| 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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| 2. |
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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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| 5. |
- Asplund, Maria. E., 1970, et al.
(författare)
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Dynamics and fate of blue carbon in a mangrove-seagrass seascape : influence of landscape configuration and land-use change
- 2021
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Ingår i: Landscape Ecology. - : Springer. - 0921-2973 .- 1572-9761. ; 36, s. 1489-1509
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Tidskriftsartikel (refereegranskat)abstract
- Context Seagrass meadows act as efficient natural carbon sinks by sequestering atmospheric CO2 and through trapping of allochthonous organic material, thereby preserving organic carbon (C-org) in their sediments. Less understood is the influence of landscape configuration and transformation (land-use change) on carbon sequestration dynamics in coastal seascapes across the land-sea interface. Objectives We explored the influence of landscape configuration and degradation of adjacent mangroves on the dynamics and fate of C-org in seagrass habitats. Methods Through predictive modelling, we assessed sedimentary C-org content, stocks and source composition in multiple seascapes (km-wide buffer zones) dominated by different seagrass communities in northwest Madagascar. The study area encompassed seagrass meadows adjacent to intact and deforested mangroves. Results The sedimentary C-org content was influenced by a combination of landscape metrics and inherent habitat plant- and sediment-properties. We found a strong land-to-sea gradient, likely driven by hydrodynamic forces, generating distinct patterns in sedimentary C-org levels in seagrass seascapes. There was higher C-org content and a mangrove signal in seagrass surface sediments closer to the deforested mangrove area, possibly due to an escalated export of C-org from deforested mangrove soils. Seascapes comprising large continuous seagrass meadows had higher sedimentary C-org levels in comparison to more diverse and patchy seascapes. Conclusion Our results emphasize the benefit to consider the influence of seascape configuration and connectivity to accurately assess C-org content in coastal habitats. Understanding spatial patterns of variability and what is driving the observed patterns is useful for identifying carbon sink hotspots and develop management prioritizations.
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| 6. |
- Dahl, Martin, et al.
(författare)
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The influence of hydrodynamic exposure on carbon storage and nutrient retention in eelgrass (Zostera marina L.) meadows on the Swedish Skagerrak coast
- 2020
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Cold-temperate seagrass (Zostera marina) meadows provide several important ecosystem services, including trapping and storage of sedimentary organic carbon and nutrients. However, seagrass meadows are rapidly decreasing worldwide and there is a pressing need for protective management of the meadows and the organic matter sinks they create. Their carbon and nutrient storage potential must be properly evaluated, both at present situation and under future climate change impacts. In this study, we assessed the effect of wave exposure on sedimentary carbon and nitrogen accumulation using existing data from 53 Z. marina meadows at the Swedish west coast. We found that meadows with higher hydrodynamic exposure had larger absolute organic carbon and nitrogen stocks (at 0-25 cm depth). This can be explained by a hydrodynamically induced sediment compaction in more exposed sites, resulting in increased sediment density and higher accumulation (per unit volume) of sedimentary organic carbon and nitrogen. With higher sediment density, the erosion threshold is assumed to increase, and as climate change-induced storms are predicted to be more common, we suggest that wave exposed meadows can be more resilient toward storms and might therefore be even more important as carbon- and nutrient sinks in the future.
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| 7. |
- Silas, Mathew O., et al.
(författare)
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Seascape configuration influences big blue octopus (Octopus cyanea) catches: Implications for a sustainable fishery
- 2023
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Ingår i: FISHERIES RESEARCH. - : Elsevier. - 0165-7836 .- 1872-6763. ; 264
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Tidskriftsartikel (refereegranskat)abstract
- Seascape configuration is known to influence fish distribution and abundance in coastal waters. However, there is little information regarding how the shape of the coastal seascape influences catches of landed fisheries species, particularly so in the understudied western Indian Ocean (WIO). With focus on big blue octopus (Octopus cyanea), which is a widely found cephalopod species in the WIO, we compared landed catches (biomass, catch rate, and density) in submerged and exposed reefs, and explored the influence of proximity to fishing villages and reef habitat size on octopus landings. We used fishery-dependent data collected between 2018 and 2020 from eight landing sites spread across the Tanzanian coast. We found a strong relationship between biomass of octopus catch and distance from fished reefs to fishing villages, with higher fished biomass on reefs farther away. Octopus densities were higher, while catch rates were lower, on reefs very close to (within one km distance from) fishing villages compared to more distant reefs. In general, submerged reefs provided higher catches than exposed reefs. The low octopus catches on the exposed reefs were attributed to high fishing pressure, while submerged reefs that are only accessible through diving provide optimal areas for octopuses to grow. Octopus catches were, however, not significantly affected by reef size. The findings suggest that management policies should propor-tionate fishing efforts to ensure sustainable exploitation of reefs and associated fishery resources.
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| 8. |
- 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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| 9. |
- Dew, Kristin N., et al.
(författare)
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Producing Printability : Articulation Work and Alignment in 3D Printing
- 2019
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Ingår i: Human-Computer Interaction. - : Informa UK Limited. - 0737-0024 .- 1532-7051. ; 34:5-6, s. 433-469
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Tidskriftsartikel (refereegranskat)abstract
- Three-dimensional printing is widely celebrated as enabling open design and manufacturing practice. With easy-to-use techniques such as automated modeling, fabrication machines ostensibly help designers turn ideas into fully fledged objects. Prior HCI literature focuses on improving printing through optimization and by developing printer and material capabilities. This paper expands such considerations by asking, how do 3D printing practitioners understand and create “printability?” And how might HCI better support the work that holds together printing workflows and changing ecosystems of materials and techniques? We conducted studies in two sites of open design: a technology firm in Silicon Valley, California and a makerspace in Stockholm, Sweden. Deploying workshops and interviews, we examine how practitioners negotiate the print experience, revealing a contingent process held together by trial and error exploration and careful interventions. These insights point to the value of tools and processes to support articulation work, what Strauss and colleagues have called the acts of fitting together people, tasks, and their ordering to accomplish an overarching project. We show that despite the sought-after efficiencies of such manufacturing, 3D printing entails articulation work, particularly acts of alignment, exposing messy modes of production carried out by a varied cast of practitioners, machines, and materials.
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| 10. |
- Eggertsen, Linda, 1981-, et al.
(författare)
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Where the grass is greenest in seagrass seascapes depends on life history and simple species traits of fish
- 2022
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Ingår i: Estuarine, Coastal and Shelf Science. - : Academic Press. - 0272-7714 .- 1096-0015. ; 266
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Tidskriftsartikel (refereegranskat)abstract
- Tropical seagrass meadows are critical habitats for many fish species, yet few studies have investigated the influence of multiple scale-dependent factors and marine protected areas on seagrass fish species of differing life histories. We assessed the influence of fine-scale seagrass meadow characteristics and seascape-scale variables on the abundance of fish in a seagrass-dominated seascape in the Bazaruto Archipelago, Mozambique, particularly examining patterns of nursery- vs. resident species as well as mobile- vs. sedentary species. We found that fish distribution patterns in this seagrass-dominated seascape were dependent on species’ life history characteristics; nursery taxa showed lower abundance in seagrass meadows further from adult reef habitats, while resident species within seagrass meadows occurred in higher abundances far from reefs. For taxa utilizing both mangroves and seagrass meadows as nursery habitat, proximity to mangroves was an important factor. Fish abundances were generally influenced by variables at the seascape scale (km), while sedentary species were predominantly influenced by area variables, and smaller seascapes (<500 m in radius) better explained distribution patterns. The influence of marine protected areas was taxon-specific, with the strongest effects of protection on resident species. Our results indicate that protection efforts in seagrass-dominated seascapes can have varying impacts on fish distribution, depending on the life history of the species present, and the geographical placement of the reserve within the seascape. Further, we suggest that simple species attributes can be utilised to describe generalized abundance patterns of fish in seagrass seascapes.
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