Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refi nements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2∙4 billion and 1∙6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537∙6 million in 1990 to 764∙8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114∙87 per 1000 people to 110∙31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world’s population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to nonfatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

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.

Keys to the larvae of the species of the genera Diamesa, Eukiefferiella, Orthocladius, Cricotopus, Psectrocladius and Chaetocladius. [Translation from: Larvae and pupae of midges of the subfamily Orthocladiinae of the fauna of the USSR (Diptera, Chironomidae = Tendipedidae) (ed. V.Y. Pankratova) p76-8,151-152,173-174,188-189. Leningrad, Nauka, 1970. ]

Eudiaptomus vulgaris Schmeil is the most abundant copepod in Lake Maggiore and forms also, in respect to other entomostraca, the most important element, through its average biomass and because it is fairly numerous throughout the year. Plankton samples collected in a systematic and quantitative way, gave the opportunity to study some aspects of the dynamics of the population of this copepod, in safety in view of the uncertainty which in this kind of study can ensue when samples are taken only at a single station - in consequence of the changes in size of population between different water masses. The results of the biometrical observations are of the population of Eudiaptomus vulgaris is presented.

木薯良种南植188及其组培快繁研究

中国科学院华南植物研究所从1981年开始，先后从哥伦比亚国际热带作物研究中心引进去病毒的试管苗木薯品种25个，经应用生物工程技术进行试管苗微型繁殖和试管苗移栽成功，移栽成活率达95%以上。通过比较筛选试验，又从25个试管苗品种中选出了“南植188”木薯新品种，经连续试验证实，该新品种具有抗性强、叶色浓绿、植株高大、枝叶繁茂、结薯早、薯块大、纤维少、产量高等特点。在同等栽培和管理条件下，其单位面积产量比现植的面包木薯、竹叶薯等品种高60～150%，属于高产、优质、低毒的甜种类型。列入“星火计划”，在广州市和省内有关县进行南植188良种木薯苗的生产。

~(188)Tl的πh_(9／2)vi_(13／2)扁椭球转动带的旋称反转研究

利用能量为170MeV的35Cl束流,通过157Gd(35Cl,4n)熔合蒸发反应研究了188Tl的高自旋态能级结构．依据实验结果建立了188Tl基于πh9／2(?)vi13／2组态的转动带．根据双奇Tl核能级结构的相似性,指定了188Tlπh9／2(?)vi13／2扁椭球转动带的自旋值．结果表明在188Tl中,πh9／2(?)vi13／2扁椭球转动带在低自旋区具有旋称反转性质．利用包含了质子-中子剩余相互作用的准粒子-转子模型,定性地解释了πh9／2(?)vi13／2扁椭球转动带的低自旋区旋称反转现象．

双奇核~(188)Au的准粒子带结构研究

利用在束γ谱学实验技术,通过173Yb(19F,4nγ)反应布居了188Au的高自旋态,并对其准粒子带结构进行了研究．基于实验测量结果,对原有的双奇核188Au能级纲图做了较大的修改．通过系统性比较,对15+以上的能级结构进行了讨论．

Prolate and oblate shape coexistence in Pt-188

A standard in-beam gamma-spectroscopy experiment for Pt-188 is performed via the Yb-176(O-18, 6n) reaction at beam energies of 88 and 95 MeV, and the level scheme for (188) Pt is established. Prolate and oblate shape coexistence has been demonstrated to occur in Pt-188 by applying the projected shell model. The rotation alignment of i(13/2) neutrons drives the yrast sequence changing suddenly from prolate to oblate shape at angular momentum 10th, indicating likely a new type of shape phase transition along the yrast line in Pt-188.

Observation of a pi h(9/2) circle times nu i(13/2) oblate band in Tl-188

Excited states in Tl-188 have been studied experimentally using the Gd-157(Cl-35;4n) reaction at a beam energy of 170 MeV. A rotational band built on the pi h(9/2) x nu i(13/2) configuration with oblate deformation has been established for Tl-188. Based on the structure systematics of the oblate pi h(9/2) x nu i(13/2) bands in the heavier odd-odd Tl nuclei, we have tentatively proposed spin values for the new band in Tl-188. The pi h(9/2) x nu i(13/2) oblate band in Tl-188 shows low-spin signature inversion, and it can be interpreted qualitatively by the two-quasiparticle plus rotor model including a J-dependent p-n residual interaction.

Properties of the pi h(9/2)circle times nu i(13/2) oblate band in Tl-188

High spin states in Tl-188 have been investigated via the Gd-157(Cl-35,4n) reaction at beam energy of 170 MeV. A rotational band built on the pi h(9/2) circle times nu(13/2) configuration with oblate deformation has been established. Considering the similarity between the band structure observed in odd-odd Tl nuclei, spin values have been tentatively proposed for the new band in Tl-188. The pi h(9/2) circle times nu(13/2) oblate band in Tl-188 shows low-spin signature inversion, and it can be interpreted qualitatively by the two quasiparticle plus rotor model including a J-dependent p-n residual interaction.

Signature inversion in pi h(9/2) circle times nu i(13/2) oblate band of Tl-188

High-spin Level structure of Tl-188 has been studied via Gd-157 (Cl-35,4n) fusion-evaporation reaction at beam energy of 170MeV. A rotational band built on the pi h(9/2) circle times nu i(13/2) configuration with oblate deformation has been established. Spin values have been proposed to the pi h(9/2) circle times nu i(13/2) oblate band based on the similarities between the oblate band of Tl-188 and those in odd-odd Tl190-200. With the spin assignments, the low-spin signature inversion has been revealed for the pi h(9/2) circle times nu i(13/2) oblate band of Tl-188. The low-spin signature inversion can be interpreted qualitatively in the framework of the quasi-particles plus rotor model including a J dependent p-n residual interaction.

Study of quasiparticles bands in odd-odd Au-188

High-spin level structure of Au-188 has been studied via the Yb-173(F-19, 4n gamma) reaction using techniques of in-beam gamma-ray spectroscopy. Based on the experimental results, the level scheme of 188Au has been revised significantly. The previously reported positive parity levels have been modified and a new 20(+) level was proposed to feed the 18(+) states via two low-energy transitions. The existence of the 20(+) and the level structures above it are similar to those in the neighboring odd-odd Au-190,Au-192, therefore, the pi h(11/12)(-1)circle times-vi(13/2)(-2)h(9/2)(-1) configuration was assigned to the 20(+) state.

High-spin states in Au-188: Further evidence for nonaxial shape

The high-spin level structure of Au-188 has been investigated via the Yb-173(F-19,4n gamma) reaction at beam energies of 86 and 90 MeV. The previously reported level scheme has been modified and extended significantly. A new I-pi = 20(+) state associated with pi h(11/2)(-1) circle times nu i(13/2)(-2)h(9/2)(-1) configuration and two new rotational bands, one of which is built on the pi h(9/2) circle times nu i(13/2) configuration, have been identified. The prolate-to-oblate shape transition through triaxial shape has been proposed to occur around Au-188 for the pi h(9/2) circle times nu i(13/2) bands in odd-odd Au isotopes. Evidence for pi h(11/2)(-1) circle times nu i(13/2)(-1) structure of nonaxial shape with gamma < -70 degrees has been obtained by comparison with total Routhian surface and cranked-shell-model calculations.

C 188 INST-D 2013. 369 Ilustración de procesos rudimentarios de peinado del fique.

7 fotografías a color.

HG 188.30-188.35

Very fine grained. Organic matter present. Lineations can also be seen throughout, mainly in one orientation suggesting a masepic fabric.