| 1. |
- Barber, R. M., et al.
(författare)
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Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
- 2017
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Ingår i: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
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Tidskriftsartikel (refereegranskat)abstract
- Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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| 3. |
- 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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| 4. |
- Griswold, Max G., et al.
(författare)
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Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2018
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 392:10152, s. 1015-1035
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week.Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
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| 6. |
- Charisiadou, S., et al.
(författare)
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Coastal aquaculture in Zanzibar, Tanzania
- 2022
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Ingår i: Aquaculture. - : Elsevier. - 0044-8486 .- 1873-5622. ; 546
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Tidskriftsartikel (refereegranskat)abstract
- This study provides an overview of the multi-sectoral coastal aquaculture development in Zanzibar (Tanzania) over the last thirty years based on empirical evidence from interviews, field observations, policy reports and literature reviews. Despite the immense potential of aquaculture for food and livelihoods, only seaweed farming has so far established into commercial-scale production. This activity is dominated by women and became widespread in the early 1990s as a small but regular source of income. However, seaweed farming constraints such as frequent seaweed die-offs, as well as economic and institutional constraints inhibit its development. Other types of aquaculture activities such as fish farming, mud crab fattening, half-pearl farming, sea cucumber farming and sponge and coral cultures are under development with limited production or in experimental stages. Common constraints among these activities are economic limitations, lack of technical infrastructure and skills, small and irregular production, and limited trade and market availabilities. At the same time, there is a lack of sufficient management and monitoring systems, while there are no formal regulations or clear strategies to boost aquaculture at the national level. In addition, new aquaculture initiatives are often dominated by donor-driven projects instead of local entrepreneurships. This situation does not encourage engagement in aquaculture and thus such activities are outcompeted by other already established sectors (e.g. agriculture and fisheries). We conclude that aquaculture has great potential to evolve due to high environmental capacity. Nevertheless, achieving profitable production and a stronger commitment within local communities, as well as developing effective mariculture governance through support mechanisms and clear strategies to boost the sector at the national level, are essential for sustainable mariculture development in Zanzibar.
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| 7. |
- Dublinowska, M., et al.
(författare)
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Intersexuality in the Blue Mussel Mytilus edulis Complex (Mytilidae) from the Baltic Sea and the Danish Strait
- 2016
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Ingår i: American Malacological Bulletin. - : American Malacological Society. - 0740-2783 .- 2162-2698. ; 34:1, s. 28-39
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Tidskriftsartikel (refereegranskat)abstract
- Populations of Mytilus edulis complex were studied from 13 stations located at three areas of the Baltic Sea (the Gulf of Gdańsk, Poland; Tvärminne area, Finland; Trosa Archipelago, Sweden) and the Skagerrak sound (Kristineberg, Sweden). The main purpose of the study was to document the occurrence of intersexuality along longitudinal salinity change using squash and histology for comparative reasons. Intersex was identified in all four geographical areas at an average frequency of 1.8%. Squash technique revealed the highest intersex frequency in the Gulf of Gdańsk (up to 6.25%) whereas histology examination did so in the Kristineberg area (up to 10%). In the Tvärminne area and in the Trosa Archipelago the average frequency of intersex did not exceed 2% regardless of the technique used; this suggests a natural induction of the phenomenon. Statistically significant spatial differences in intersex frequency were confirmed for mussels inhabiting polluted hotspots in the Gulf of Gdańsk and at the west coast of Sweden (Kristineberg). Therefore, for these localities artificial induction of intersexuality as a consequence of adverse environmental threats (pollution, parasite outbreaks) is further suggested. Furthermore, squash technique - being less sensitive in identifying intersex when compared to histology - is not recommended for mussels with severe reproductive impairments making a proper analysis of gonads impossible. Intersexual individuals were also characterized by less developed gonads and lower gonado-somatic index (GSI) than males and females. Significantly lower GSI revealed less energy allocation towards reproduction in populations from the Trosa Archipelago and Tvärminne area in comparison to those from the Gulf of Gdańsk and from Kristineberg.
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| 8. |
- Eggertsen, Maria, 1981-, et al.
(författare)
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Different environmental variables predict distribution and cover of the introduced red seaweed Eucheuma denticulatum in two geographical locations
- 2021
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Ingår i: Biological Invasions. - : Springer. - 1387-3547 .- 1573-1464. ; 23, s. 1049-1067
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Tidskriftsartikel (refereegranskat)abstract
- In this study we examined abiotic and biotic factors that could potentially influence the presence of a non-indigenous seaweed, Eucheuma denticulatum, in two locations, one outside (Kane’ohe Bay, Hawai’i, USA) and one within (Mafia Island, Tanzania) its natural geographical range. We hypothesized that the availability of hard substrate and the amount of wave exposure would explain distribution patterns, and that higher abundance of herbivorous fishes in Tanzania would exert stronger top–down control than in Hawai’i. To address these hypotheses, we surveyed E. denticulatum in sites subjected to different environmental conditions and used generalized linear mixed models (GLMM) to identify predictors of E. denticulatum presence. We also estimated grazing intensity on E. denticulatum by surveying the type and the amount of grazing scars. Finally, we used molecular tools to distinguish between indigenous and non-indigenous strains of E. denticulatum on Mafia Island. In Kane’ohe Bay, the likelihood of finding E. denticulatum increased with wave exposure, whereas on Mafia Island, the likelihood increased with cover of coral rubble, and decreased with distance from areas of introduction (AOI), but this decrease was less pronounced in the presence of coral rubble. Grazing intensity was higher in Kane’ohe Bay than on Mafia Island. However, we still suggest that efforts to reduce non-indigenous E. denticulatum should include protection of important herbivores in both sites because of the high levels of grazing close to AOI. Moreover, we recommend that areas with hard substrate and high structural complexity should be avoided when farming non-indigenous strains of E. denticulatum.
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| 9. |
- Hjortswang, H I, et al.
(författare)
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KNOTTED1-like homeobox genes of a gymnosperm, Norway spruce, expressed during somatic embryogenesis
- 2002
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Ingår i: Plant physiology and biochemistry (Paris). - 0981-9428 .- 1873-2690. ; 40:10, s. 837-843
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Tidskriftsartikel (refereegranskat)abstract
- Two Norway spruce (Picea abies (L.) Karst.) genes belonging to class I of the KNOTTED1-like homeobox (KNOX) genes, HBK2 and HBK3, were cloned with PCR-based methods. The expression of these and a previously characterised related gene, HBK1, in different organs and during somatic embryogenesis was studied with RTPCR. Transcripts of all three genes were detected in stems, roots and in cone buds, but not in needles. HBK1 and HBK3 are expressed throughout development in a normal cell line with embryogenic potential and in a cell line unable to form somatic embryos. HBK2 is expressed in the normal cell line, but not in the developmentally arrested cell line. This suggests that the HBK2 gene is involved in the somatic embryo development.
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| 10. |
- Larsson, Andreas, et al.
(författare)
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Collaborative Healthcare Innovation in Sweden
- 2012
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Ingår i: Sustainable Innovation. - New York : Springer. - 9781461420767 - 9781461420774 ; , s. 49-62
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Bokkapitel (refereegranskat)abstract
- Abstract in UndeterminedThe medical technology (medtech) industry in Sweden is situated withina complex innovation ecosystem, in which various stakeholders from the public,private and academic sectors need to collaborate to meet demands on effective andeffi cient healthcare. Demographics are changing and those in need of healthcare arenot only larger in numbers than ever but they are also more knowledgeable anddemanding. Increasing innovative performance is crucial in both the private andpublic healthcare sectors, but bold steps forward need to be taken in light of stricterrules and regulations for how healthcare stakeholders should manage both theirinternal processes and the ways in which they interact with other stakeholders in thelarger innovation system. The traditional way in which medtech companies gainaccess to user needs, primarily working through a sales–purchasing relationshipwith the public healthcare sector, is outdated and needs to be replaced with anincreasingly collaborative and cocreative model of healthcare innovation.This chapter describes experiences and lessons learned from InnoPlant, a 3-year(2008–2011) action learning project involving three companies from the Swedishmedtech industry, two county/regional councils responsible for public healthcare,and four academic institutions—carried out within the framework of the SwedishProduct Innovation Engineering program (PIEp). The purpose of the project was toadvance the capability of stakeholders from the public, private, and academic sectorsto collaborate in the cocreation of healthcare innovations.
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