Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Osmolality electrolyte and carbohydrate type and oral rehydration solutions: A controlled study to compare the efficacy of two commercially available solutions (osmolalities 240 mmol/L and 340 mmol/L)

An open-label, inpatient study was undertaken to compare the efficacy of two oral rehydration solutions (ORS) given randomly to children aged 1-10 years who had acute gastroenteritis with mild or moderate dehydration (n = 45). One solution contained 60 mmol/L sodium and 1.8% glucose, total osmolality 240 mosm/l (gastrolyte, Rhone-poulenc, Rorer) and the other contained 26 mmol/l sodium, 2.7% glucose and 3.6% sucrose, total osmolality 340 mOsm/l (Glucolyte, Gilseal). Analysis of data indicated that Gastrolyte therapy resulted in significantly fewer episodes and volume of vomiting over all time periods in comparison to Glucolyte and significantly less stool volume during the first 8 h and in the 0-24 h period. The differences between treatments in degree of dehydration at each follow-up period, duration of diarrhea, and duration of hospital stay were not significant. No adverse drug reactions occurred. Six patients received intravenous rehydration treatment and were considered treatment failures. We conclude that oral rehydration therapy is safe and efficacious in the management of dehydration in acute diarrhoea and that the lower osmolar rehydration solution has clinically marginal advantages.

Inference of the genetic architecture underlying BMI and height with the use of 20,240 sibling pairs

Evidence that complex traits are highly polygenic has been presented by population-based genome-wide association studies (GWASs) through the identification of many significant variants, as well as by family-based de novo sequencing studies indicating that several traits have a large mutational target size. Here, using a third study design, we show results consistent with extreme polygenicity for body mass index (BMI) and height. On a sample of 20,240 siblings (from 9,570 nuclear families), we used a within-family method to obtain narrow-sense heritability estimates of 0.42 (SE = 0.17, p = 0.01) and 0.69 (SE = 0.14, p = 6 x 10(-)(7)) for BMI and height, respectively, after adjusting for covariates. The genomic inflation factors from locus-specific linkage analysis were 1.69 (SE = 0.21, p = 0.04) for BMI and 2.18 (SE = 0.21, p = 2 x 10(-10)) for height. This inflation is free of confounding and congruent with polygenicity, consistent with observations of ever-increasing genomic-inflation factors from GWASs with large sample sizes, implying that those signals are due to true genetic signals across the genome rather than population stratification. We also demonstrate that the distribution of the observed test statistics is consistent with both rare and common variants underlying a polygenic architecture and that previous reports of linkage signals in complex traits are probably a consequence of polygenic architecture rather than the segregation of variants with large effects. The convergent empirical evidence from GWASs, de novo studies, and within-family segregation implies that family-based sequencing studies for complex traits require very large sample sizes because the effects of causal variants are small on average.

Diário da Constituinte [gravação de vídeo] : [programa n. 240]

Começa a votação do novo substitutivo do Relator Bernardo Cabral (PMDB-AM) na Assembleia Nacional Constituinte (ANC). A grande preocupação é com o número elevado de destaques. O Deputado Aécio Neves (PMDB-MG) alerta que o substitutivo tem problemas sérios como a instituição do colégio eleitoral para o segundo turno das eleições presidenciais. Sessenta funcionários do Congresso foram mobilizados para facilitar a votação dos destaques. Carlos Brasil, funcionário da Comissão de Sistematização, explica os trâmites do trabalho. O Deputado Nelson Jobim (PMDB-RS) acha que muitos destaques poderão ser votados em conjunto para agilizar o trabalho. Elaborado pelo Banco Nordeste do Brasil, o livro Nordeste foi lançado no Salão Nobre da Câmara dos Deputados. O Deputado Waldec Ornelas (PFL-BA) aprova os artigos que tratam do tema. O Senador Luiz Viana (PMDB-BA) acredita que a região foi atendida em parte e que apresentou uma emenda reservando 1% da arrecadação para a irrigação no Nordeste. José Camargo (PFL-SP) relata que o substitutivo tem falhas, mas lembra as emendas apresentadas por ele aceitas no substitutivo. No debate sobre o sistema de governo constituintes defenderam suas posições. O Líder do PDT, Deputado Brandão Monteiro (PDT-RJ) lembrou que seu partido defende o presidencialismo. O Presidente da Assembleia Nacional Constituinte (ANC), Deputado Ulysses Guimarães esclarece que é favorável ao presidencialismo, mas que o parlamentarismo está com maior número de adeptos.

利用树木年轮宽度资料重建长白山地区240年来降水量的变化

根据长白山地区水曲柳年轮宽度资料,分析了树木年轮宽度与气候要素的关系,重建了1765年来该地区的降水变化。结果表明:长白山地区近240年降水波动明显,1850年以前降水波动幅度较大,1850—1900年波动比较平稳,并且降水量偏低,1900年以后降水的波动幅度明显增大,且湿润和干旱的持续时间增长,特别是1920年以后,降水波动剧烈;降水减少幅度最大的干旱期是1816—1820年,湿润期是1975—1979年;而1925—1936年和1947—1957年的2个干旱期在持续时间上最为显著。周期分析结果表明,长白山地区降水具有显著的2.64～3.03年、5.28～6.96年以及12.13～22.63年的周期。

Kazimierz Denek, Na wakacyjnych szlakach, Wyd. Adam Marszałek, Toruń 1996, ss. 240.

Recenzje i sprawozdania z książek

Liste ordinaire de 270 actions et 240 dixièmes d'action tirées à la loterie de la Compagnie des Indes le 25 janvier 1731...

[Acte. 1731]

Liste ordinaire de 270 actions et 240 dixièmes d'action tirés à la loterie de la Compagnie des Indes le 26 février 1731...

[Acte. 1731]

Resolución N° 240 ¿Cuáles son los presupuestos necesarios para que sea procedente la inscripción de una medida cautelar sobre un establecimiento de comercio?

Servicios registrales

HG 240.0-240.10 Thin Section

Dark brown sediment with sub-angular to rounded clasts. Contained areas of darker clay material. Contains rotation structures, mainly around rounded clasts. One side of the sample had significantly larger clasts than the other. Two different domains can be seen in this sample; a fine grained domain and a coarse grained domain.

El esquema corporal en Primaria : 240 ejercicios para su adquisición y desarrollo.

Se presentan unas pautas teóricas del concepto Esquema Corporal y los elementos básicos que los componen: conocimiento del cuerpo, tonicidad y control postural, lateralidad, relajación y respiración. Se aportan también unas actividades o ejercicios de aplicación en el ámbito escolar, que permitan al profesor de Educación Física en Primaria tener una orientación sobre el concepto y cómo aplicarlo. Se pretende también salvar el déficit de materiales y recursos bibliográficos sobre este tema y aportar nuevas formas de entender la Educación Física tradicional, desde la reflexión, el estudio y la aplicación práctica. El libro está pensado para alumnos de 6 a 12 años. Los contenidos prácticos pueden ser trabajados, adaptándolos, para edades anteriores y posteriores. Además de servir a los profesionales de Educación Física, los materiales pueden ser útiles a monitores de tiempo libre y deportivos, entre otros.