Prácticas de bioseguridad en lecherías comerciales de la Zona Central de Chile

Biosecurity is defined as the set of measures designed to reduce the entry of pathogens to the herd as well as to avoid or reduce their dissemination within the herd. Biosecurity status is becoming increasingly important, since it influences herd health and product quality. However, biosecurity status in dairy farms in Chile is not known. The aim of the present study was to describe the main biosecurity practices carried out in commercial dairies of the Central Zone of Chile. To carry out this, a survey was designed and subsequently applied to 33 dairy farms located in the regions of Valparaiso, O`Higgins and Metropolitan. This activity was complemented with a visit and inspection of the dairy. Regarding to the arrival of cattle from other farms, in 13 dairies (39.4 %) new cattle were brought into the herd during the last 2 years. Heifers were the class most frequently brought. In 6 of these dairies (46.2%), quarantine to the incoming animals was carried out. In relation to the people's traffic, in 8 operations (24.2 %) there was some kind of signposting in the entry of the facilities and only in one (3 %), visitors had to clean and disinfect its footwear before entering to the facilities. Regarding vehicle traffic, only two operations (6 %) keep a process of disinfection for the wheels of the vehicles entering to the facilities. In all the dairies surveyed there were other animal species, which, in the majority of the cases, had direct contact with the bovines or with its sources of water or food. The species observed with the highest frequencies were: cats (90.9%), dogs (72.7%), horses (60.6%), and poultry (36.4%). In relation to the food management, in 17 cases (51.5 %) the remaining food of the adult cattle was used in the ration of another group of females, being the most frequent destination the rations of dry cows and weaned calves. It is concluded that in general the biosecurity status of the dairies surveyed is insufficient. The most deficient areas regarding biosecurity practices are people's entrance and control, and the contact of cattle with other domestic species. However, there is a low degree of inclusion of foreign animals into the herd, since it is widely acknowledged that keeping a closed herd is an effective way to prevent the access of pathogens to the farm.    La bioseguridad se define como el conjunto de medidas tendientes a reducir la entrada de patógenos a la explotación animal así como a evitar o disminuir su diseminación dentro del predio. Hoy en día, la situación de bioseguridad adquiere gran importancia, ya que influye en la salud del rebaño y la calidad del producto final. El presente estudio tuvo por objetivo describir las principales prácticas de bioseguridad que se aplican en lecherías comerciales de la Zona Central de Chile. Para esto, se elaboró una encuesta que se realizó en 33 predios de las regiones de Valparaiso, O´Higgins y Metropolitana. Esta actividad se complementó con una visita e inspección del plantel. En relación al ingreso de bovinos desde otros predios, en 13 lecherías (39,4%) se incorporó algún tipo de ganado nuevo a su rebaño, durante los últimos 2 años. El tipo de ganado más frecuente de ingresar fueron las vaquillas. De estas lecherías, en 6 de ellas (46,2%) se realizó cuarentena de los animales ingresados. En relación al ingreso de personas, en 8 predios (24,2%) había algún tipo de señalización en la entrada del predio y sólo en una (3%) los visitantes debían limpiar y desinfectar su calzado antes de ingresar a las instalaciones. Para el ingreso de vehículos, sólo dos planteles (6%) mantenían un rodiluvio o proceso de desinfección para las ruedas de los vehículos que ingresaban al plantel. En todas las lecherías encuestadas existían otras especies de animales, donde la mayoría de ellas, tenían contacto directo con los bovinos o con sus fuentes de agua o de alimento. Las especies observadas con mayor frecuencia fueron: gatos (90,9%), perros (72,7%), caballos (60,6%) y aves de corral (36,4%). Respecto al manejo alimentario, en 17 casos (51,5%), el alimento sobrante de los animales adultos era utilizado en la ración de otro grupo de hembras, siendo su destino más frecuente la ración de las vacas secas y las terneras en recría. Se concluye que en general la situación de bioseguridad en las lecherías encuestadas es insuficiente. Las áreas más deficientes en prácticas de bioseguridad fueron el ingreso y control de personas externas al predio y el contacto de los bovinos con otras especies domésticas. Sin embargo, existe una baja incorporación de animales desde otros predios, ya que se reconoce que mantener un rebaño cerrado es una medida eficaz para prevenir el ingreso de patógenos al plantel.  

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)

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

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting

Relationship of Weather Types on the Seasonal and Spatial Variability of Rainfall, Runoff, and Sediment Yield in the Western Mediterranean Basin

Rainfall is the key factor to understand soil erosion processes, mechanisms, and rates. Most research was conducted to determine rainfall characteristics and their relationship with soil erosion (erosivity) but there is little information about how atmospheric patterns control soil losses, and this is important to enable sustainable environmental planning and risk prevention. We investigated the temporal and spatial variability of the relationships of rainfall, runoff, and sediment yield with atmospheric patterns (weather types, WTs) in the western Mediterranean basin. For this purpose, we analyzed a large database of rainfall events collected between 1985 and 2015 in 46 experimental plots and catchments with the aim to: (i) evaluate seasonal differences in the contribution of rainfall, runoff, and sediment yield produced by the WTs; and (ii) to analyze the seasonal efficiency of the different WTs (relation frequency and magnitude) related to rainfall, runoff, and sediment yield. The results indicate two different temporal patterns: the first weather type exhibits (during the cold period: autumn and winter) westerly flows that produce the highest rainfall, runoff, and sediment yield values throughout the territory; the second weather type exhibits easterly flows that predominate during the warm period (spring and summer) and it is located on the Mediterranean coast of the Iberian Peninsula. However, the cyclonic situations present high frequency throughout the whole year with a large influence extended around the western Mediterranean basin. Contrary, the anticyclonic situations, despite of its high frequency, do not contribute significantly to the total rainfall, runoff, and sediment (showing the lowest efficiency) because of atmospheric stability that currently characterize this atmospheric pattern. Our approach helps to better understand the relationship of WTs on the seasonal and spatial variability of rainfall, runoff and sediment yield with a regional scale based on the large dataset and number of soil erosion experimental stations

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.; 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. 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). With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health

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

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.; We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Prácticas de bioseguridad en lecherías comerciales de la Zona Central de Chile

Biosecurity is defined as the set of measures designed to reduce the entry of pathogens to the herd as well as to avoid or reduce their dissemination within the herd. Biosecurity status is becoming increasingly important, since it influences herd health and product quality. However, biosecurity status in dairy farms in Chile is not known. The aim of the present study was to describe the main biosecurity practices carried out in commercial dairies of the Central Zone of Chile. To carry out this, a survey was designed and subsequently applied to 33 dairy farms located in the regions of Valparaiso, O`Higgins and Metropolitan. This activity was complemented with a visit and inspection of the dairy. Regarding to the arrival of cattle from other farms, in 13 dairies (39.4 %) new cattle were brought into the herd during the last 2 years. Heifers were the class most frequently brought. In 6 of these dairies (46.2%), quarantine to the incoming animals was carried out. In relation to the people's traffic, in 8 operations (24.2 %) there was some kind of signposting in the entry of the facilities and only in one (3 %), visitors had to clean and disinfect its footwear before entering to the facilities. Regarding vehicle traffic, only two operations (6 %) keep a process of disinfection for the wheels of the vehicles entering to the facilities. In all the dairies surveyed there were other animal species, which, in the majority of the cases, had direct contact with the bovines or with its sources of water or food. The species observed with the highest frequencies were: cats (90.9%), dogs (72.7%), horses (60.6%), and poultry (36.4%). In relation to the food management, in 17 cases (51.5 %) the remaining food of the adult cattle was used in the ration of another group of females, being the most frequent destination the rations of dry cows and weaned calves. It is concluded that in general the biosecurity status of the dairies surveyed is insufficient. The most deficient areas regarding biosecurity practices are people's entrance and control, and the contact of cattle with other domestic species. However, there is a low degree of inclusion of foreign animals into the herd, since it is widely acknowledged that keeping a closed herd is an effective way to prevent the access of pathogens to the farm.    La bioseguridad se define como el conjunto de medidas tendientes a reducir la entrada de patógenos a la explotación animal así como a evitar o disminuir su diseminación dentro del predio. Hoy en día, la situación de bioseguridad adquiere gran importancia, ya que influye en la salud del rebaño y la calidad del producto final. El presente estudio tuvo por objetivo describir las principales prácticas de bioseguridad que se aplican en lecherías comerciales de la Zona Central de Chile. Para esto, se elaboró una encuesta que se realizó en 33 predios de las regiones de Valparaiso, O´Higgins y Metropolitana. Esta actividad se complementó con una visita e inspección del plantel. En relación al ingreso de bovinos desde otros predios, en 13 lecherías (39,4%) se incorporó algún tipo de ganado nuevo a su rebaño, durante los últimos 2 años. El tipo de ganado más frecuente de ingresar fueron las vaquillas. De estas lecherías, en 6 de ellas (46,2%) se realizó cuarentena de los animales ingresados. En relación al ingreso de personas, en 8 predios (24,2%) había algún tipo de señalización en la entrada del predio y sólo en una (3%) los visitantes debían limpiar y desinfectar su calzado antes de ingresar a las instalaciones. Para el ingreso de vehículos, sólo dos planteles (6%) mantenían un rodiluvio o proceso de desinfección para las ruedas de los vehículos que ingresaban al plantel. En todas las lecherías encuestadas existían otras especies de animales, donde la mayoría de ellas, tenían contacto directo con los bovinos o con sus fuentes de agua o de alimento. Las especies observadas con mayor frecuencia fueron: gatos (90,9%), perros (72,7%), caballos (60,6%) y aves de corral (36,4%). Respecto al manejo alimentario, en 17 casos (51,5%), el alimento sobrante de los animales adultos era utilizado en la ración de otro grupo de hembras, siendo su destino más frecuente la ración de las vacas secas y las terneras en recría. Se concluye que en general la situación de bioseguridad en las lecherías encuestadas es insuficiente. Las áreas más deficientes en prácticas de bioseguridad fueron el ingreso y control de personas externas al predio y el contacto de los bovinos con otras especies domésticas. Sin embargo, existe una baja incorporación de animales desde otros predios, ya que se reconoce que mantener un rebaño cerrado es una medida eficaz para prevenir el ingreso de patógenos al plantel.  

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

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Manual de Buenas Prácticas para el manejo de plantaciones forestales en el noroeste de la Patagonia

El presente manual sistematiza y propone las técnicas de manejo más apropiadas para la planificación, conducción y aprovechamiento sustentable de plantaciones forestales en la Patagonia Andina. Para su elaboración se ha recopilado la información existente las experiencias aplicadas en la región a través de numerosos técnicos, investigadores, extensionistas, prestadores de servicios y propietarios forestales. Por lo tanto este manual ordena y propone un conjunto de criterios y técnicas para el manejo sustentable de las plantaciones forestales en la zona de secano de la región noroeste patagónica acordes con el estado actual de conocimientos, que promueva la producción de bienes y servicios en un paisaje multiproductivo y en un marco de conservación de la biodiversidadFil: Attis Beltran, Hernan. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Barroetaveña, Carolina. Universidad Nacional de la Patagonia "San Juan Bosco"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bava, Jose E.. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Bonino, Never Antonio. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Bulgarelli, Luciano. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; ArgentinaFil: Caballe, Gonzalo Omar. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Calvi, Francisco. No especifíca;Fil: Castañeda, Sara Rita. No especifíca;Fil: Chauchards, Luis Mario. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Chavat, Florencia. No especifíca;Fil: Claps, Leonardo Luis. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche. Grupo de Genética Forestal; ArgentinaFil: Contardi, Liliana. Universidad Nacional de la Patagonia "San Juan Bosco"; Argentina. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Danklmaiert, Christine. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Davel, Miguel M.. Centro de Investigación y Extensión Forestal Andino Patagónico; Argentina. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: de Errasti, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración de Parques Nacionales; ArgentinaFil: Defossé, Guillermo Emilio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto Andino Patagónico de Tecnologías Biológicas y Geoambientales. Universidad Nacional del Comahue. Instituto Andino Patagónico de Tecnologías Biológicas y Geoambientales; ArgentinaFil: Del Vas, Javier. No especifíca;Fil: Alejandro, Dezzotti. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Diez, Juan P.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Dillon, Yanina. No especifíca;Fil: Fernandez, Maria Elena. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Felicetti, Augusto. No especifíca;Fil: Frugoni, Maria Cristina Margarita. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Focarazzo, Silvia. No especifíca;Fil: Fontana, Virginia. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Godoy, M. Marcela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto Andino Patagónico de Tecnologías Biológicas y Geoambientales. Universidad Nacional del Comahue. Instituto Andino Patagónico de Tecnologías Biológicas y Geoambientales; ArgentinaFil: Gonda, Héctor Eduardo. Universidad Nacional de la Patagonia "San Juan Bosco"; Argentina. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Greslebin, Alina Gabriela. Universidad Nacional de la Patagonia "San Juan Bosco". Facultad de Ciencias Naturales - Sede Esquel. Departamento de Biología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Guglielmin, Dante A.. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: Gyenge, Javier Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; ArgentinaFil: Lantschner, María Victoria. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Letourneau, Federico Jorge. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Loguercio, Gabriel Ange. Centro de Investigación y Extensión Forestal Andino Patagónico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: Martinez, Andrés. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mattes Fernández, Hernán. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Mele, Uriel. No especifíca;Fil: Melzner, Guillermo E.. Ministerio de Agricultura Ganaderia y Pesca de la Nacion.; ArgentinaFil: Mondino, Victor Alejandro. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Sur. Estación Experimental Agropecuaria Esquel; ArgentinaFil: Mortoro, Ariel Mario. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Novak, Carla. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Nuñez, Cecilia Inés. Universidad Nacional del Comahue; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nuñez, Martin Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; ArgentinaFil: Orellana, Ivonne. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: Pantaenius, Pedro Maximiliano. Universidad Nacional de la Patagonia "San Juan Bosco"; Argentina. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Pastorino, Mario Juan. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rajchenberg, Mario. Centro de Investigación y Extensión Forestal Andino Patagónico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: Rusch, Verónica. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Salvador, Gustavo. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Sur. Estación Experimental Agropecuaria Esquel; ArgentinaFil: Sarasola, Mauro Miguel. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Sbrancia, Renato Ernesto. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Stecher, Gabriel Andre. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Troncoso, Oscar Alberto. Universidad Nacional de la Patagonia "san Juan Bosco". Secretaria de Ciencia y Tecnica. Instituto Biotecnologico Esquel.; ArgentinaFil: Urretavizcaya, M. Florencia. Centro de Investigación y Extensión Forestal Andino Patagónico; ArgentinaFil: Varela, Santiago Agustín. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Velásquez, Abel. Universidad Nacional del Comahue. Asentamiento Universidad San Martín de Los Andes; ArgentinaFil: Villacide, José María. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Weigandt, Mariana Noemi. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Zalazar, Gabriel. Ministerio de Agricultura Ganaderia y Pesca de la Nacion.; Argentin