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- 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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| 2. |
- Li, Xueying, et al.
(författare)
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Triple collocation-based merging of multi-source gridded evapotranspiration data in the Nordic Region
- 2023
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Ingår i: Agricultural and Forest Meteorology. - 1873-2240. ; 335
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Tidskriftsartikel (refereegranskat)abstract
- Accurate evapotranspiration (ET) data are required for many hydro-meteorological applications. Compared with the traditional evaluation that requires in-situ measurements, the triple collocation (TC) technique estimates geophysical product errors without the need for ground truth, which is especially suitable over large areas lacking a dense in-situ network. However, violations of the zero-error cross-correlation (ECC) assumption are found to be the dominant sources of impairing the TC robustness. This study presents the first application of a TC-based merging framework that optimally considers ECC to merge multi-source gridded ET products in the Nordic Region during 2003–2018. The ECC estimates of each ET dataset pair calculated by the quadruple collocation approach are used to select the qualified triplets from four products, including FLUXCOM, Global Land Surface Satellite (GLASS), Global Land Evaporation and Amsterdam Model (GLEAM), and Penman-Monteith-Leuning Version 2 (PML-V2). Then the ET merged datasets are generated by weighting TC-based rescaled error variances of the parent datasets through least square merging. Finally, the accuracy of both the parent and the merged datasets are assessed with the Integrated Carbon Observation System (ICOS) flux data in the Nordic Region based on multiple statistical metrics. Results demonstrate that the ECC values provide intuitive evidence for filtering unqualified TC triplets. Both the absolute and relative error variances (signal-to-noise ratio) are considered for ET dataset evaluation. Overall PML-V2 has the best performance among the evaluated four products. Two merged ET datasets with the reference climatology of FLUXCOM outperform all parent products with the lowest errors by using ICOS data as reference among all sites – indicating the feasibility of TC technique for improving ET accuracy in the Nordic Region. This study also analyses the impacts of reference climatology selection on the TC merged results.
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| 3. |
- Liang, Hua, et al.
(författare)
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Recognition of maturity-onset diabetes of the young in China
- 2021
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Ingår i: Journal of Diabetes Investigation. - : Wiley. - 2040-1116 .- 2040-1124. ; 12:4, s. 501-509
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Tidskriftsartikel (refereegranskat)abstract
- Aims/Introduction: Given that mutations related to maturity-onset diabetes of the young (MODY) are rarely found in Chinese populations, we aim to characterize the mutation spectrum of MODY pedigrees. Materials and Methods: Maturity-onset diabetes of the young candidate gene- or exome-targeted capture sequencing was carried out in 76 probands from unrelated families fulfilling the clinical diagnostic criteria for MODY. MAF <0.01 in the GnomAD or ExAC database was used to filter significant variants. Sanger sequencing was then carried out to validate findings. Function prediction by SIFT, PolyPhen-2 and PROVEAN or CADD was carried out in missense mutations. Results: A total of 32 mutations in six genes were identified in 31 families, accounting for 40.79% of the potential MODY families. The MODY subtype detection rate was 18.42% for GCK, 15.79% for HNF1A, 2.63% for HNF4A, and 1.32% for KLF11, PAX4 and NEUROG3. Seven nonsense/frameshift mutations and four missense mutations with damaging prediction were newly identified novel mutations. The clinical features of MODY2, MODY3/1 and MODYX are similar to previous reports. Clinical phenotype of NEUROG3 p.Arg55Glufs*23 is characterized by hyperglycemia and mild intermittent abdominal pain. Conclusions: This study adds to the emerging pattern of MODY epidemiology that the proportion of MODY explained by known pathogenic genes is higher than that previously reported, and found NEUROG3 as a new causative gene for MODY.
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| 4. |
- Yang, Xiaoliu, et al.
(författare)
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Institutional Arrangement for Integrated River Basin Management
- 2016
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- This study concerns the management functions, institutional and legal frameworks to foster IRBM in the Yangtze River Basin. It is implemented as part of the EU China River Basin Management Programme funded by the EU.The overall objective of the study is to contribute to an enabling framework of policies, legislation and institutions that will promote IRBM in China and assist the government to harmonise social and economic development and water and environmental protection within the Yangtze River Basin. Specifically, the study will provide the CWRC with a better basis for informed decisions on adjustment of its organization, responsibilities and management functions to be incorporated in the Yangtze River Master Plan. Based on stakeholder mapping an assessment has been made to characterise the present situation of water resources management in China and provide direction for future changes. The assessment found that 1) China has established a legal framework supporting water management in a river basin context, 2) plans embodying IRBM are drafted at national, river basin and provincial levels, and 3) the existing funding of water management is dominated by government investment. A diagnosis and evaluation of the management functions of the CWRC is presented with focus on gaps and overlaps providing recommendations for a more effective governance structure in accordance with internationally accepted principles that have emerged during the past 10 years. The diagnosis is based on key informant interviews and questionnaires and indicated that 1) Chinese legislation enables decentralized river basin management, 2) river basin, regional and provincial management functions are not clearly defined, 3) some management functions of the CWRC are difficult to implement due to discrepancies between authority and responsibilities 4) there are no efficient consultation and coordination mechanisms among stakeholders within the river basin, 5) the implementation of IRBM lacks support of provincial and local authorities, and 6) the CWRC sees stakeholder participation as the key to better river basin governance. Water management in the Yangtze River Basin has been analysed with the Rhine River, Danube River, France and the European Union as reference. The comparisons indicate that 1) legislation or formal agreements between different administrative units, nations or provinces, are required for efficient cooperation, 2) an inter-provincial river basin organization is an ideal platform to promote IRBM and resolve conflicts between nations or provinces within a river basin, 3) political governance and technical support should be separated, 4) stakeholder participation is imperative for efficient IRBM, and 5) pollution of the Yangtze River is at risk of increasing while the Rhine River and to some extent the Danube River have passed a turning point (top of Kuznet’s curve), where pollution is effectively managed and declining.Strategically institutional arrangements for IRBM will be conditional on central government initiative. At the national level four initiatives are proposed as umbrella for basin level action, 1) a national water framework plan to be inspired by the EU Water Framework Directive (WFD), 2) an assessment of basin institutional arrangements inspired by the Rhine and Danube rivers, 3) an assessment of provincial institutions inspired by France and 4) an assessment of legal efficiency taking the EU WFD as benchmark.In close consultation with the CWRC an action plan to foster IRBM in the Yangtze River Basin has been formulated in terms of legislation, institutions, capacity building, financing, information disclosure and stakeholder participation.The principal recommendations of the study are:1) Water Law to be amended or supplemented with legislation, which clearly defines the division of responsibilities between the national, river basin and provincial level authorities.2) A National Water Resource Commission to be established to strengthen cross-sectorial coordination and cooperation and mitigate the current fragmentation of responsibilities, especially the overlapping responsibilities of the Ministry of Water Resources (MWR) and Ministry of Environmental Protection (MEP) in water pollution management and of the Ministry of Water Resources and Ministry of Land and Resources in groundwater management.3) Reform of the CWRC may take one of three basic models: Unified management as branch of central government, essentially the current structure; Coordinated management governed by stakeholders, including central government; Autonomous enterprise authorised by central government.4) Institutions and responsibilities for water resources management and water service delivery to be separated and clearly defined.5) River basin commissions to be assigned responsibility for coordination of water resources management at basin scale and provinces for implementation in accordance with overall management objectives.6) River basin commissions to be responsible for operation of multipurpose infrastructure and bulk water supply.7) Provinces and municipalities to be the responsible for management and delivery of water supply and sanitation services in both rural and urban areas.8) Cost recovery for water resources management, bulk water supply, water supply and sanitation services to be scaled up and serve as water demand management tool as well as a significant source of funding for infrastructure development.9) National Water Resources Council to be set up at national level to supervise and regulate water resources management and services delivery by benchmarking of river basin commissions, provincial administrations and water utility companies using clear and well defined performance indicators.
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