these outcomes. Results: 15 studies were selected. Both types of neurosurgery for Parkinson's disease have been effective in improving patients' motor symptoms, especially tremors, rigidity, and bradykinesia. However, deep brain stimulation had an advantage over ablative surgery in terms of reducing medication side effects, such as motor fluctuations and dyskinesias. Deep brain stimulation was also safer and less invasive than ablative surgery, presenting fewer complications such as hemorrhage, infection, neurological deficits, and cognitive or psychiatric changes. However, deep brain stimulation showed greater improvement than ablative surgery, especially in physical, emotional and social aspects of quality of life. Conclusion: neurosurgery for Parkinson's disease is a valid therapeutic option for patients who do not respond adequately to drug treatment or who have intolerable side effects. Among the two main types of neurosurgery for Parkinson's disease, deep brain stimulation appears to be superior to ablative surgery in terms of efficacy, safety, and impact on patients' quality of life.Parkinson's disease is caused by the progressive degeneration of nerve cells that produce dopamine, a neurotransmitter essential for motor coordination. The most common symptoms of Parkinson's disease are resting tremors, muscle rigidity, slow voluntary movements and postural instability. Furthermore, the disease can cause cognitive, emotional, sensory and autonomic changes. There are two main types of neurosurgery for Parkinson's disease: ablative surgery and deep brain stimulation (DBS). Objective: to evaluate the impact of neurosurgery for Parkinson's disease in improving motor symptoms, reducing medication side effects, preserving cognitive functions and improving patients' quality of life. Methodology: followed the PRISMA checklist. The databases used were PubMed, Scielo, Web of Science and Google Scholar. The descriptors used were: “Parkinson's disease”, “neurosurgery”, “ablation”, “deep brain stimulation” and “outcome”. The inclusion criteria were: articles that compared the two types of neurosurgery for Parkinson's disease (ablative surgery and deep brain stimulation), that evaluated clinical outcomes (motor symptoms, medication side effects, cognitive functions and quality of life) and that used standardized scales to measure these outcomes. The exclusion criteria were: articles that did not compare the two types of neurosurgery for Parkinson's disease, that did not evaluate the clinical outcomes of interest, that used non-validated or inadequate scales to measure these outcomes. Results: 15 studies were selected. Both types of neurosurgery for Parkinson's disease have been effective in improving patients' motor symptoms, especially tremors, rigidity, and bradykinesia. However, deep brain stimulation had an advantage over ablative surgery in terms of reducing medication side effects, such as motor fluctuations and dyskinesias. Deep brain stimulation was also safer and less invasive than ablative surgery, presenting fewer complications such as hemorrhage, infection, neurological deficits, and cognitive or psychiatric changes. However, deep brain stimulation showed greater improvement than ablative surgery, especially in physical, emotional and social aspects of quality of life. Conclusion: neurosurgery for Parkinson's disease is a valid therapeutic option for patients who do not respond adequately to drug treatment or who have intolerable side effects. Among the two main types of neurosurgery for Parkinson's disease, deep brain stimulation appears to be superior to ablative surgery in terms of efficacy, safety, and impact on patients' quality of life

Clonal expansion across the seas as seen through CPLP-TB database: A joint effort in cataloguing Mycobacterium tuberculosis genetic diversity in Portuguese-speaking countries.

Tuberculosis (TB) remains a major health problem within the Community of Portuguese Language Speaking Countries (CPLP). Despite the marked variation in TB incidence across its member-states and continued human migratory flux between countries, a considerable gap in the knowledge on the Mycobacterium tuberculosis population structure and strain circulation between the countries still exists. To address this, we have assembled and analysed the largest CPLP M. tuberculosis molecular and drug susceptibility dataset, comprised by a total of 1447 clinical isolates, including 423 multidrug-resistant isolates, from five CPLP countries. The data herein presented reinforces Latin American and Mediterranean (LAM) strains as the hallmark of M. tuberculosis populational structure in the CPLP coupled with country-specific differential prevalence of minor clades. Moreover, using high-resolution typing by 24-loci MIRU-VNTR, six cross-border genetic clusters were detected, thus supporting recent clonal expansion across the Lusophone space. To make this data available to the scientific community and public health authorities we developed CPLP-TB (available at http://cplp-tb.ff.ulisboa.pt), an online database coupled with web-based tools for exploratory data analysis. As a public health tool, it is expected to contribute to improved knowledge on the M. tuberculosis population structure and strain circulation within the CPLP, thus supporting the risk assessment of strain-specific trends

uma nova ferramenta de vigilância transnacional da tuberculose no espaço lusófono

A Tuberculose (TB) permanece um grave problema de saúde pública na Comunidade dos Países de Língua Portuguesa (CPLP). Apesar da ampla variância da incidência da TB nos seus estados-membro e de um fluxo migratório contínuo entre os países que integram este grupo, existe uma enorme lacuna no que diz respeito ao conhecimento da estrutura populacional conjunta do Mycobacterium tuberculosis e circulação de estirpes entre estes países. Para fazer face a esta necessidade, foi agregado e analisado o maior conjunto de dados respeitante à diversidade genotípica e resistência fenotípica na CPLP que compreende um total de 1447 isolados clínicos, incluindo 423 isolados multirresistentes de cinco países da CPLP. Por forma a tornar estes dados disponíveis para a comunidade científica e autoridades de saúde pública, foi desenvolvida a CPLP-TB (disponível em http://cplp-tb.ff.ulisboa.pt), uma base de dados disponível online e provida de aplicativos para análise exploratória do conteúdo. Como ferramenta de saúde pública, espera-se que venha a contribuir para um conhecimento mais aprofundado da estrutura populacional do M. tuberculosis e circulação de estirpes na CPLP de forma a apoiar a avaliação de risco e tendências específicas para diversos clones. Tuberculosis (TB) remains a major health problem within the Community of Portuguese Language Speaking Countries (CPLP). Despite the marked variation in TB incidence across its member-states and continued human migratory flux between countries, a considerable gap in the knowledge on the Mycobacterium tuberculosis population structure and strain circulation between the countries still exists. To address this, we have assembled and analyzed the largest CPLP M . tuberculosis molecular and drug susceptibility dataset, comprised by a total of 1447 clinical isolates, including 423 multidrug-resistant isolates, from five CPLP countries. To make this data available to the scientific community and public health authorities we developed CPLP-TB (available at http://cplp-tb.ff.ulisboa.pt), an online database coupled with web-based tools for exploratory data analysis. As a public health tool, it is expected to contribute to improved knowledge on the M. tuberculosis population structure and strain circulation within the CPLP, thus supporting the risk assessment of strain-specific trends.publishersversionpublishe

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

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

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)