La (poli)crisis ecosociocultural global del siglo XXI

Call to action for equitable access to human milk for vulnerable infants

The WHO AFRO Regional Director candidates

Background:In 2015, the UN General Assembly set Sustainable Development Goals (SDGs), in which SDG 3.2 called for all countries to reach a neonatal mortality to at least as low as 12 per 1000 live births by 2030. As the SDG era enters its final years, especially after the COVID-19 pandemic, it is time to take stock of worldwide trends in terms of neonatal mortality and progress towards SDG target 3.2. We aimed to evaluate the time trends in neonatal mortality from 1990 to 2023 with projections towards SDG target 3.2 at the global, regional, and national levels.Materials and methods:Annual neonatal deaths and neonatal mortality rate (NMR) between 1990 and 2023 at the global, regional, and national levels were collected from a dataset complied by the UN Inter-agency group for Child Mortality Estimation. The percentage changes in neonatal deaths and the estimated annual percentage changes (EAPCs) in NMRs at the global, regional, and national levels were calculated. The year in which the location with an NMR above 12 deaths per 1000 live births would achieve the SDG 3.2 NMR target was estimated using time-series analyses.Results:Globally, the number of neonatal deaths decreased by 56.42% from 5.24 million in 1990 to 2.28 million in 2023 and the NMR decreased by an average of 2.54% (95% CI: 2.44%, 2.63%) per year from 36.70 deaths per 1000 live births in 1990 to 17.33 deaths per 1000 live births in 2023. The global NMR is expected to achieve SDG target 3.2 by 2036. At the regional level, the NMR decreased significantly in all SDG regions between 1990 and 2023 but remained above SDG target 3.2 in Sub-Saharan Africa, Central and Southern Asia, and Western Asia and Northern Africa, with NMRs of 26.41, 20.74, and 12.80 deaths per 1000 live births in 2023, respectively. Sub-Saharan Africa and Central and Southern Asia are projected to reach the SDG 3.2 target by 2068 and 2041, respectively. At the national level, the NMR increased significantly in Dominica (EAPC = 3.95; 95% CI: 3.74, 4.17), Botswana (EAPC = 1.92; 95% CI: 1.14, 2.70), Grenada (EAPC = 1.06; 95% CI: 0.48, 1.63), and Eswatini (EAPC = 0.32; 95% CI: 0.19, 0.44) between 1990 and 2023. Among the 200 countries and territories worldwide, 125 have already met SDG target 3.2, and 7 are expected to do so by 2030. Of the remaining 68 countries that would not achieve SDG target 3.2 by 2030, 11 would meet it between 2031 and 2040, 12 would meet it between 2041 and 2050, and 37 would meet it after 2050, if the average rate of decline from 1990 to 2023 continues; however, the NMR would be deteriorating in Dominica, Botswana, Grenada, Venezuela (Bolivarian Republic of), Eswatini, Zimbabwe, Dominican Republic, and Fiji.Conclusions:Despite substantial progress in reducing the NMR worldwide since 1990, more than a quarter of countries and territories would miss SDG target 3.2 by 2030, and nearly half of those countries and territories would meet SDG target 3.2 after 2050. Urgent actions are needed in most regions and countries with high NMRs, particularly those in sub-Saharan Africa.

BackgroundGlaucoma is a leading cause of irreversible blindness globally, with a particularly significant impact on middle-aged and older adults (aged 45 years and above), substantially affecting their quality of life and imposing considerable socio-economic burdens. Comprehensive assessments of the burden of glaucoma in this age group at global, regional, and national levels are crucial for shaping health policies and optimizing resource allocation.MethodsData on the burden of glaucoma among individuals aged 45 years and above were obtained from the 2021 Global Burden of Disease (GBD) study. The Average Annual Percent Change (AAPC) was used to evaluate trends in glaucoma burden from 1990 to 2021 among this population. The Slope Index of Inequality (SII) and the Concentration Index (CI) were employed to analyze both absolute and relative health inequalities in the burden of glaucoma. An Age–Period–Cohort model focusing on the 45+ age group was fitted using the NORDPRED package to predict the future burden of glaucoma. Additionally, frontier analysis was conducted to assess the relationship between the burden of glaucoma and socio-demographic development in the older adult population, using non-parametric Data Envelopment Analysis (DEA) to define a boundary based on the level of development for the minimal achievable burden.ResultsIn 2021, there were 5.34 million cases of glaucoma among the global population aged 45 years and above (95% UI: 4.22–6.45 million), with an age-standardized prevalence rate (ASPR) of 889.3 per 100,000 population (95% UI: 700.2–1078.5). The AAPC for glaucoma in this age group from 1990 to 2021 was −0.82 (95% CI: −0.85 to −0.8), indicating a downward trend in both ASPR and age-standardized DALY rate (ASDR) globally among middle-aged and older adults. At the regional level, areas with lower Socio-Demographic Index (SDI) exhibited higher ASPRs, whereas high SDI regions recorded lower rates. Nationally, countries such as Niger and Nigeria demonstrated the highest age-standardized rates within this demographic. Health inequality analyses revealed that countries with lower SDI bear a disproportionately higher burden of glaucoma among middle-aged and older adults. Predictions indicate that although the number of global cases in this age group may rise, the overall burden of glaucoma is expected to gradually decline.ConclusionAs one of the leading causes of blindness among middle-aged and older adults worldwide, glaucoma remains a significant public health concern. Although the absolute number of cases in individuals aged 45 years and above continues to rise due to population growth and aging, both the ASPR and ASDR have shown declining trends. This decline reflects meaningful progress in the prevention, diagnosis, and management of the disease. To address the ongoing increase in case numbers, targeted policy interventions are needed to ensure effective prevention and management strategies, contributing to the achievement of global sustainable development goals. Furthermore, frontier analysis identifying disparities between national development levels and the burden of glaucoma in the older adult population can aid in optimizing the allocation of global health resources.

Innovation and entrepreneurship in regions is one of essential tools, in added value creation in economics and in development in national level. It is very important to encourage creativity, new ways of thinking and continuous process of learning of individuals. There are some different approaches how to measure competitiveness of state economy and competitiveness in regional level. Global Competitiveness Index shows competitiveness of state among other world economies based on the 12 pillars of competitiveness, which is difficult to apply in regional or entrepreneurial level due to lack of data at regional level. Innovation is a key factor for development and competitiveness in individual (individual, enterprise) and institutional (local governmental institutions, regional, national and global level. Scientific problem of article is that impact of creativity, knowledge creation and dissemination and cooperation could not be measured trough quantitative data. Aim of the article is to define support model for cooperation of individual – institutional level in innovative entrepreneurship and its impact on regional development. Methods ar analysis of scientific literature, and political planning documents for define of support model in dynamic external environment.

IntroductionAn accurate understanding of total energy intake, energy requirements for healthy body weights and the resultant imbalance is important for many aspects of dietary analysis. Despite its importance, existing estimates are highly uncertain and not well aligned with trends in body weight and malnutrition, especially at regionally comparable and global levels. We estimated energy intake, energy requirements and energy imbalances at global, regional, national and sociodemographic levels based on anthropometric measures.MethodsWe used predictive equations for estimating energy requirements derived from a comprehensive database of doubly labelled water studies, and paired them with global datasets on body weight, height and physical activity to estimate a new proxy of energy intake. We calculated energy requirements to attain healthy body weights by applying the predictive equations to a body mass index that minimises risks for weight-related diseases and is classified as normal. We calculated energy imbalances as the difference between the estimated intake and energy requirements to attain healthy body weights.ResultsOn average, 2160 kilocalories per person per day (kcal/day) were required in 2020 to sustain measured levels of body weight, height and physical activity (95% CI, 2100 to 2210 kcal/day), ranging from 1980 (95% CI, 1900 to 2060) kcal/day in low-income countries to 2360 (95% CI, 2310 to 2410) kcal/day in high-income countries. The estimated intake exceeded energy requirements to attain healthy body weights by 80 (95% CI, 70 to 100) kcal/day on average, with 192 countries (97%) having average intakes above recommendations, and 6 countries (3%) with intake below, and increasing to 14 (7%) when considering rural residences. Between 1990 and 2020, 50 countries (25%) changed from average intakes below recommendations to intakes above.ConclusionsEstimating total energy intake based on anthropometric measures captures the regional and temporal trends in body weight, height and physical activity. The estimates can be used as a complementary measure to existing proxies of energy intake. Among other things, they can inform misreporting of intake in dietary surveys, uncertainty in the amount of food wasted and the lack of data on at-home production in food availability statistics. Aligning existing measures of food intake with consistent estimates of overall energy intake could improve dietary analyses and policy planning.

The author examines the contemporary concept of development at the global and national level, through the prism of the ideas of the world's leading economists. Joseph Stiglitz advocates the concept of capitalism that would be based on a harmonious relationship between the state and the market. Jean Tirole emphasizes the need to respect the greater good and to reconcile personal, group (private) and public interests.Thomas Piketty raises the problem of inequality in a society that creates capital and its logic and advocates the necessity of progressive taxation. Rutger Bregman discusses the importance of the social function of the state and offers the solution of the universal basic income. Mariana Mazzukato emphasizes the importance of the entrepreneurial function of the state.

The author examines the contemporary concept of development at the global and national level, through the prism of the ideas of the world's leading economists. Joseph Stiglitz advocates the concept of capitalism that would be based on a harmonious relationship between the state and the market. Jean Tirole emphasizes the need to respect the greater good and to reconcile personal, group (private) and public interests.Thomas Piketty raises the problem of inequality in a society that creates capital and its logic and advocates the necessity of progressive taxation. Rutger Bregman discusses the importance of the social function of the state and offers the solution of the universal basic income. Mariana Mazzukato emphasizes the importance of the entrepreneurial function of the state.

Global energy flows embodied in international trade: A combination of environmentally extended input–output analysis and complex network analysis

ObjectivesCarbon monoxide (CO) poisoning is one of the most frequent causes of fatal poisoning worldwide. Few studies have explored the mortality trends of CO poisoning grouped by age and gender,...

Liver cancer due to hepatitis C (LCDHC) is one of the leading causes of cancer-related deaths worldwide, and the burden of LCDHC is increasing. We aimed to report the burden of LCDHC at the global, regional, and national levels in 204 countries from 1990 to 2019, stratified by etiology, sex, age, and Sociodemographic Index. Data on LCDHC were available from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study 2019. Numbers and age-standardized mortality, incidence, and disability-adjusted life year (DALY) rates per 100,000 population were estimated through a systematic analysis of modeled data from the GBD 2019 study. The trends in the LCDHC burden were assessed using the annual percentage change. Globally, in 2019, there were 152,225 new cases, 141,810 deaths, and 2,878,024 DALYs due to LCDHC. From 1990 to 2019, the number of incidences, mortality, and DALY cases increased by 80.68%, 67.50%, and 37.20%, respectively. However, the age-standardized incidence, mortality, and DALY rate had a decreasing trend during this period. In 2019, the highest age-standardized incidence rates (ASIRs) of LCDHC were found in high-income Asia Pacific, North Africa and the Middle East, and Central Asia. At the regional level, Mongolia, Egypt, and Japan had the three highest ASIRs in 2019. The incidence rates of LCDHC were higher in men and increased with age, with a peak incidence in the 95+ age group for women and the 85-89 age group for men in 2019. A nonlinear association was found between the age-standardized rates of LCDHC and sociodemographic index values at the regional and national levels. Although the age-standardized rates of LCDHC have decreased, the absolute numbers of incident cases, deaths, and DALYs have increased, indicating that LCDHC remains a significant global burden. In addition, the burden of LCDHC varies geographically. Male and older adult/s individuals have a higher burden of LCDHC. Our findings provide insight into the global burden trend of LCDHC. Policymakers should establish appropriate methods to achieve the HCV elimination target by 2030 and reducing the burden of LCDHC.

What is the current burden of infertility attributable to PCOS at global, regional, and national levels by age and socio-demographic index (SDI) across 21 regions and 204 countries and territories? The burden of infertility attributable to PCOS increased from 6.00 million prevalent cases in 1990 to 12.13 million in 2019 globally and increased sharply in most regions and nations. PCOS is the most common cause of anovulatory infertility, affecting up to 80% of women with anovulation. No comprehensive and detailed epidemiological estimates of infertility attributable to PCOS in reproductive women aged 15-49 years by age and SDI, at the global, regional, and national level, have been reported. An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of infertility attributable to PCOS across 21 regions and 204 countries and territories from 1990 to 2019 has been performed. The prevalence and YLD of female infertility attributable to PCOS in reproductive women aged 15-49 years from 1990 to 2019 were retrieved directly from the Global Burden of Diseases 2019. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels. Globally, the prevalent cases of infertility attributable to PCOS among women of reproductive age (15-49 years) doubled from 1990 to 2019, with 6.00 million prevalent cases in 1900 and 12.13 million in 2019. The global age-standardized prevalence rates (ASPRs) of infertility attributable to PCOS were 223.50/100 000 persons in 1990 and 308.25/100 000 persons in 2019. At global level, the YLDs of infertility attributable to PCOS increased by 98.0% from 35.20 thousand in 1990 to 69.70 thousand in 2019. The burden of infertility attributable to PCOS in the high SDI region was significantly higher than that in the other four SDI regions. The greatest annual increases in rates of ASPR and age-standardized YLD rate were observed in the middle SDI region (AAPC 1.96 [95% CI 1.87-2.06], 1.94 [1.87-2.00], respectively) and the low-middle SDI region (AAPC 1.96 [1.90-2.03], 1.90 [1.85-1.94], respectively). The regional highest ASPR and the age-standardized YLD rate of infertility were observed in High-income Asia Pacific. The national highest ASPR and the age-standardized YLD rate of infertility were observed in Italy. Positive associations were observed between these burden estimates and the SDI level (all P < 0.001). Although the Global Burden of Diseases 2019 has tried its best to collect all available data, some countries have limited data, which may result in an underestimation of the burden of infertility attributable to PCOS. The diagnostic criteria of PCOS are constantly changing, which may induce bias in infertility attributable to PCOS. No information on the PCOS phenotype is provided in the Global Burden of Diseases 2019, so we cannot estimate the infertility attributable to a specific PCOS phenotype. Detection bias would lead to a higher prevalence of PCOS and infertility attributable to PCOS in developed countries with well-established medical systems and greater willingness of the populace to seek medical attention. Thus, health resource allocation for infertility attributable to PCOS in low-prevalence areas should not be ignored. The global burden of infertility attributable to PCOS increased sharply from 1990 to 2019. Effective health interventions and efficient preventative and managerial strategies should be established to reduce the burden of infertility attributable to PCOS. Weight control is suggested to reduce the burden of infertility attributable to PCOS, especially in the high SDI region. This study was supported by the National Key Research and Development Program of China (grant number, 2022YFC2704100) and the National Natural Science Foundation of China (Nos 82001498 and 82371648). The authors declare no competing interests. N/A.

Securing Platinum-Group Metals for Transport Low-Carbon Transition

ABSTRACTThis study is a structured review on the interlinkages between agri‐food trade and the SDGs in the environmental, social and economic dimensions to identify any missed opportunities that agri‐food trade could positively impact the SDGs and provide policy guidance for the missed opportunities at the global, regional and national levels. A great deal of diversity in the papers at the global level, and papers at the regional level are similar, but there is additional analysis on promoting regional markets and value chains. Papers at the local level are product‐specific to emphasise how the trade of specific agricultural commodities would affect the achievement of particular SDGs in question. There is a concern regarding whether agri‐food trade can promote sustainability and the attainment of the SDGs. This is particularly important given that gains from trade are not entirely equitable. Questions relating to concrete innovations, policies and behavioural changes that can ensure systemic transformations remain critical and need to be addressed.

Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.