Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Empire, Tourism, Nostalgia: Joseph Brodsky and Travel Writing

Joseph Brodsky, one of the most influential Russian intellectuals of the late Soviet period, was born in Leningrad in 1940, emigrated to the United States in 1972, received the Nobel Prize for Literature in 1987, and died in New York City in 1996. Brodsky was one of the leading public figures of Soviet emigration in the Cold War period, and his role as a model for the constructing of Russian cultural identities in the last years of the Soviet Union was, and still is, extremely important. One of Joseph Brodsky’s great contributions to Russian culture of the latter half of the twentieth century is the wide geographical scope of his poetic and prose works. Brodsky was not a travel writer, but he was a traveling writer who wrote a considerable number of poems and essays which relate to his trips and travels in the Soviet empire and outside it. Travel writing offered for Brodsky a discursive space for negotiating his own transculturation, while it also offered him a discursive space for making powerful statements about displacement, culture, history and geography, time and space—all major themes of his poetry. In this study of Joseph Brodsky’s travel writing I focus on his travel texts in poetry and prose, which relate to his post-1972 trips to Mexico, Brazil, Turkey, and Venice. Questions of empire, tourism, and nostalgia are foregrounded in one way or another in Brodsky’s travel writing performed in emigration. I explore these concepts through the study of tropes, strategies of identity construction, and the politics of representation. The theoretical premises of my work draw on the literary and cultural criticism which has evolved around the study of travel and travel writing in recent years. These approaches have gained much from the scholarly experience provided by postcolonial critique. Shifting the focus away from the concept of exile, the traditional framework for scholarly discussions of Brodsky’s works, I propose to review Brodsky’s travel poetry and prose as a response not only to his exilic condition but to the postmodern and postcolonial landscape, which initially shaped the writing of these texts. Discussing Brodsky’s travel writing in this context offers previously unexplored perspectives for analyzing the geopolitical, philosophical, and linguistic premises of his poetic imagination. By situating Brodsky’s travel writing in the geopolitical landscape of postcolonial postmodernity, I attempt to show how Brodsky’s engagement with his contemporary cultural practices in the West was incorporated into his Russian-language travel poetry and prose and how this engagement thus contributed to these texts’ status as exceptional and unique literary events within late Soviet Russian cultural practices.

"Four Ways of Writing the City" : St. Petersburg-Leningrad as a Metaphor in the Poetry of Joseph Brodsky

The present study discusses the theme of St. Petersburg-Leningrad in Joseph Brodsky's verse works. The chosen approach to the evolving im-age of the city in Brodsky's poetry is through four metaphors: St. Petersburg as "the common place" of the Petersburg Text, St. Petersburg as "Paradise and/or Hell", St. Petersburg as "a Utopian City" and St. Petersburg as "a Void". This examination of the city-image focusses on the aspects of space and time as basic categories underlying the poet's poetic world view. The method used is close reading, with an emphasis on semantical interpretation. The material consists of eighteen poems dating from 1958 to 1994. Apart from investigating the spatio-temporal features, the study focusses on exposing and analysing the allusions in the scrutinised works to other texts from Russian and Western belles lettres. Terminology (introduced by Bakhtin and Yury Lotman, among others) concerning the poetics of space in literature is employed in the present study. Conceptions originating from the paradigm of possible worlds are also used in elucidating the position of fictional and actual chronotopes and heroes in Brodsky's poetry. Brodsky's image of his native city is imbued with intertextual linkings. Through reminiscences of the "Divine Comedy" and Russian modernists, the city is paralleled with Dante's "lost and accursed" Florence, as well as with the lost St. Petersburg of Mandel'shtam and Akhmatova. His city-image is related to the Petersburg myth in Russian literature through their common themes of death and separation as well as through the merging of actual realia with the fictional worlds of the Petersburg Text. In his later poems, when his view of the city is that of an exiled poet, the city begins to lose its actual world referents, turning into a mental realm which is no longer connected to any particular geographical location or historical time. It is placed outside time. The native city as the homeland in its entirety is replaced by another existence created in language.

Joseph Molling with wife Margarete "Gretchen" nee Benjamin and son Peter on a walk.

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Portrait of Hedwig and Ludwig Heinemann and Margarete nee Benjamin and Joseph Molling.

Elderly couple Hedwig and Ludwig Heinemann envolved with Adolph Molling Business. Younger couple is Margarete "Gretchen" Molling geb. Benjamin and Joseph Molling.

Portrait of Joseph and his sister Elly Schoenbeck; Cologne, Germany. Portraits family

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Portrait of Joseph Rothschild and his wife Rosalie nee Stern; Bad Ems, Germany. Portraits Couples

Handwritten on verso of original photograph: Joseph u Rosalie Rothschild

Tombstone of Joseph Benjamin; Strangriede Cemetery, R83.8; Hannover Cemeteries Tombs

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Tombstones of Joseph Benjamin and Marianne Benjamin nee Sussmann; Strangriede Cemetery (R 83.8 and R 83.9); Hannover Cemeteries Tombs

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Portrait of Dr. Joseph Wallerstein holding his infant grandson Hans Stern.

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Tombstone of Joseph Benjamin; Strangriede Cemetery (R 83.8); Hannover Cemeteries Tombs

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Joseph Ritter von Wertheimer, Moritz Lazarus and Abraham Geiger; Officers of the first Jewish Council of Leipzig Portraits; Groups; Men

"Praesidium der ersten israelitischen Synode zu Leipzig. II Vicepraesident Ritter V. Wertheimer aus Wien. Praesident Prof. Dr. M. Lazarus aus Berlin. I Vicepraesident Dr. A. Geiger aus Frankfurt a/M."

Portrait of Dr. Joseph Wallerstein; Danzig.

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Studio portrait of Joseph Molling and business partner Ernst Joachim (?); Hannover, Germany.

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