Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Liderazgo de apoyo e inteligencia emocional para la productividad de los empleados en las organizaciones educativas: un cambio sugerido en el enfoque de gestión hacia la motivación, los incentivos y el empoderamiento.

Este documento analiza estrategias de liderazgo en la práctica en organizaciones educativas de la Unión Europea (UE) y la Comunidad de Estados Independientes (CEI), con el objetivo de aumentar la productividad de los empleados de esas organizaciones. Durante esta investigación, se descubrió que este enfoque no solo trae mucho bien a la nueva generación, sino que también sirve a las organizaciones en términos de rentabilidad. El estudio postula que las organizaciones que cambian a enfoques modernizados crecen enormemente en el mercado y están en una mejor posición para servir a la causa de una educación de calidad, revolucionando el campo y redefiniendo el papel y las responsabilidades de los empleados. Esta investigación proporciona resultados e implicaciones para la práctica y la política de estrategias de liderazgo en la práctica en organizaciones educativas de la UE y la CEI.</jats:p

El descubrimiento de problemas de liderazgo para crear un ambiente amigable para la Educación a Distancia.

Este estudio busca desarrollar la importancia de la educación a distancia y ayuda a mejorar las diferentes habilidades de liderazgo a través de la educación a distancia. El documento utiliza teorías de liderazgo para estudiar la capacidad de crear un espacio amigable para fomentar la educación a distancia en la sociedad. Para este propósito, se tomó una muestra de 392 estudiantes que estudian a través del modelo de aprendizaje de educación a distancia, con edades entre 18 y 25 años, para la identificación de sus habilidades relevantes. Se examinaron los detalles de la educación a distancia para cada grupo de edad. Los resultados refutan los estereotipos sobre la educación a distancia que causa aislamiento, problemas en la comunicación adecuada y la desconexión grupal. Se ha encontrado que la educación a distancia ayuda en la evaluación y las implicaciones de la afiliación grupal y la autoexpresión en las actividades académicas. Por lo tanto, se puede concluir que la estructura de la educación a distancia ayuda en el desarrollo de habilidades de liderazgo en personas involucradas en la enseñanza y el aprendizaje a través del modelo de educación a distancia.</jats:p

IAN McEwan’s Depiction of World as a Dystopian Social Space

This paper aims to study Ian McEwan’s presentation of the world as a dystopian social space. McEwan paints an ugly picture of the present times and gives a warning to contemporary society against the inhuman cruelties that rock it every moment. The present world confronts alienation, anxiety, fear and death etc. on a daily basis and the fundamental role is played by fiction in expressing such experiences. The novels of McEwan present a bleak and dystopian picture before the readers as the things are going in a horrible direction. It can be inferred that McEwan is trying to bring home the idea of destruction and other mishappenings which have taken a toll on the world and thereby giving a message to the people to act before it is too late.</jats:p

La identificación de competencias STEM de estudiantes de Ciencias Técnicas.

El estudio realizó un análisis de datos para identificar las competencias profesionales claves para la educación STEM que son esenciales para los estudiantes jóvenes que tienen una educación especial en ciencias técnicas. El presente artículo se basa en tres objetivos: elaborar un concepto detallado de STEM que se base en habilidades blandas, de liderazgo e inteligencia emocional, explorar la importancia de las habilidades de liderazgo en el sistema educativo STEM y desarrollar el método tradicional de gestión con El nuevo método que se basa en el principio de la inteligencia emocional. Por último, para todos, los hallazgos del artículo ayudan a ambos sectores, tanto educativo como corporativo, a comprender la importancia de STEM.</jats:p

A Contextual Review of the Selected English Writings on Japan’s Secret War Theatre, 1941-1945

This article explores the English writings, which have substantially examined the Japanese secret war, abroad Indian revolutionaries’ collaboration with the Japanese intelligence networks, and British counter-intelligence amid World War-II. Further, the paper spotlights the formation of the Indian National Army (INA), the role of Subhash Chandra Bose, and other Indian revolutionaries settled in Southeast Asia and Far East Asia. However, the British portrayed those revolutionaries as ‘Japanese Inspired Fifth Column’ (JIFC) through their propaganda agencies and efficient organizational setups, including Indian troops. The article also spotlights the covert activities of Japanese in British India, which gathered military and strategic information, and dispatched it to Tokyo. The British thwarted the Japanese espionage networks as well as activities by recruiting the Indians as the double agents, prior they were furthering Japanese interests in India. Unfortunately, the history of British India, English Empire in India and the WW-II bypasses the contribution of abroad Indian revolutionaries and their associations with Japanese-intelligence networks, and their impact upon the Indian nationalist movement during WW-II.</jats:p

LABORATORY TURN AROUND TIME FOR BIOCHEMISTRY INVESTIGATIONS IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL OF NORTH INDIA

Background: Laboratory turnaround time is considered one of the most important indicators of work efficiency in hospitals, physicians always need timely results to take effective clinical decisions especially in the emergency department where these results can guide physicians whether to admit patients to the hospital, discharge them home or do further investigations. Objectives:1. Calculate the turnaround time for the various biochemical investigations from accident and emergency of a tertiary care institute.2. To find the percentage contribution of pre-analytical, analytical and post analytical phases to TAT. Materials And Methods: This was a prospective, descriptive, single-center study of therapeutic TAT for biochemistry investigations in accident and emergency of a tertiary care hospital. The study was conducted for a period of 3 months from August 2020 to Oct 2020. During the present study period, all biochemistry investigations ordered from emergency department were studied. The Lundberg definition of TAT was used in this study. This means that the pre-analytical TAT used was from the point of order of tests to the receipt of samples at the laboratory. Similarly, the post-analytic phase started from the time results were available at the laboratory to the point where clinicians could access it for action. Results: The turnaround time (TAT) has been monitored in total of 7515 samples for biochemistry evaluation with mean TAT of 169.6 min. It was noted that the mean pre analytical time period was 120.6 min , Analytical time period 34 min while post analytical time period was 15 min. In our study of the pre-analytical phase 37.7%, 39.3%, and 22.9% tests were completed within 60, 60-120 and above 120 minutes, respectively. With respect to the analytical phase, 80.4% and 19.6% tests were completed below 45 minutes and above 45 minutes, respectively. Conclusion: Despite efficient analysis of results, the pre analytic period contributed the most delay in TAT. Collecting the blood samples under standard conditions, filling the test request slips, marking the samples with bar-codes contributed to long TAT.</jats:p