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.

Diário da Constituinte [gravação de vídeo] : [programa n. 306]

A Sistematização aprova emenda que dá prioridade no uso dos recursos hídricos e minerais para os cidadãos brasileiros e empresas nacionais, emenda do Deputado Luiz Salomão (PDT-RJ). De acordo com o Constituinte, a emenda reestabelece às pessoas físicas a possibilidade de pesquisar e explorar as jazidas, e o Estado reduzir o período das concessões das mineradoras. Para o Deputado Ademir Andrade (PMDB-RJ), o artigo aprovado democratiza a exploração da riqueza mineral. Criado o Estatuto Unificado das Empresas Estatais, que define a relação de trabalho entre as estatais, o Estado e a sociedade, explica o Deputado Nelton Friedrich (PMBD-PR). Quadro Constituição: o Brasil precisa desta força - Um novo partido inicia seus trabalhos na Constituinte, o Partido Trabalhista Renovador (PTR). O Deputado Messias Soares (PMDB-RJ), líder do partido na Constituinte, explica as propostas do partido. Quadro Constituição: a força maior - A Assembléia Nacional Constituinte (ANC) fará sessão extraordinária para receber pedido de mudança do Regimento Interno, que permite apresentar emendas de todos os tipos ao projeto de constituição. Segundo Ulysses Guimarães (PMDB-SP), presidente da ANC, a abertura de novos prazos para as emendas é necessário, desde que não atrapalhe a qualidade e/ou a dinâmica dos trabalhos.

William Shakspeare : drame en six actes. [Suivi de] Une minute trop tard : opérette en un acte. Livr. 306 / par Ferdinand Dugué... ; par M. Vernon, musique de M. Villebichot...

Collection : Théâtre contemporain illustré ; 306e et 307e livraisons

Français 306

Contient : 1° « Histoire de la royne Arthemise », de « NICOLAS HOUEL, Parisien », dédiée à Catherine de Médicis et ; 2° « Discours de l'excellence de la plate painture en l'antiquité », du même

Jornal da UNESP, 2014, ano XXVIII, n. 306

Jornal elaborado pela Assessoria de Comunicação e Imprensa da Reitoria da UNESP

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 306 - Mitteilung an Professor Hugo von Meltzl im Zusammenhang der geplanten Veröffentlichung des 4. Bandes des "Handschriftlichen Nachlasses"

u.a.: Eduard Grisebach; Arthur Schopenhauer;

Ms.Ff.F.Stoltze 3. 306 - Brief von Leopold Sonnemann an Friedrich Stoltze

(Unbekannte) "Sache", Sitzungen in Berlin, Otto von Bismarck

Inc. oct. 306 - [Sammelband in 3 Teilen: Konvolut aus Inkunabeln]

Vorbesitzer: Dominikanerkloster Frankfurt am Main

Planktonic foraminifera of IODP Site 306-U1314

Surface water conditions at the Integrated Ocean Drilling Program (IODP) Site U1314 (Southern Gardar Drift, 56° 21.8' N, 27° 53.3' W, 2820 m depth) were inferred using planktic foraminifer assemblages between Marine Isotope Stage (MIS) 19 and 11 (ca. 800-400 ka). Factor analysis of the planktic foraminifer assemblages suggests that the assemblage was controlled by three factors. The first factor (which explained 49% of the variance) is dominated by transitional and subpolar species and points to warm and salty surface water conditions (Atlantic water). The second factor (37%) is dominated by Neogloboquadrina pachyderma sin and has been associated with the presence of cold and low saline surface waters (Arctic water). Finally, the third factor (9%), linked to a significant presence of Turborotalita quinqueloba, reflects the closeness of the Arctic front (the boundary between Atlantic and Arctic water). The position of the Arctic and Polar fronts has been estimated across the glacial-interglacial cycles studied according to planktic foraminifer abundances from Site U1314 (and their factor analysis) combined with a synthesis of planktic foraminifer and diatom data from other North Atlantic sites. Regarding at the migrations of the Arctic front and the surface water masses distribution across each climatic cycle we determined five phases of development. Furthermore, deep ocean circulation changes observed in glacial-interglacial cycles have been associated with each phase. The high abundance of transitional-subpolar foraminifers (above 65% at Site U1314) during the early interglacial phase indicated that the Arctic front position and surface water masses distribution were similar to present conditions. During the late interglacial phase, N. pachyderma sin and T. quinqueloba slightly increased indicating that winter sea ice slightly expanded southwestwards whereas the ice volume remained stable or was still decreasing. N. pachyderma sin increased rapidly (above 65% at Site U1314) at the first phase of glacial periods indicating the expansion of the Arctic waters in the western subpolar North Atlantic. During the second phase of glacial periods the transitional-subpolar assemblage throve again in the central subpolar North Atlantic associated with strong warming events that followed ice-rafting events. The third phase of glacial periods corresponds to full glacial conditions in which N. pachyderma sin dominated the assemblage for the whole subpolar North Atlantic. This division in phases may be applied to the last four climatic cycles.