For richer, for poorer: Financial behaviors, power (im)balance, and relational aggression among different-gender newlyweds in the U.S.

Guided by an intersectional feminism framework, we used three-wave, dyadic survey data from a nationally representative sample of 1625 U.S. different-gender newlywed couples to test three research questions. First, as balanced power is considered a key concept for relational well-being in feminism, we examined developmental trajectories in husbands' and wives' perception of power (im)balance. Second, considering money as a major influence on power and aggression, we examined how financial behaviors relate to power (im)balance and in turn relational aggression-a type of intimate partner violence that is controlling and manipulative in nature. Third, informed by the intersectionality between gender and socioeconomic status (SES), we examined gender differences and SES disparities in the associations among financial behaviors, developmental trajectories of perception of power (im)balance, and relational aggression. Our findings demonstrate that newlywed different-gender couples are experiencing power struggles, where two partners diminish each other's influence over time. We also found that healthy financial behaviors are associated with balanced power and, in turn, less relational aggression (especially for wives and in lower-SES households). Taken collectively, we continue calling for efforts to facilitate money management skills and promote balanced marital power.

Analysis of Social Media Use, Mental Health, and Gender Identity Among US Youths.

Importance: Mental health among children and adolescents is a critical public health issue, and transgender and gender nonbinary youths are at an even greater risk. Social media has been consistently associated with youth mental health, but little is known about how gender identity interacts with this association. Objective: To use a risk and resilience approach to examine the association between social media use and mental health among transgender, gender nonbinary, and cisgender youths. Design, Setting, and Participants: This cross-sectional study analyzed data collected from an online survey between May and August 2021. Participants included a random sample of US youths; eligibility requirements included being aged 10 to 17 years and residing in the US. Statistical analysis was performed from February to April 2022. Main Outcomes and Measures: Social media use (time, type of use, favorite site, social comparisons, mindfulness, taking intentional breaks, cleaning and curating feeds, problematic use, and media literacy programs at their school) and mental health (depression, emotional problems, conduct problems, and body image) as main outcomes. Results: Participants included 1231 youths aged 10 to 17 years from a national quota sample from the United States; 675 (54.8%) identified as cisgender female, 479 (38.9%) as cisgender male, and 77 (6.3%) as transgender, gender nonbinary, or other; 4 (0.3%) identified as American Indian or Alaska Native, 111 (9.0%) as Asian, 185 (15.0%) as Black, 186 (15.1%) as Hispanic or Latinx, 1 (0.1%) as Pacific Islander, 703 (57.1%) as White, and 41 (3.3%) as mixed and/or another race or ethnicity. Gender identity moderated both the strength and the direction of multiple associations between social media practices and mental health: active social media use (eg, emotional problems: B = 1.82; 95% CI, 0.16 to 3.49; P = .03), cleaning and/or curating social media feeds (eg, depression: B = -0.91; 95% CI, -1.98 to -0.09; P = .03), and taking intentional breaks (eg, depression: B = 1.03; 95% CI, 0.14 to 1.92; P = .02). Conclusions and Relevance: In this cross-sectional study of gender identity, social media, and mental health, gender identity was associated with youths' experiences of social media in ways that may have distinct implications for mental health. These results suggest that research about social media effects on youths should attend to gender identity; directing children and adolescents to spend less time on social media may backfire for those transgender and gender nonbinary youths who are intentional about creating safe spaces on social media that may not exist in their offline world.

Change in Financial Stress and Relational Wellbeing During COVID-19: Exacerbating and Alleviating Influences.

Guided by the family adjustment and adaptation response (FAAR) model and using a panel survey of 1510 adults in the US administered during the summer of 2020 and a mixed methods approach, we explored associations between changes in financial stress related to COVID-19 and relational wellbeing. Regression analyses showed that, compared to those who maintained their levels of financial stress, those who reported increased financial stress reported increased conflict and those who reported decreased financial stress reported decreased conflict. However, decreased financial stress was also associated with decreases in emotional closeness and relationship happiness, suggesting that changes in financial stress can lead to both maladaptation and bonadaptation in families. Qualitative findings provide insights into factors that may exacerbate or help alleviate financial stress related to COVID-19.

Relationship quality and support for family policy during the COVID-19 pandemic.

Objective: We examined how relationship satisfaction changed during the coronavirus (COVID-19) pandemic, as well as how relationship satisfaction related to public policy support. Background: Conservation of resources (COR) theory suggests that societal-level stressors (such as a global pandemic) threaten familial and individual resources, straining couple relationships. Relationship satisfaction is in turn linked with important individual, familial, and societal outcomes, necessitating research on how COVID-19 impacted this facet of relationships. Method: Drawing from an international project on COVID-19 and family life, participants included 734 married and cohabiting American parents of children under 18 years of age. Results: Findings revealed relationship satisfaction declined moderately compared to retrospective reports of relationship satisfaction prior to the pandemic. This decline was more precipitous for White individuals, women, parents less involved in their children's lives, and those reporting higher levels of depressive symptoms. We also found that higher relationship satisfaction was associated with higher levels of support for family policy, particularly for men. At higher levels of relationship satisfaction, men and women had similarly high levels of support for family policy, while at lower levels, women's support for family policy was significantly higher. Conclusion: The COVID-19 pandemic likely amplified facets of social inequality, which is especially concerning when considering the large socioeconomic gaps prior to the pandemic. Implications: Therapists, researchers, and policy makers should examine how relationship satisfaction may have changed during the pandemic because relationship satisfaction is linked to child and adult well-being and relationship dissolution. Further, the link between relationship satisfaction and support for family policy deserves further scrutiny.

Parental mental health and child anxiety during the COVID-19 pandemic in Latin America.

This study examined parents' (N = 10,141, 64% women) reports of their and their childrens' depression, anxiety, and stress in Brazil, Mexico, Colombia and Argentina. The data come from the COVID-19 Family Life Study (Ben Brik, 2020) and cohort recruited between April and December 2020. Participants completed online surveys that included the DASS-21 and the Revised Children's Manifest Anxiety Scale. Our findings indicate that socio-economically disadvantaged families fared worse in mental health during the early phases of the COVID-19 pandemic compared with families with more social and economic resources. Mothers reported higher anxiety, depression, and stress compared with fathers. Parents of adolescents and adolescents fared worse than did families with younger children. Parental physical activity was associated with better parent and child mental health of anxiety symptoms. We discuss the need to address the adverse impacts of the COVID-19 pandemic on mental health in families in Latin America via coordinated mental health and psychosocial support services that are integrated into the pandemic response currently and after the pandemic subsides.

Latent profiles of sleep quality, financial management behaviors, and sexual satisfaction in emerging adult newlywed couples and longitudinal connections with marital satisfaction.

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands-problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands' and wives' financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands' and wives' marital satisfaction, in relation to profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers (mostly medium effect sizes). Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only (small effect size). However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed.

Teens, screens and quarantine; the relationship between adolescent media use and mental health prior to and during COVID-19.

This study examines associations between media use and mental health for adolescents prior to and during the COVID-19 pandemic. Using two separate datasets that sampled adolescents (8th, 10th, and 12th graders) in 2018 (n = 31,825) and 2020 (n = 1,523), mental health (hopelessness and happiness), media use (time spent using a variety of media), and personal health habits (sleep) were assessed. Overall, we found that there were significant differences by year in adolescent hopelessness, with adolescents reporting less hopelessness in 2020 (during COVID-19) than in 2018 (pre COVID-19). There were not â€‹practical significant differences in adolescent happiness and loneliness. Adolescents also reported getting more sleep in our 2020 sample than the 2018 sample. Adolescents in 2020 spent significantly more time watching movies and video chatting, but less time texting and on social media than adolescents in 2018. Finally, we found that time spent video chatting and sleep had a different relationship with various aspects of mental health (happiness, hopelessness, or loneliness) in 2018 vs. 2020.

Marital quality over the life course and child well-being from childhood to early adolescence.

Research on marital quality and child well-being is currently limited by its common use of geographically constrained, homogenous, and often cross-sectional (or at least temporally limited) samples. We build upon previous work showing multiple trajectories of marital quality and data from the National Longitudinal Survey of Youth-1979 (NLSY79) regarding mothers and their children (inclusive of ages 5-14). We examine how indicators of child well-being are linked to parental trajectories of marital quality (happiness, communication, and conflict). Results showed children whose parents had consistently poor marital quality over the life course exhibited more internalizing and externalizing problems, poorer health, lower quality home environments, and lower math and vocabulary scores than children of parents in consistently higher-quality marriages. Group differences remained stable over time for child health, home environment, and vocabulary scores. Group differences for internalizing problems declined over time, whereas group differences increased for externalizing problems and math scores. Initial advantages for females across nearly all indicators of child well-being tended to shrink over time, with boys often moving slightly ahead by mid adolescence. We discuss the implications of these findings in regard to children's development and well-being and suggest treating marriage as a monolithic construct betrays important variation within marriage itself.

Mindfulness and Sexual Mindfulness as Moderators Between Conflict Resolution and Sexual and Relationship Satisfaction.

Mindfulness has shown positive links with conflict resolution. Additionally, couples skilled in conflict resolution report greater sexual and relationship satisfaction. However, no research has examined the moderating effect of mindfulness, specifically sexual mindfulness, between conflict resolution and sexual and relationship satisfaction. We used 1,627 couples from wave III of the Couple Relationships and Transition Experiences (CREATE) study. Sexual mindfulness moderated the association between conflict resolution and sexual satisfaction, even after controlling for attachment. Wives higher in sexual mindful awareness may rely less on conflict resolution for their sexual satisfaction. Karremans and colleagues' (2017) model of mindfulness and romantic relationships provides a framework for testing whether, when, and how mindfulness increases positive romantic relationship processes and outcomes. Under this framework, mindfulness may provide a mechanism to help couples achieve sexual and relationship satisfaction. Mindfulness and sexual mindfulness may provide a useful mechanism for therapists, educators, social workers, and couples to enhance satisfaction within the romantic and sexual relationship even without partner buy-in.

Linking Sexual Mindfulness to Mixed-Sex Couples' Relational Flourishing, Sexual Harmony, and Orgasm.

Marriage is an important adult relationship, and recent research indicates that sexual mindfulness, awareness and non-judgment, may be an important tool in helping maintain relational and sexual well-being. Using a nationally representative U.S. sample of newly married, mixed-sex couples (women's age M = 29.70 years; men's age M = 31.76 years; N = 1473 couples), we evaluated whether the two factors of sexual mindfulness, awareness and non-judgment, were linked with relational flourishing, sexual harmony, and orgasm consistency. We utilized an actor-partner interdependence model within a structural equation modeling framework to evaluate how husbands' and wives' awareness and non-judgment were associated with relational flourishing, sexual harmony, and orgasm consistency. Results indicated that both wives' and husbands' awareness was positively associated with relational flourishing, sexual harmony, and orgasm consistency. Partner effects were found for all outcomes. However, no partner effects were found between non-judgment and orgasm consistency. Therapists, educators, and couples may consider the use of sexual mindfulness skills when addressing marriage and sexual relationships.

Hospital utilization rates for influenza and RSV: a novel approach and critical assessment.

BACKGROUND: Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone. METHODS: This study estimates rates of influenza and RSV hospitalization by calculating the proportion of ALRI due to influenza and RSV and applying this proportion to inpatient admissions with ALRI coded as primary diagnosis. Proportions of ALRI attributed to influenza and RSV were extracted from a meta-analysis of 360 total sources describing inpatient hospital admissions which were input to a Bayesian mixed effects model over age with random effects over location. Results of this model were applied to inpatient admission datasets for 44 countries to produce rates of hospital utilization for influenza and RSV respectively, and rates were compared to raw coded admissions for each disease. RESULTS: For most age groups, these methods estimated a higher national admission rate than the rate of directly coded influenza or RSV admissions in the same inpatient sources. In many inpatient sources, International Classification of Disease (ICD) coding detail was insufficient to estimate RSV burden directly. The influenza inpatient burden estimates in older adults appear to be substantially underestimated using this method on primary diagnoses alone. Application of the mixed effects model reduced heterogeneity between countries in influenza and RSV which was biased by coding practices and between-country variation. CONCLUSIONS: This new method presents the opportunity of estimating hospital utilization rates for influenza and RSV using a wide range of clinical databases. Estimates generally seem promising for influenza and RSV associated hospitalization, but influenza estimates from primary diagnosis seem highly underestimated among older adults. Considerable heterogeneity remains between countries in ALRI coding (i.e., primary vs non-primary cause), and in the age profile of proportion positive for influenza and RSV across studies. While this analysis is interesting because of its wide data utilization and applicability in locations without laboratory-confirmed admission data, understanding the sources of variability and data quality will be essential in future applications of these methods.

How Empathy Moderates Associations Between Sexual and Relational Satisfaction.

Those with low sexual satisfaction tend to have low relational satisfaction. However, literature provides examples of those who maintain satisfying relationships despite low sexual satisfaction yet provides few clues as to what factors protect these individuals. Using U.S. nationally representative data from 1569 newlywed couples, we investigated if empathy for one's partner buffers individuals and couples from low relational satisfaction due to low sexual satisfaction. The positive connection between sexual satisfaction and relational satisfaction was weak for those reporting high empathy but was strong for those reporting low empathy. Empathy may protect against poor relational satisfaction when sexual satisfaction is low.

Thermal Conductivity of Aluminum Scandium Nitride for 5G Mobile Applications and Beyond.

Radio frequency (RF) microelectromechanical systems (MEMS) based on Al1-xScxN are replacing AlN-based devices because of their higher achievable bandwidths, suitable for the fifth-generation (5G) mobile network. However, overheating of Al1-xScxN film bulk acoustic resonators (FBARs) used in RF MEMS filters limits power handling and thus the phone's ability to operate in an increasingly congested RF environment while maintaining its maximum data transmission rate. In this work, the ramifications of tailoring of the piezoelectric response and microstructure of Al1-xScxN films on the thermal transport have been studied. The thermal conductivity of Al1-xScxN films (3-8 W m-1 K-1) grown by reactive sputter deposition was found to be orders of magnitude lower than that for c-axis-textured AlN films due to alloying effects. The film thickness dependence of the thermal conductivity suggests that higher frequency FBAR structures may suffer from limited power handling due to exacerbated overheating concerns. The reduction of the abnormally oriented grain (AOG) density was found to have a modest effect on the measured thermal conductivity. However, the use of low AOG density films resulted in lower insertion loss and thus less power dissipated within the resonator, which will lead to an overall enhancement of the device thermal performance.

Missing Piece of the Puzzle: Evaluating a General Meaning of Sex Measure.

The presence of and search for meaning has divergent and salient outcomes for individuals' physical, mental, and emotional well-being. Although numerous domains of meaning have been examined, the literature on the meaning of sex is sparse and lacks a quantitative measure. In this study, we evaluated a new general Meaning of Sex (MOS) Measure that captured the presence of (MOS-P) and search for (MOS-S) the meaning of sex by analyzing how these subscales were associated with important relational and sexual outcomes (i.e., relationship stability and satisfaction and sexual satisfaction) in two samples. For Sample 1, all participants (N = 865) reported engaging in what they considered to be sexual intercourse and were either single or in a relationship. For Sample 2, all participants (N = 884) reported being in a committed relationship for at least two years. With both samples, confirmatory factor analyses showed good construct validity as the two subscales were distinct from one another and had good reliability. The analyses also demonstrated divergent validity between both scales and meaning in life, sexual motivations, sexual beliefs, and religiosity. The MOS-S had a strong (and negative) association with relationship stability in both samples. The MOS-P had a strong (and positive) association with relationship satisfaction in both samples.

La presencia y la búsqueda de significado tiene consecuencias divergentes y prominentes para el bienestar físico, mental y emocional de las personas. Aunque se han analizado varios componentes de significado, la bibliografía sobre el significado del sexo es escasa y carece de un instrumento de medición cuantitativo. En este estudio, evaluamos un nuevo instrumento general de medición del significado del sexo que captó la presencia y la búsqueda del significado del sexo analizando cómo estas subescalas estuvieron asociadas con resultados sexuales y relacionales importantes (p. ej.: la estabilidad y la satisfacción en la relación y la satisfacción sexual) en dos muestras. En la muestra 1, todos los participantes (N = 865) informaron participar en lo que consideraron relaciones sexuales y estaban solteros o en una relación. En la muestra 2, todos los participantes (N = 884) informaron estar en una relación de pareja estable durante al menos dos años. Con ambas muestras, los análisis factoriales confirmatorios indicaron una buena validez de constructo, ya que las dos subescalas eran distintas entre sí y tenían buena fiabilidad. Los análisis también indicaron una validez divergente entre ambas escalas y el significado en la vida, las motivaciones sexuales, las creencias sexuales y la religiosidad. La búsqueda del significado del sexo tuvo una asociación fuerte (y negativa) con la estabilidad de la relación en ambas muestras. La presencia del significado del sexo tuvo una asociación fuerte (y positiva) con la satisfacción en la relación en ambas muestras.

National burden estimates of hospitalisations for acute lower respiratory infections due to respiratory syncytial virus in young children in 2019 among 58 countries: a modelling study.

BACKGROUND: Respiratory syncytial virus (RSV) is the predominant viral pathogen associated with acute lower respiratory infection (ALRI) in children who are younger than 5 years. Little is reported on the national estimates of RSV-associated ALRI hospitalisations in these children on the basis of robust epidemiological data. We aimed to generate national level estimates for RSV-associated ALRI hospitalisations in children aged younger than 5 years. METHODS: We included data for RSV and ALRI hospitalisation in children who were younger than 5 years from systematic literature reviews (including unpublished data) and from inpatient databases, representing 58 countries. We used two different methods, the rate-based method and the proportion-based method, to estimate national RSV-associated ALRI hospitalisations in children younger than 5 years in 2019. The rate-based method synthesised data for laboratory-confirmed RSV-associated ALRI hospitalisation rates using a spatiotemporal Gaussian process meta-regression (ST-GPR). The proportion-based method applied data for RSV positive proportions among ALRI to all-cause ALRI hospitalisation envelopes (ie, total disease burden of ALRI hospitalisations of any cause) using a Bayesian regularised trimmed meta-regression (MR-BRT). Where applicable, we reported estimates by both methods to provide a plausible range for each country. FINDINGS: A total of 334 studies and 1985 data points (defined as an individual estimate for one age group and 1 year for each study) were included in our analysis, accounting for 398 million (59%) of the 677 million children aged younger than 5 years worldwide representing 58 countries. We reported the number of annual national RSV-associated ALRI hospitalisations for 29 countries using the rate-based method, and for 42 countries using the proportion-based method. The median number of RSV-associated ALRI hospitalisations in children younger than 5 years was 8·25 thousand (IQR 1·97-48·01), and the median rate of RSV-associated ALRI hospitalisations was 514 (339-866) hospitalisations per thousand children younger than 5 years. Despite large variation among countries, a high proportion of the RSV-associated ALRI hospitalisations were in infants aged younger than 1 year in all countries (median proportion 45%, IQR 32-56). In 272 (76%) of the 358 years included in the analysis, the RSV-associated ALRI hospitalisation rate fluctuated between 0·8 and 1·2 times the country's median yearly rate. General agreement was observed between estimates by the rate-based method and proportion-based method, with the exceptions of India, Kenya, Norway, and Philippines. INTERPRETATION: By incorporating data from various sources, our study provides robust estimates on national level burden of RSV-associated ALRI hospitalisation in children aged younger than 5 years. These estimates are important for informing policy for the introduction of RSV immunisations and also serve as baseline data for the RSV disease burden in young children. FUNDING: The Foundation for Influenza Epidemiology.

Effectiveness of an Automated Error Checking and Feedback System to Improve Text Message Reporting for Disease Surveillance in Viet Nam.

Purpose: Viet Nam currently relies on a manual paper-based system to track and monitor 28 major infectious diseases. This inefficient system takes 2 or more months to complete. Method: We designed and pilot tested the use of text messaging to report certain infectious disease symptoms in rural areas of northern Viet Nam. The project was divided into three 6-month phases carried out in two provinces. The current analysis focuses on the implementation of a two-way feedback system between Phases II and III, which aims at (1) evaluating whether this system improves efficiency by determining the number of correctly (vs. incorrectly) formatted text messages; (2) assessing this system's influence on accuracy by comparing text messages with their respective official paper-based documented forms; and (3) determining whether the amount of information required to report through text messages influences the efficiency and accuracy of the text messages. Results: Between Phases II and III, results revealed a significant improvement in correctly formatted texts in comparison to incorrectly formatted texts. As the number of fields required to report increased, the number of correctly formatted texts (efficiency) as well as the number of matched text messages (accuracy) decreased. Conclusion: Our research demonstrates that an automated error bidirectional feedback system can significantly improve both the efficiency and accuracy of a Short Message Service-based method for disease surveillance. Also, our data may suggest that two-way communication has better engaged health care staff to follow reporting protocols as well as to maintain accuracy from their clinic's own data.

Blood transfusion trends by disease category in the United States, 2000 to 2014.

BACKGROUND: Better understanding of blood usage rates could identify trends in transfusion practices over time and inform more efficient management. METHODS: Inpatient admissions from the Healthcare Cost and Utilization Project National Inpatient Sample and State Inpatient Databases were analyzed for packed red blood cell (PRBC), plasma, platelet, and whole blood (WB) transfusions. The transfusion rates per admission and per prevalent case were calculated. Prevalence estimates were from the Global Burden of Disease 2017 study (GBD). RESULTS: From 2000 to 2014, blood usage rates for most causes peaked around 2010. Across all causes, PRBC were the most commonly transfused component, followed by plasma, platelets, and WB. However, the relative use of each type varied by cause. Nutritional deficiencies (1.75 blood product units across all components per admission; 95 % uncertainty interval (UI) 1.62-1.87), neoplasms (0.95; 0.87-1.04), and injuries (0.92; 0.86 - 0.98) had the greatest blood use per admission. Cardiovascular diseases (96.9 units per 1000 prevalent cases; 89.3-105.0) and neoplasms (92.7 units per 1000 prevalent cases; 84.3-101.5) had the greatest blood use per prevalent case. Across all admissions, over three million blood units were saved in 2014 compared to 2011 due to transfusing at a reduced rate. CONCLUSIONS: Blood transfusion rates decreased from 2011 to 2014 in the United States. This decline occurred in most disease categories, which points towards broad strategies like patient blood management systems and disease specific improvements like changes in surgical techniques being effective.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. METHODS: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. RESULTS: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. CONCLUSIONS: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.