Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

After Sex? On Writing since Queer Theory, edited by Janet Halley and Andrew Parker [Review]

In its earliest and simplest form queer theory proposes that sexual identity is not essential, but socially constructed, and understandings of identity, gender and sexuality are constructed differently at different times and in different places. Queer theory aims to challenge normative understandings of sex, sexuality and gender, and also normative concepts of knowledge and being. Since its inception, queer theory has been taken up by a number of disciplines as an analytical framework. These include cultural geography, education studies, film studies and sociology. In the last decade queer theory has been used to consider citizenship, diasporas and post colonial experiences. A queer theoretical perspective has also been used to analyse emotions, the Death Drive, phenomenology, and disability. As queer theory enters its third decade Janet Halley and Andrew Parker ask what is after sex? ‘What has queer theory become now that it has a past?’

Close Encounters of the Continuum: Speaking (to), Performing and Experiencing Gender In Janet Cardiff’s Whispering Room

This 'project' investigates Janet Cardiff's Whispering Room. It examines how Cardiff deconstructs the privileging of the visual over all other corporeal senses in her work, the Whispering Room. Using sound as a fulcrum, Cardiff explores the links between subjects, collective narratives, memories, experiences and performances. Janet Cardiff destabilizes time and space and fractures the continuum through the use of sound. My 'project' celebrates sound as a transgressive medium — sound not as a gendered medium but as a vehicle in which to speak (to) gender. It explores how sound can destabilize notions of perception and reception and question art and museal practices. In the process this 'project' reveals the complexity of interpreting and representing art as an object. My aim is to reflect the very intertextual and expressionist collage that Cardiff has created in Whispering Room in my own text. Cardiff solicits the viewer's intimacy and participation. Whispering Room is a physical yet metonymic space in which Cardiff creates a place for performatvity, experience, memory, desire and speech, thus she opens up a space for the utterance and performance of the viewer. Viewers construct and create meaning/s for themselves within this mnemonic space by digging up their own memories, desires and reveries. The strength of Cardiff's work is that it relies on a viewer to perform, a body to trigger the pseudo-spectacle and a voice to interrupt the whispers. One might ask of Whispering Room where the illusionistic space begins and where the physical space ends. This 'project' investigates how in Whispering Room there is no one experience but many experiences.

The relationship between Internet use and perceived performance in retail and professional service firms

lnformation technology (IT) and, in particular, the Internet is dramatically impacting on the services sector. This paper specifically investigates the relative impact of several forms of internet use on perceived performance for two groups of service organisations - retail service firms and professlonal health service firms. Using a mailed out self-administered questionnaire, 625 completed questionnaires were obtained and 43 per cent of respondents reported that they used the lternet. Thus the final usable sample in the study comprised 262 respondents. Results showed that the Internet does significantly influence perceived performance in both types of service firms. However,there are differences in the forms of lntemet use between the two service groups and their relative effect on performance. For retail firms, use of transactional function, such as ordering, selling and payment was found to be positively related to increases in perceived performance. In contrast, for professional health service firms, the ability to search for information on products and/or services was found to be positively associated with perceived performance. Finally, theoretical and managerial implications of the findings of this study are discussed.