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| 63. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 64. |
- Lyons, Padraig, et al.
(författare)
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Quantifying the Impact of Engaging Religious Leaders to Promote Safe Burial Practices During the 2014-2016 Ebola Outbreak in Sierra Leone
- 2024
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Ingår i: SSRN Electronic Journal. - : Elsevier BV. - 1556-5068.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Traditional burials involving physical contact with deceased Ebola Virus Disease (Ebola) victims were linked to disease transmission during the 2014-2016 Ebola outbreak in West Africa. An estimated 2 · 5 new cases of Ebola resulted from each traditional burial. Over 6,000 religious leaders across Sierra Leone were engaged to promote the use of specialised burial teams in order to avoid risky traditional practices. We aimed to quantify the impact of engaging religious leaders in promoting safe burials during the outbreak in Sierra Leone. Methods: We analysed population-based household survey data (N=3,540) collected around the peak of the outbreak in Sierra Leone in December 2014. Multilevel logistic regression modelling was used to examine if exposure to faith-based messages was associated with protective burial intentions and behaviours. Findings: Exposure to faith-based messages was associated with a nearly two-fold increase in the intention to accept safe alternatives to traditional burials and the intention to await burial teams for ≥2 days (adjusted odds ratio [aOR] 1·69, 95% confidence interval [CI] 1·23-2·31 and aOR 1·84; 95% CI 1·38-2·44 respectively). Behaviourally, exposure to faith-based messages was also associated with an increased reported avoidance of traditional burials and an increased reported avoidance of suspected Ebola patients (aOR 1·46, 95%CI 1·14-1·89, aOR 1·65 95% CI, CI 1·27-2·13 respectively).Interpretation: Faith-based messages promoted by religious leaders may have influenced safe burial intentions and protective behaviours during the Ebola outbreak in Sierra Leone. Engagement of religious leaders in risk communication should be prioritised during health emergencies in similar settings.
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| 65. |
- Middha, Pooja K., et al.
(författare)
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A genome-wide gene-environment interaction study of breast cancer risk for women of European ancestry
- 2023
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Ingår i: Breast Cancer Research. - : BioMed Central (BMC). - 1465-5411 .- 1465-542X. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Genome-wide studies of gene-environment interactions (GxE) may identify variants associated with disease risk in conjunction with lifestyle/environmental exposures. We conducted a genome-wide GxE analysis of similar to 7.6 million common variants and seven lifestyle/environmental risk factors for breast cancer risk overall and for estrogen receptor positive (ER +) breast cancer. Methods Analyses were conducted using 72,285 breast cancer cases and 80,354 controls of European ancestry from the Breast Cancer Association Consortium. Gene-environment interactions were evaluated using standard unconditional logistic regression models and likelihood ratio tests for breast cancer risk overall and for ER + breast cancer. Bayesian False Discovery Probability was employed to assess the noteworthiness of each SNP-risk factor pairs. Results Assuming a 1 x 10(-5) prior probability of a true association for each SNP-risk factor pairs and a Bayesian False Discovery Probability < 15%, we identified two independent SNP-risk factor pairs: rs80018847(9p13)-LINGO2 and adult height in association with overall breast cancer risk (ORint = 0.94, 95% CI 0.92-0.96), and rs4770552(13q12)-SPATA13 and age at menarche for ER + breast cancer risk (ORint = 0.91, 95% CI 0.88-0.94). Conclusions Overall, the contribution of GxE interactions to the heritability of breast cancer is very small. At the population level, multiplicative GxE interactions do not make an important contribution to risk prediction in breast cancer.
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| 66. |
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| 69. |
- Ryan, Jean, et al.
(författare)
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Cycling and cycling cessation in later life : Findings from the city of Malmö
- 2016
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Ingår i: Journal of Transport & Health. - Amsterdam : Elsevier. - 2214-1405 .- 2214-1413. ; 3:1, s. 38-47
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to gain a greater insight into cycling as an element of mobility among those in later life. The characteristics and views of those who cycle, those who have never cycled, as well as those who have discontinued cycling in later life are the main focus. Malmö, a city in the south of Sweden with a strong emphasis on bicycle planning, is the study area. This study employed a mixed methods approach. The quantitative element comprised a survey which aimed to capture the trends at play when it comes to cycling within this age group. The qualitative element encompassed two focus groups which were carried out in order to gain a deeper insight into older persons' perspectives and perceptions with respect to cycling. The study's findings illustrate the very positive and important role cycling can play in the mobility of older persons in the city of Malmö. It is not only possible but also mostly enjoyable for many older people to cycle. Cycling is a facilitator of activities and is largely associated with convenience and ease. There are clear differences between cyclists and non-cyclists, with the former generally having a wider range of mobility opportunities available to them. Cycling cessation is anticipated as a very distressing, yet inevitable, life event by those who still cycle. The results of this study suggest that campaigns aimed at increasing the awareness and consideration of other road users towards older cyclists, as well as the introduction of clearer and more visible signage could support older cyclists in prolonging their cycling, as well as improving the experience they have as they do cycle. Increasing awareness of the health benefits of cycling could be another means of encouraging people to continue cycling as they age.
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| 70. |
- Ryan, Jean, et al.
(författare)
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Cycling in later life : To cycle or not to cycle
- 2015
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Ingår i: TRANSED 2015. - 9789892062624 ; , s. B335-B336
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The importance of introducing measures to increase the modal share of cycling has come to the fore in both policy and research in recent years. The benefits of increased cycling are wide-ranging; with cycling often considered to contribute to more attractive public spaces, increased safety, and more sustainable urban life.Different parts of the world are seeing an increase in the modal share of cycling. However, these increases are largely attributed to commuter traffic, with older persons somewhat underrepresented. There is, however, some evidence to suggest that developing strategies for cycling promotion across the lifespan, and particularly into later life, would allow people to continue travelling by bicycle as they age. While much is known about the car and the importance of the car in facilitating mobility in later life, much less is known about cycling and its role in the mobility of older persons.Employing a mixed method approach, this study aims to gain a greater insight into cycling as a mode of transport among those in later life. The study explores (1) the key differences between older cyclists and older noncyclists; (2) the perceptions of older cyclists in relation to cycling as a mode of transport; and (3) the factors which are associated with cycling cessation in later life.Malmö, a city in the south of Sweden with a strong emphasis on bicycle planning, is the study area. The city of Malmö is an interesting case as Malmö Municipality has put a strong emphasis on its aim for cycling to be apart of its inhabitants’ everyday lives.A survey aimed to capture the trends at play when it comes to cycling among those aged 65-85 living in Malmö city (N = 456). Two focus groups were carried out in order to gain a deeper insight into older persons’ perspectives and perceptions with respect to cycling. The focus group discussion guide comprised two main themes: ‘Reasons for cycling/not cycling’; and ‘The cycling experience in Malmö’.The key differences between older cyclists and older non-cyclists were focused around the factors of gender; health and activity; mobility opportunities; and life course and intentions.Cycling cessation was associated with those who do not participate in all desired activities, those who do not have access to a car in the household and those who do not associate cycling with health. The only variable associated with a higher odds of having ceased cycling was age, meaning that, by and large, the older the respondent the more likely he/she is to have ceased cycling.The study’s findings illustrated the very positive and important role cycling can play in the mobility of older persons in the city of Malmö. It is not only possible but also mostly enjoyable for many older people to cycle. Cycling is a facilitator of activities and is largely associated with convenience and ease.There are clear differences between cyclists and non-cyclists, with the former generally having a wider range of mobility opportunities available to them. Cycling cessation is anticipated as a very distressing, yet inevitable, life event by those who still cycle.The results of this study suggest that campaigns aimed at increasing the awareness and consideration of other road users towards older cyclists, as well as the introduction of clearer and more visible signage could support older cyclists in prolonging their cycling, as well as improving the experience they have as they do cycle. Increasing awareness of the health benefits of cycling could be another means of encouraging people to continue cycling as they age.
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