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.

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.

A revisit to Pope's cohort analysis

Gulland's [Gulland, J.A., 1965. Estimation of mortality rates. Annex to Arctic Fisheries Working Group Report (meeting in Hamburg, January 1965). ICES. C.M. 1965, Doc. No. 3 (mimeographed)] virtual population analysis (VPA) is commonly used for studying the dynamics of harvested fish populations. However, it necessitates the solving of a nonlinear equation for the instantaneous rate of fishing mortality of the fish in a population. Pope [Pope, J.G., 1972. An investigation of the accuracy of Virtual Population Analysis using cohort analysis. ICNAF Res. Bull. 9, 65-74. Also available in D.H. Cushing (ed.) (1983), Key Papers on Fish Populations, p. 291-301, IRL Press, Oxford, 405 p.] eliminated this necessity in his cohort analysis by approximating its underlying age- and time-dependent population model. His approximation has since become one of the most commonly used age- and time-dependent fish population models in fisheries science. However, some of its properties are not well understood. For example, many assert that it describes the dynamics of a fish population, from which the catch of fish is taken instantaneously in the middle of the year. Such an assertion has never been proven, nor has its implied instantaneous rate of fishing mortality of the fish of a particular age at a particular time been examined, nor has its implied catch equation been derived from a general catch equation. In this paper, we prove this assertion, examine its implied instantaneous rate of fishing mortality of the fish of a particular age at a particular time, derive its implied catch equation from a general catch equation, and comment on how to structure an age- and time-dependent population model to ensure its internal consistency. This work shows that Gulland's (1965) virtual population analysis and Pope's (1972) cohort analysis lie at the opposite end of a continuous spectrum as a general model for a seasonally occurring fishery; Pope's (1972) approximation implies an infinitely large instantaneous rate of fishing mortality of the fish of a particular age at a particular time in a fishing season of zero length; and its implied catch equation has an undefined instantaneous rate of fishing mortality of the fish in a population, but a well-defined cumulative instantaneous rate of fishing mortality of the fish in the population. This work also highlights a need for a more careful treatment of the times of start and end of a fishing season in fish population models.

Aaron Lopez papers, undated, 1752-1794, 1846, 1852, 1953.

Contains approximately 6800 manuscripts arranged chronologically by year for years 1752-1794. Approximately 100 are letters received or written by Lopez, his partner and father-in-law, Jacob Rodriguez Rivera, members of his family and company, and commercial agents pertaining to business activities and sailing orders for the captains of various ships. Several also refer to personal matters and acquaintances, including a series of six letters from Silas Cooke of White Hall (Middletown), R.I., to Aaron Lopez, asking his aid in returning a run-away slave (1776). The great majority of the collection consists of account records, bills of sale, orders, shipping agreements, lists of sailors on the various ships, repair records and cargo invoices. Of particular interest are a receipt for payment of a half-year's subscription to the "tzedakah" of Congregation Nefutzei Israel, Newport (1755) and several documents that reveal Lopez as a supplier of kosher meat and other religious articles to people in various parts of the colonies, Surinam, and Jamaica. Also included in this group are copies of sailing lists, documents pertaining to Lopez's naturalization which shed light upon the status of a Jew applying for citizenship in Massachusetts and a check to Lopez from the United States government for a loan made during the Revolutionary War (1779).

One Word, One Body, One Voice : Studies in Apophatic Theology and Christocentric Anthropology in Gregory of Nyssa

The thesis consists of five international congress papers and a summary with an introduction. The overarching aim of the studies and the summary is to examine the inner coherency of the theological and anthropological thinking of Gregory of Nyssa (331-395). To the issue is applied an "apophatic approach" with a "Christological focus". It is suggested that the coherency is to be found from the Christological concept of unity between "true God" and "true man" in the one person of Jesus Christ. Gregory is among the first to make a full recognition of two natures of Christ, and to use this recognition systematically in his writings. The aim of the studies is pursued by the method of "identification", a combination of the modern critical "problematic method" and Gregory's own aphairetic method of "following" (akolouthia). The preoccupation with issues relating to the so-called Hellenization of Christianity in the patristic era was strong in the twentieth-century Gregory scholarship. The most discussed questions have been the Greek influence in his thought and his philosophical sources. In the five articles of the thesis it is examined how Gregory's thinking stands in its own right. The manifestly apophatic character of his theological thinking is made a part of the method of examining his thought according to the principles of his own method of following. The basic issue concerning the relation of theology and anthropology is discussed in the contexts of his central Trinitarian, anhtropological, Christological and eschatological sources. In the summary the Christocentric integration of Gregory's thinking is discussed also in relation to the issue of the alledged Hellenization. The main conclusion of the thesis concerns the concept of theology in Gregory. It is not indebted to the classical concept of theology as metaphysics or human speculation of God. Instead, it is founded to the traditional Judeo-Christian idea of God who speaks with his people face to face. In Gregory, theologia connotes the oikonomia of God's self-revelation. It may be regarded as the state of constant expression of love between the Creator and his created image. In theology, the human person becomes an image of the Word by which the Father expresses his love to "man" whom he loves as his own Son. Eventually the whole humankind, as one, gives the divine Word a physical - audible and sensible - Body. Humankind then becomes what theology is. The whole humanity expresses divine love by manifesting Christ in words and deeds, singing in one voice to the glory of the Father, the Son and the Holy Spirit.

Studies in sesquiterpenes-XVI. Zerumbone, a monocyclic sesquiterpene ketone

The structure, previously assigned to zerumbone, has been found to be untenable. The ketone has been shown to be monocyclic containing three ethylenic linkages, and has been further correlated with humulene. Results from ozonolysis, and base-catalysed cleavage allowed the compound to be formulated as 2,6,9,9-tetramethyl-2,6,10-cyclo-undecatrien-1-one.

"Ei kansa elä vain leivästä" : Suomen Taideyhdistys ja kuvataiteen kannattajakunnan muotoutuminen Helsingissä 1846-1865.

Tutkielma käsittelee kuvataideyleisön muotoutumista Suomen Taideyhdistyksen piirissä 1800-luvun puolivälissä sosiaalihistoriallisesta näkökulmasta. Tärkein lähdemateriaali on Suomen Taideyhdistyksen arkisto, jonka avulla tarkastellaan laajemmin yhdistyksen ideaa, sen jäsenyyttä, maanlaajuista jäsenkartuntaa ja johtokunnan taiteen kannattajiin suuntaamaa missiota toiminnan alkuvuosikymmeninä. Yhdistyksen helsinkiläinen jäsenistö vuosina 1846−1865 on luokiteltu kymmeneen luokkaan jäsenluettelossa annettujen nimikkeiden perusteella. Lähdeaineiston ja sen pohjalta tehdyn luokittelun avulla analysoidaan pääkaupungin jäsenkuntaa ja sen suhdetta koko maan jäsenistöön. Jäsenkunnasta nostetaan esille myös joitakin kiinnostavia yksilöitä. Tutkielman pääasiallinen teoreettinen viitekehys on Sosiologi Everett Rogersin malli innovaatioiden diffuusiosta. Taiteen kannattaminen uutena ideana vertautuu tutkielmassa uuteen keksintöön ja sen leviämiseen. Tutkielmassa osoitetaan, että kuvataiteen saadessa 1800-luvun kuluessa uudenlaisia merkityksiä myös taiteen yleisö määrittyi uudelleen. Vuonna 1846 perustetulla Suomen Taideyhdistyksellä oli tässä ratkaiseva ja aktiivinen rooli. Taiteen kannattajakunnan ydin oli Helsingissä, jossa vaikutti yhdistyksen lähinnä korkeista virkamiehistä ja professoreista koostunut johtokunta. Taideyhdistyksen toiminnan vakiintuessa taiteen kannattamisen idea levisi ja sitä levitettiin yhä useammille paikkakunnille sekä laajempiin kansankerroksiin. Yhdistyksen jäsenkuntaan liittyi lähinnä säätyläistöä, mutta taidenäyttelytoiminta tavoitti myös alempia yhteiskuntaluokkia. Taideyhdistyksen helsinkiläisessä jäsenkunnassa virkamiehistön rooli oli suuri. Alkuvaiheessa liittyneet yhteiskunnalliselta statukseltaan korkeat henkilöt saivat hallitsijan vakuuttumaan toiminnan luotettavuudesta. Taiteen kannattajakunta muodostui kuitenkin kasvavassa määrin alemmasta virkamiehistöstä ja elinkeinojen harjoittajista. Merkittävä osuus oli myös Keisarillisen Aleksanterinyliopiston opettajilla ja siellä tutkinnon suorittaneilla. Tärkein taiteen pääkaupunkilaista kannattajakuntaa yhdistänyt sosiaalinen viitekehys olikin yliopisto. Sen antama koulutus, sivistys ja henkinen pääoma olivat taustalla suurimmalla osalla yhdistykseen Helsingissä liittyneistä. He kuuluivat pääsääntöisesti aktivoituvaan sivistyneistöön, joka syntyi sääty-yhteiskunnan vanhojen rakenteiden hämärtyessä ja yliopistotutkintojen saadessa yhä suurempaa yhteiskunnallista merkitystä.

Sapientia, 1961, Vol. XVI, nº 61 (número completo)

Contenido: Conocimiento y cultura / Octavio N. Derisi – Itinerario de Manuel Gonzalo Casas / Alberto Caturelli – Los orígenes hegelianos y la esencia del marxismo / Juan A. Casaubón – Notas y comentarios -- Bibliografía

Hermeneútica jurídica y comunión en la fe católica. (Apostillas al discurso de Benedicto XVI a la Rota romana, el 21 de enero de 2012)

La convocatoria a recorrer un “Año de la fe” permitió a Benedicto XVI centrar su alocución de 2012 a la Rota romana en ese próximo acontecimiento eclesial. La extrema importancia que el Pontífice atribuye a su llamada a renovar la fe católica se puso de manifiesto en las palabras que dirigiera unos días más tarde a la plenaria de la Congregación para la Doctrina de la Fe...

Benedicto XVI y la recepción mediática de sus declaraciones

Entrevista concedida por el Santo Padre Benedicto XVI a los periodistas durante el vuelo hacia África. Martes 17 de marzo de 2009.

Teología, 1979, Tomo XVI nº 033 (número completo)

Pensar la utopía / Eduardo Briancesco -- El “Confesionario breve” de Fr. Alonso de Molina (1565). Un ejemplo para el estudio de la disciplina penitencial en el Nuevo Mundo / Guillermo Durán -- Diaconado permanente: evaluación de un encuentro y algunas reflexiones teológicas / Luciano Bertelli -- ¿La filosofía amor a la sabiduría o sabiduría del amor? Diálogo con Emmanuel Levinas / Pablo Sudar -- Puebla: Evangelización de la cultura / Lucio Gera -- Notas bibliográficas -- Libros recibidos

Perspectivas y otredad del continente africano en libros de viaje hispánicos (siglos XIV y XVI) y en Javier Reverte

Número monográfico: El viaje y sus discursos