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- Wang, Haidong, et al.
(författare)
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Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013
- 2014
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 384:9947, s. 957-979
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.
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| 2. |
- Yousef, Mohammad, et al.
(författare)
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Glucose Changes and Working Memory in Individuals with Type 1 Diabetes During Air Pressure Changes Simulating Skydiving
- 2014
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 16:1, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several countries restrict individuals with type 1 diabetes mellitus (T1DM) from skydiving because of concerns over possible alterations in consciousness. To our knowledge, glucose levels and working memory in individuals with T1DM during skydiving have not been assessed earlier. The objective of this study was to investigate changes in glucose levels and working memory in selected subjects with T1DM compared with control subjects without diabetes mellitus (DM) during ambient air pressure changes as those anticipated during standard skydiving. Subjects and Methods: Six subjects with T1DM and six controls were included. Using a hypobaric chamber, the ambient air pressure was changed to simulate a standard skydive from 4,000m (13,000 feet) above mean sea level. The procedure was repeated six times to mimic a day of skydiving activity with a median of 8.7h/day (5(th), 95(th) percentile: 8.1, 9.8h). All subjects carried a continuous glucose monitor (CGM). Capillary glucose tests were taken in order to calibrate the CGM. Hemoglobin oxygen saturation, heart rate, and working memory, evaluated through digit span, were monitored regularly. Results: No subject experienced documented symptomatic hypoglycemia with impaired working memory during the simulations. One asymptomatic hypoglycemia episode with a plasma glucose level of <3.9 mmol/L was recorded in a subject with T1DM, with a corresponding CGM trend indicating declining glucose levels. Interstitial glucose levels of <3.9 mmol/L were recorded by CGM in three of the controls during the simulations. There were no significant differences in hemoglobin oxygen saturation, heart rate, or working memory between the T1DM patients and the controls. Conclusions: This study of interstitial glucose levels and working memory could not show the activity-specific risk factor (i.e., repetitive rapid-onset hypobaric hypoxia exposures) to be a greater safety concern for selected subjects with T1DM compared with subjects without DM during a simulated day of skydiving. Further studies are needed to clarify the suitability of subjects with T1DM to participate in this air sport.
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