Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021:a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDetailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.MethodsThe GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.FindingsGlobal DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021.InterpretationPutting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.FundingBill &amp; Melinda Gates Foundation.<br/

The dental workforce in Malaysia: drivers for change from the perspectives of key stakeholders

Objective: The dental workforce is facing unprecedented change globally as a result of multiple influences. There is a need for research informed action to map possible drivers for change at the national level and examine their potential implications in order to shape the dental workforce to serve population needs. The objective of this study was to explore key stakeholders’ views on the drivers for change for the Malaysian dental workforce and their potential implications. Method: Stakeholders from key dental organisations/professions in Malaysia were purposively sampled and invited to participate in a semi-structured interview (n = 20) using a pre-tested topic guide. Interviews were recorded, transcribed verbatim and analysed using Framework Analysis. Results: Drivers for workforce were identified across four main domains: policy-politics; trends in demography; social and economic; and, technology-scientific development. The pace of change and possible interplay between drivers, most notably government policy, liberalisation of education and health services and challenges of workforce governance, followed by Malaysian demography and health trends. Implications for the future, including possible uncertainties, particularly in relation to specialisation and privatisation were identified, together in balancing and meeting public health needs/demands with professional career expectations. Conclusion: Stakeholders’ views on the high-level drivers for change broadly mirror those of high-income countries; however, specific challenges for Malaysia relate to rapid expansion of dental education and a young workforce with significant career aspirations, together with imbalances in the health care system. The impact of these drivers was perceived as leading to greatest uncertainty around specialisation and privatisation of the future workforce

Free ion diffusivity and charge concentration on cross-linked Polymeric Ionic Liquid iongels films based on sulfonated zwitterion salts and Lithium ions

[EN] The properties of various mixtures of a zwitterionic ionic liquid (ZIs-1) and LiNTf 2, including their conductivity, have been studied showing how they can be adjusted through their molar composition. Conductivity tends to increase with the LiNTf2 content although it presents a minimum at the region close to the eutectic point. These mixtures also provide excellent features as liquid phases for the preparation of composite materials based on crosslinked PILs. The prepared films display excellent and tuneable properties as conducting materials, with conductivities that can be higher than 10 2 S cm 1 above 100 1C. The selected polymeric compositions show very good mechanical properties and thermal stability, even for low crosslinking degrees, along with a suitable flexibility and good transparency. The final properties of the films correlate with the composition of the monomeric mixture used and with that of the ZIs-1:LiNTf2 mixture.Financial support has been provided by MINECO (ENE/2015-69203-R and RTI2018-098233-B-C22) and Generalitat Valenciana (PROMETEO/2016/071). Technical support from the SECIC of the UJI is also acknowledged. DV thanks UNED (Costa Rica) for a predoctoral fellowship.Valverde, D.; Garcia Bernabe, A.; Andrio Balado, A.; Garcia-Verdugo, E.; Luis Lafuente, S.; Compañ Moreno, V. (2019). Free ion diffusivity and charge concentration on cross-linked Polymeric Ionic Liquid iongels films based on sulfonated zwitterion salts and Lithium ions. Physical Chemistry Chemical Physics. 21(32):17923-17932. https://doi.org/10.1039/c9cp01903kS17923179322132Etacheri, V., Marom, R., Elazari, R., Salitra, G., & Aurbach, D. (2011). Challenges in the development of advanced Li-ion batteries: a review. 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Factors Associated with Anti-Tuberculosis Medication Adverse Effects: A Case-Control Study in Lima, Peru

BACKGROUND: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. METHODOLOGY AND RESULTS: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89), anemia (OR = 2.10; IC95%: 1.13-3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6), and smoking (OR = 2.00; 95%CI: 1.03-3.87) were independently associated with adverse drug reactions. CONCLUSIONS: Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients

ACESSO BICORONAL PARA TRATAMENTO DE FRATURA PANFACIAL

Com o dinamismo da sociedade contemporânea os traumas acabam tendo grande importância e prevalência dentro dos serviços de pronto atendimento dos hospitais. Segundo dados da Organização Mundial de Saúde, os traumas estão entre as principais causas de morte e morbidade no mundo. Dentre os diversos tipos, o trauma de face destaca-se pela sua importância, uma vez que apresenta repercussões emocionais, funcionais e muitas vezes deformidades permanentes. A grande prevalência de lesões em face se deve a grande exposição dessa área corporal e a falta de proteção, o que acarreta muitas vezes em lesões graves.Trata-se de um trauma de abrangência multidisciplinar, envolvendo principalmente as especialidades de cirurgia geral, oftalmologia, cirurgia plástica, cirurgia buco-maxilo-facial e neurocirurgia. O objetivo desse trabalho é mostrar um caso clínico de um paciente atendido na emergência do Hospital de Fraturas da XV em Curitiba, o qual havia sofrido um trauma em face decorrente de acidente de trabalho. Após exame tomográfico verificou-se múltiplas fraturas em face, fratura naso-orbito-etmoidal, assoalho de órbita direito, Le fort-II e frontal. Ele foi então submetido a cirurgia sob anestesia geral, na qual realizado o acesso bicoronal para redução e fixação interna rígida das fraturas.      

Auditoria e controle de execução de processos no setor público brasileiro / Audit and control of processes execution in the brazilian public sector

A falta de urgência para a melhoria, a gestão desestruturada da qualidade de serviço e a desconexão com a criação de valor, são alguns dos fatores que dificultam a busca pelo setor público da melhoria contínua dos serviços prestados à população em geral. Entretanto, a Gestão de Processos de Negócio (BPM) no setor público tem sido usada como fator decisivo para o aumento da eficácia e eficiência e para a reestruturação das organizações ao longo de processos interfuncionais. Além disso, somado ao BPM, a Auditoria é o componente fundamental de um sistema regulatório cujo objetivo é mostrar desvios de padrões aceitáveis e violações de princípios de legalidade, eficiência, efetividade e administração da economia pública. Diante dessas e outras constatações e por meio de um questionário de estrutura do tipo Survey, o presente artigo visou identificar as principais características de auditoria e controle de execução de processos em instituições públicas brasileiras, destacando métodos e ferramentas e evidenciando particularidades aplicáveis às mesmas. 

Processo De Formulação De Ciclodextrina Brassinosteróides, Para Aplicação Agrìcola, Utilizados Como HormÈnios Vegetais

A presente invenção refere-se a uma metodologia para formulação de cidodextrina/brassinosteróides em várias proporções aumentando a performance dos fitormônios para sua utilização como promotores de crescimento vegetal bem como aumento no rendimento de sementes, incremento da fertilidade e o aumento da resistência a estresse abióticos. Os estudos feitos nesta invenção com os complexos de inserção da ciclodextrina/brassinosteróides mostraram sua grande aplicabilidade em medidas do acréscimo do rendimento da colheita.BR9906202 (A)A01N43/90A01N43/90BR19999906202A01N43/90A01N43/9

Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019

"Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.