University of Opole

Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research--studies that use prospective designs or include multivariate analyses of predictor and outcome measures--relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention. 1. Disasters cause serious psychological harm in a minority of exposed individuals. People exposed to disaster show myriad psychological problems, including PTSD, grief, depression, anxiety, stress-related health costs, substance abuse, and suicidal ideation. However, severe levels of these problems are typically observed only in a relatively small minority of exposed individuals. In adults, the proportion rarely exceeds 30% of most samples, and in the vast majority of methodologically sound studies, the level is usually considerably lower. Among youth, elevated symptoms are common in the first few months following a high-impact disaster, but again, chronic symptom elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some survivors recover their psychological equilibrium within a period ranging from several months to 1 or 2 years. A sizeable proportion, often more than half of those exposed, experience only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been evidenced across different methodologies, including recent studies that identified patterns of outcome using relatively sophisticated data analytic approaches, such as latent growth mixture modeling. 3. Disaster outcome depends on a combination of risk and resilience factors. As is true for most highly aversive events, individual differences in disaster outcomes are informed by a number of unique risk and resilience factors, including variables related to the context in which the disaster occurs, variables related to proximal exposure during the disaster, and variables related to distal exposure in the disaster's aftermath. Multivariate studies indicate that there is no one single dominant predictor of disaster outcomes. Rather, as with traumatic life events more generally, most predictor variables exert small to moderate effects, and it is the combination or additive total of risk and resilience factors that informs disaster outcomes. 4. Disasters put families, neighborhoods, and communities at risk. Although methodologically complex research on this facet of disasters' impact is limited, the available literature suggests that disasters meaningfully influence relationships within and across broad social units. Survivors often receive immediate support from their families, relatives, and friends, and for this reason many survivors subsequently claim that the experience brought them closer together. On the whole, however, the empirical evidence suggests a mixed pattern of findings. There is evidence that social relationships can improve after disasters, especially within the immediate family. However, the bulk of evidence indicates that the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience. 5. The remote effects of a disaster in unexposed populations are generally limited and transient. Increased incidence of extreme distress and pathology are often reported in remote regions hundreds if not thousands of miles from a disaster's geographic locale. Careful review of these studies indicates, however, that people in regions remote to a disaster may experience transient distress, but increased incidence of psychopathology is likely only among populations with preexisting vulnerabilities (e.g., prior trauma or psychiatric illness) or actual remote exposure (e.g., loss of a loved one in the disaster). Finally, we review the implications for intervention. There is considerable interest in prophylactic psychological interventions, such as critical incident stress debriefing (CISD), that can be applied globally to all exposed survivors in the immediate aftermath of disaster. Multiple studies have shown, however, that CISD is not only ineffective but in some cases can actually be psychologically harmful. Other less invasive and more practical forms of immediate intervention have been developed for use with both children and adults. Although promising, controlled evaluations of these less invasive interventions are not yet available. The available research suggests that psychological interventions are more likely to be effective during the short- and long-term recovery periods (1 month to several years postdisaster), especially when used in combination with some form of screening for at-risk individuals. Such interventions should also target the maintenance and enhancement of tangible, informational, and social-emotional support resources throughout the affected community. Language: en

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

AIMS: To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. METHODS AND RESULTS: An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their risk-based 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). CONCLUSION: Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.

Abstract Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

The partitioning of space with Hirshfeld surfaces enables the analysis of fingerprint molecular interactions in crystalline environments. This study uses the decomposition of the crystal contact surface between pairs of interacting chemical species to derive an enrichment ratio. This quantity enables the analysis of the propensity of chemical species to form intermolecular interactions with themselves and other species. The enrichment ratio is obtained by comparing the actual contacts in the crystal with those computed as if all types of contacts had the same probability to form. The enrichments and contact tendencies were analyzed in several families of compounds, based on chemical composition and aromatic character. As expected, the polar contacts of the type H⋯N, H⋯O and H⋯S, which are generally hydrogen bonds, show enrichment values larger than unity. O⋯O and N⋯N contacts are impoverished while H⋯H interactions display enrichment ratios which are generally close to unity or slightly lower. In aromatic compounds, C⋯C contacts can display large enrichment ratios due to extensive π⋯π stacking in the crystal packings of heterocyclic compounds. C⋯C contacts are, however, less enriched in pure (C,H) hydrocarbons as π⋯π stacking is not so favourable from the electrostatic point of view compared with heterocycles. C⋯H contacts are favoured in (C,H) aromatics, but these interactions occur less in compounds containing O, N or S as some H atoms are then involved in hydrogen bonds. The study also highlights the fact that hydrogen is a prefered interaction partner for fluorine.

The programme of identification, cataloguing and evaluation of Polish landscapes, part of the implementation of the European Landscape Convention, has caused an increase in interest in physico-geographical regionalisation over recent years. The commonly accepted regionalisation of Poland developed by J. Kondracki (Kondracki & Richling 1994) is sufficient for work at an overview scale (e.g. 1:500,000), whereas its spatial accuracy is too low to make use of it for the purpose of Polish landscape cataloguing. The aim of this article is to present a more up-to-date and detailed division of Poland into mesoregions, adjusted to the 1:50,000 scale. In comparison with older work, the number of mesoregions has increased from 316 to 344. In many cases, somefar-reaching changes in meso- and macroregions were made. Nevertheless, in most cases the previous system of units was maintained, with more detailed adjustment of boundaries based on the latest geological andgeomorphological data and the use of GIS tools for the DEM analysis. The division presented here is a creatively developing new work aligning the proposals of the majority of Polish researchers. At the same time, it is a regionalisation maintaining the idea of the work developed by J. Kondracki as well as his theoretical assumptions and the criteria used to distinguish units, which makes it a logical continuation of his regional division.

Heavy metals enter the human body through the gastrointestinal tract, skin, or via inhalation. Toxic metals have proven to be a major threat to human health, mostly because of their ability to cause membrane and DNA damage, and to perturb protein function and enzyme activity. These metals disturb native proteins' functions by binding to free thiols or other functional groups, catalyzing the oxidation of amino acid side chains, perturbing protein folding, and/or displacing essential metal ions in enzymes. The review shows the physiological and biochemical effects of selected toxic metals interactions with proteins and enzymes. As environmental contamination by heavy metals is one of the most significant global problems, some detoxification strategies are also mentioned.

The authors examined social causation and social selection explanations for the association between perceptions of social support and psychological distress. Data came from a sample of 557 victims of natural disaster in Mexico. Structural equation modeling analyses indicated that social causation (more social support leading to less posttraumatic stress disorder [PTSD]) explained the support-to-distress relationship in the earlier postdisaster phase, 6 to 12 months after the impact. Both causal mechanisms emerged as significant paths in the midpoint of the study (12 and 18 months). Only social selection (more PTSD leading to less social support) accounted for the support-to-distress relationship at 18 to 24 months after the event. Interpersonal and social dynamics of disasters may explain why these two contrasting causal mechanisms emerged over time.

The behavior of a number of commonly used pressure media, including nitrogen, argon, 2-propanol, a 4:1 methanol–ethanol mixture, glycerol and various grades of silicone oil, has been examined by measuring the X-ray diffraction maxima from quartz single crystals loaded in a diamond-anvil cell with each of these pressure media in turn. In all cases, the onset of non-hydrostatic stresses within the medium is detectable as the broadening of the rocking curves of X-ray diffraction peaks from the single crystals. The onset of broadening of the rocking curves of quartz is detected at ∼9.8 GPa in a 4:1 mixture of methanol and ethanol and at ∼4.2 GPa in 2-propanol, essentially at the same pressures as the previously reported hydrostatic limits determined by other techniques. Gigahertz ultrasonic interferometry was also used to detect the onset of the glass transition in 4:1 methanol–ethanol and 16:3:1 methanol–ethanol–water, which were observed to support shear waves above ∼9.2 and ∼10.5 GPa, respectively, at 0.8–1.2 GHz. By contrast, peak broadening is first detected at ∼3 GPa in nitrogen, ∼1.9 GPa in argon, ∼1.4 GPa in glycerol and ∼0.9 GPa in various grades of silicone oil. These pressures, which are significantly lower than hydrostatic limits quoted in the literature, should be considered as the practical maximum limits to the hydrostatic behavior of these pressure media at room temperature.

This study sets out to test the assumption that concepts of leadership differ as a function of cultural differences in Europe and to identify dimensions which describe differences in leadership concepts across European countries. Middle‐level managers ( N = 6052) from 22 European countries rated 112 questionnaire items containing descriptions of leadership traits and behaviours. For each attribute respondents rated how well it fits their concept of an outstanding business leader. The findings support the assumption that leadership concepts are culturally endorsed. Specifically, clusters of European countries which share similar cultural values according to prior cross‐cultural research (Ronen & Shenkar, 1985), also share similar leadership concepts. The leadership prototypicality dimensions found are highly correlated with cultural dimensions reported in a comprehensive cross‐cultural study of contemporary Europe (Smith, Dugan, & Trompenaars, 1996). The ordering of countries on the leadership dimensions is considered a useful tool with which to model differences between leadership concepts of different cultural origin in Europe. Practical implications for cross‐cultural management, both in European and non‐European settings, are discussed.

Upon fusion of multivesicular bodies (MVBs) with the plasma membrane, intraluminal vesicles (ILVs) are released into the extracellular space as exosomes. Since the lipid composition of the exosomal membrane resembles that of raft microdomains, the inward budding process involves the raft-like region of the MVB limiting membrane. Although published research suggests that cellular RNAs may be selectively sorted into exosomes, the molecular mechanisms remain elusive. In this review, we suggest that there is a continuous interaction of cellular RNAs with the outer (cytoplasmic) surface of MVBs and that the selection for incorporation of these RNAs into ILVs is based on their affinity to the raft-like region in the outer layer of the MVB membrane.

PURPOSE: The purpose of this study is to examine the association of anxiety with self-rated general health, satisfaction with life, stress and coping strategies of university students during the COVID-19 pandemic outbreak in Poland. PARTICIPANTS AND METHODS: = 2.60), participated in an online survey. The study was performed between 30 March and 30 April 2020, during the general coronavirus quarantine. Participants completed a standard psychological questionnaire, including General Anxiety Disorder (GAD-7), General Self-Rated Health (GSRH), Satisfaction With Life Scale (SWLS), Perceived Stress Scale (PSS), and Coping Inventory for Stressful Situations (CISS). RESULTS: The majority of students (65%) showed mild to severe GAD and a high level of perceived stress (56%). Those students who had the worst evaluated current GSRH, in comparison to the situation before the COVID-19 outbreak, also demonstrated higher levels of anxiety, perceived stress, and emotion-oriented coping styles. The study indicates that the variance of anxiety during the COVID-19 outbreak may be explained for about 60% by such variables, like high stress, low general self-rated health, female gender, and frequent use of both emotion-oriented and task-oriented coping styles. CONCLUSION: University students experience extremely high stress and anxiety during quarantine period and they need professional help to cope with COVID-19 pandemic. The results of this study may help prepare appropriate future intervention and effective prevention programs at universities.

Considerable research has examined human mate preferences across cultures, finding universal sex differences in preferences for attractiveness and resources as well as sources of systematic cultural variation. Two competing perspectives—an evolutionary psychological perspective and a biosocial role perspective—offer alternative explanations for these findings. However, the original data on which each perspective relies are decades old, and the literature is fraught with conflicting methods, analyses, results, and conclusions. Using a new 45-country sample ( N = 14,399), we attempted to replicate classic studies and test both the evolutionary and biosocial role perspectives. Support for universal sex differences in preferences remains robust: Men, more than women, prefer attractive, young mates, and women, more than men, prefer older mates with financial prospects. Cross-culturally, both sexes have mates closer to their own ages as gender equality increases. Beyond age of partner, neither pathogen prevalence nor gender equality robustly predicted sex differences or preferences across countries.

The paper presents the most significant factors that influence interpersonal and group communication in multicultural environment in education. It highlights main theories of intercultural communication and its effectiveness as well as ones which deal with coping with conflicts in the intercultural environment. In contemporary times, which require working in multicultural environment, communicative skills become more and more important. In teachers’ work cultural awareness and being openminded about differences between nations and cultures are essential. These skills are especially important while there is a need to avoid or overcome problems, conflicts which may occur. The author shows the significance of these factors. The article closes with the recommendations and clues concerning effective intercultural communication.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

Background: Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods: Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings: In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 - 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432-912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9-412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (-29·1%;23·8-38·5). YLLs decreased in self-harm (-27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation: Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding: The Bill and Melinda Gates Foundation.

Abstract High blood cholesterol is typically considered a feature of wealthy western countries 1,2 . However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world 3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health 4,5 . However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

The scarcity of precious metals has led to the development of sustainable strategies for metal-catalyzed cross-coupling reactions. The establishment of new catalytic methods using iron is attractive owing to the low cost, abundance, ready availability, and very low toxicity of iron. In the last few years, sustainable methods for iron-catalyzed cross-couplings have entered the critical area of pharmaceutical research. Most notably, iron is one of the very few metals that have been successfully field-tested as highly effective base-metal catalysts in practical, kilogram-scale industrial cross-couplings. In this Minireview, we critically discuss the strategic benefits of using iron catalysts as green and sustainable alternatives to precious metals in cross-coupling applications for the synthesis of pharmaceuticals. The Minireview provides an essential introduction to the fundamental aspects of practical iron catalysis, highlights areas for improvement, and identifies new fields to be explored.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Abstract The optimized superconducting stellarator device Wendelstein 7-X (with major radius , minor radius , and plasma volume) restarted operation after the assembly of a graphite heat shield and 10 inertially cooled island divertor modules. This paper reports on the results from the first high-performance plasma operation. Glow discharge conditioning and ECRH conditioning discharges in helium turned out to be important for density and edge radiation control. Plasma densities of with central electron temperatures were routinely achieved with hydrogen gas fueling, frequently terminated by a radiative collapse. In a first stage, plasma densities up to were reached with hydrogen pellet injection and helium gas fueling. Here, the ions are indirectly heated, and at a central density of a temperature of with was transiently accomplished, which corresponds to with a peak diamagnetic energy of and volume-averaged normalized plasma pressure . The routine access to high plasma densities was opened with boronization of the first wall. After boronization, the oxygen impurity content was reduced by a factor of 10, the carbon impurity content by a factor of 5. The reduced (edge) plasma radiation level gives routinely access to higher densities without radiation collapse, e.g. well above line integrated density and central temperatures at moderate ECRH power. Both X2 and O2 mode ECRH schemes were successfully applied. Core turbulence was measured with a phase contrast imaging diagnostic and suppression of turbulence during pellet injection was observed.