| 1. |
- Micah, Angela E., et al.
(författare)
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Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050
- 2021
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 398:10308, s. 1317-1343
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Forskningsöversikt (refereegranskat)abstract
- Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
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| 2. |
- Fujita, Thais, et al.
(författare)
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Simulating Discharge in a Non-Dammed River of Southeastern South America Using SWAT Model
- 2022
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 14:3
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Tidskriftsartikel (refereegranskat)abstract
- Within a single region, it is possible to identify opposite changes in flow production. This proved to be the case for several basins in southeastern South America. It remains challenging to the causes this behavior and whether changes in streamflow will continue at current levels or decline in the coming decades. In this study, we used the Soil Water Assessment Tool to simulate monthly river discharge in the Ivaí River Basin, an unregulated medium-sized catchment and tributary of the Upper Paraná River Basin. After calibration, the simulated flow regime for the five streamflow stations based on the Nash-Sutcliffe Efficiency index (NSE) rated four of the streamflow stations Very Good (NSE between 0.86 and 0.89) and only one in the Good index (0.70). The overall flow behavior was well represented, although an underestimation was identified in four monitoring stations. Through assessment of its functionality and limitations in terms of specific flow duration curves percentages, the calibrated model could provide (to managers) the reliability needed for a realistic intervention. The results of this study may assist managers and support public policies for the use of water resources at the Ivaí River basin.
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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. |
- Rudke, Anderson Paulo, et al.
(författare)
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Land cover data of Upper Parana River Basin, South America, at high spatial resolution
- 2019
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Ingår i: International Journal of Applied Earth Observation and Geoinformation. - : Elsevier BV. - 1569-8432. ; 83
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Tidskriftsartikel (refereegranskat)abstract
- This study presents a new land cover map for the Upper Paraná River Basin (UPRB-2015), with high spatial resolution (30 m), and a high number of calibration and validation sites. To the new map, 50 Landsat-8 scenes were classified with the Support Vector Machine (SVM) algorithm and their level of agreement was assessed using overall accuracy and Kappa coefficient. The generated map was compared by area and by pixel with six global products (MODIS, GlobCover, Globeland30, FROM-GLC, CCI-LC and, GLCNMO). The results of the new classification showed an overall accuracy ranging from 67% to 100%, depending on the sub-basin (80.0% for the entire UPRB). Kappa coefficient was observed ranging from 0.50 to 1.00 (average of 0.73 in the whole basin). Anthropic areas cover more than 70% of the entire UPRB in the new product, with Croplands covering 46.0%. The new mapped areas of croplands are consistent with local socio-economic statistics but don't agree with global products, especially FROM-GLC (14,9%), MODIS (33.8%), GlobCover (71.2%), and CCI (67.8%). In addition, all global products show generalized spatial disagreement, with some sub-basins showing areas of cropland varying by an order of magnitude, compared to UPRB-2015. In the case of Grassland, covering 25.6% of the UPRB, it was observed a strong underestimation by all global products. Even for the Globeland30 and MODIS, which show some significant fraction of pasture areas, there is a high level of disagreement in the spatial distribution. In terms of general agreement, the seven compared mappings (including the new map) agree in only 6.6% of the study area, predominantly areas of forest and agriculture. Finally, the new classification proposed in this study provides better inputs for regional studies, especially for those involving hydrological modeling as well as offers a more refined LU/LC data set for atmospheric numerical models.
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| 5. |
- Xavier, Ana Carolina Freitas, et al.
(författare)
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Stationary and non-stationary detection of extreme precipitation events and trends of average precipitation from 1980 to 2010 in the Paraná River basin, Brazil
- 2020
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Ingår i: International Journal of Climatology. - : Wiley. - 0899-8418 .- 1097-0088. ; 40:2, s. 1197-1212
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Tidskriftsartikel (refereegranskat)abstract
- The main objective of this study was to investigate the trends on average and extreme events in time series of daily precipitation from 1980 to 2010 in the Paraná River basin, Brazil. The nonparametric Mann–Kendall test was applied to detect monotonic trend in the precipitation series. The occurrence of extreme values was analysed based on three generalized extreme values (GEV) models: Model 1 (stationary), Model 2 (non-stationary for location parameter), and Model 3 (non-stationary for location and scale parameters). The GEV parameters were estimated by the Generalized Maximum Likelihood method (GMLE) and for the non-stationary models, the parameters were estimated as linear functions of time. To choose the most suitable model, the maximum likelihood ratio test (D) was used. From the results observed at the monthly scale, it was possible to infer that the months with the highest probability of an extreme weather event occurrence are February (climates Aw and Cfa), July (Cfa and Cfb), and October (Aw, Cfa, and Cfb). Approximately 90% of the 1,112 stations presented no trend regarding the GEV parameters. The non-stationarity showed by other stations (Models 2 and 3) might be associated with several factors, such as the alteration of land use due to the north expansion of the agricultural border of the Paraná River basin.
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| 6. |
- Abbafati, Cristiana, et al.
(författare)
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- 2020
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Tidskriftsartikel (refereegranskat)
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| 7. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Abou Rafee, Sameh Adib, et al.
(författare)
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Hydrologic response to large-scale land use and cover changes in the Upper Paraná River Basin between 1985 and 2015
- 2021
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Ingår i: Regional Environmental Change. - : Springer Science and Business Media LLC. - 1436-3798 .- 1436-378X. ; 21:4
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Tidskriftsartikel (refereegranskat)abstract
- The Upper Paraná River Basin (UPRB) has undergone remarkable land use and cover changes (LUCC) in recent decades. This paper analyses the hydrologic response to LUCC in the UPRB between 1985 and 2015, using the Soil and Water Assessment Tool (SWAT) model. The impacts of LUCC were examined for annual, wet, and dry season (both during calibrated and validated periods) between 1984 and 2015. The most substantial LUCC were the extensive reduction of the cerrado and the expansion of agriculture areas. The simulations demonstrated that the LUCC caused important changes in basin hydrology. For instance, an increase (decrease) of surface runoff in the wet (dry) season at most UPRB subbasins was observed. In addition, the simulation results revealed a reduction in actual evapotranspiration and an increase in soil moisture in the annual and wet season. Consequently, most of the major rivers of the basin presented an increase (decrease) in their discharge in the wet (dry) period. The major changes in the hydrologic components were observed in the central-western and southern parts of the UPRB. At the river mouth of the UPRB, the LUCC led to an increase in long-term mean discharge values of 4.2% and 1.1% in the annual and wet season and a decrease of about 2.2% in the dry period. This study provides a large-scale modeling and valuable information that could be used to improve planning and sustainable management of future water resources within the basin.
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| 9. |
- de Morais, Marcos Vinicius Bueno, et al.
(författare)
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Implementation of observed sky-view factor in a mesoscale model for sensitivity studies of the urban meteorology
- 2018
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Ingår i: Sustainability (Switzerland). - : MDPI AG. - 2071-1050. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- The sky view factor (SVF) is an important radiometric parameter for assessing the canopy energy budget of urban areas. There are several methods to determine the SVF observationally. The most common is taking a photo with a digital camera equipped with a fish-eye lens and then converting ratio of sky area to canopy area into SVF. However, most urban canopy models use this variable as derived from idealized canopy geometry. To evaluate the effect of inputting observed SVFs in numerical models, we evaluated a mesoscale model's performance in reproducing surface wind and surface temperature when subjected to different ways of SVF prescription. The studied area was the Metropolitan Area of São Paulo (MASP) in Brazil. Observed SVFs were obtained for 37 sites scattered all over the MASP. Three simulations, A, B, and C, with different SVF and aspect-ratio prescriptions, were performed to analyze the effect of SVF on the urban canopy parameterization: Simulation A (standard) used the original formulation of the Town Energy Budget (TEB) model, computing the SVFs from the aspect-ratios; Simulation B used the observed SVFs, but keeps aspect-ratios as original; and Simulation C used the aspect-ratios computed from observed SVFs. The results show that in general inputting observed SVFs improves the model capability of reproducing temperature at surface level. The comparison of model outputs with data of regular meteorological stations shows that the inclusion of observed values of SVFs enhances model performance, reducing the RMSE index by up to 3 °C. In this case, the model is able to better reproduce the expected effects in the wind field, and consequently the temperature advection, of the urban boundary layer to a large urban area. The result of Simulation C shows that the surface wind and temperature intensity for all urban types is higher than those of Simulation A, because of the lower values of the aspect ratio. The urban type with high density of tall buildings increase up to 1 m s-1 in the wind speed, and approximately 1 °C in temperature, showing the importance of a better representation of the urban structure and the SVF database improvement.
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| 10. |
- de Souza, Itamara Parente, et al.
(författare)
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Seasonal precipitation variability modes over South America associated to El Niño-Southern Oscillation (ENSO) and non-ENSO components during the 1951–2016 period
- 2021
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Ingår i: International Journal of Climatology. - : Wiley. - 0899-8418 .- 1097-0088. ; 41:8, s. 4321-4338
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Tidskriftsartikel (refereegranskat)abstract
- Anomalous seasonal patterns of precipitation variability over South America (SA) associated with El Niño-Southern Oscillation (ENSO) and non-ENSO (residual) conditions were assessed during 1951–2016. Patterns were obtained from empirical orthogonal functions analysis of total and residual precipitation seasonal anomalies. In austral spring and summer, precipitation variability is dominated by a dipolar anomaly mode with a centre extending from northwestern to northeastern SA and another in central-eastern Brazil and part of southeastern SA (SESA) during spring, and a centre in northwestern SA and another extending from northeastern SA to central and eastern Brazil and central SESA, during summer. These modes are associated with ENSO to a greater extent during spring than summer. In summer, there is a strong association of the dipolar precipitation pattern with sea surface temperature (SST) anomalies on the east coast of Brazil, which indicates local influence. In austral fall, SST anomalies in the tropical South Atlantic relate to precipitation anomalies in northeast SA, and those in the tropical north Atlantic (TNA) to precipitation anomalies in northwestern SA, through the intertropical convergence zone anomalous position modulated by SST anomalies. In this same condition, the ENSO acts only to intensify or weaken the dominant precipitation pattern, depending on its phase, mainly over SESA. In contrast, the second variability mode in fall is characterized by positive SST anomalies in the Indian Ocean and equatorial and southern Atlantic Ocean and negative in the TNA. The importance of ENSO and the Indian Ocean in the characterization of the SST dipole in the tropical Atlantic explains the main changes in precipitation patterns over northeastern Brazil not been discussed in previous studies.
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| 11. |
- Dias-Neto, Marina, et al.
(författare)
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Nationwide Analysis of Intact Abdominal Aortic Aneurysm Repair in Portugal from 2000 to 2015
- 2020
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Ingår i: Annals of Vascular Surgery. - : ELSEVIER SCIENCE INC. - 0890-5096 .- 1615-5947. ; 66:July, s. 54-64
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Tidskriftsartikel (refereegranskat)abstract
- Background: Results on the management of infrarenal abdominal aortic aneurysm (AAA) from Mediterranean countries are scarce. The aim of this study was to evaluate trends in rate of and mortality after repair of intact AAA (iAAA) in Portugal. Methods: iAAA repairs registered in the hospitals' administrative database of the National Health Service from 2000 to 2015 were retrospectively analyzed regarding demographics (age and gender) and type of repair (open surgery [OS] or endovascular repair [EVAR]). Rate and mortality were compared among three time periods: 2000-2004, 2005-2009, and 2010-2015. Results: Age-standardized rate of iAAA repair increased consistently across the time periods under analysis from 3.6 +/- 0.6/100,000/year in 2000-2004, to 5.6 +/- 0.4/100,000/year in 2005-2009 and to 7.1 +/- 0.9/100,000/year in 2010-2015 (P < 0.001). The percentage of EVAR among all iAAA repairs rose steeply from 0 to 21 +/- 19% and then to 58 +/- 7% (P < 0.001). The rate of OS also increased from the first to the second period, but there was a decrease in the third period (P < 0.001). The in-hospital mortality after iAAA repair decreased from 7.5 +/- 1.3% to 6.6 +/- 1.6% and then to 5.1 +/- 1.9% (P < 0.001). This variation corresponded to a decrease in in-hospital mortality after EVAR (from 4.0 +/- 3.5% to 2.8 +/- 0.9%, P < 0.001) and increased in-hospital mortality after OS (7.5 +/- 1.3% to 7.4 +/- 1.1% to 8.3 +/- 3.7%, P < 0.001). Low-volume centers (< 15 repairs/year) did not present higher mortality rates. The number of EVARs per year in a center presented a positive association with EVAR mortality (Spearman correlation of 0.696, P = 0.004). Conclusions: The rate of repair of iAAA continues to grow, especially in patients aged >= 75 years and did not reach an inflection point yet. This is happening along with decreased repair mortality mainly because of the increased use of EVAR. Hospital mortality for iAAA repair is still a matter of concern, warranting further investigation and planning of vascular surgical services.
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| 12. |
- Dias-Neto, Marina, et al.
(författare)
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Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015)
- 2020
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 60:1, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients >= 50 years old to assess the variations over time. Results: A total of 2 275 patients >= 50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 +/- 0.24/100 000/year in 2000-2004, 3.17 +/- 0.39/100 000/year in 2005-2009 and 3.21 +/- 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 +/- 0.25/100 000/year to 2.24 +/- 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 +/- 4.7% to 48.8 +/- 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 +/- 0.22/100 000/year). Operative mortality remained stable (48.9 +/- 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 +/- 0.10/100 000/year and 0.93 +/- 0.29/100 000/year, respectively) but later increased (1.14 +/- 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 +/- 0.18/100 000/year, 2.21 +/- 0.27/100 000/year and 2.26 +/- 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.
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| 13. |
- Egeskog, Andrea, 1981, et al.
(författare)
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Actions and opinions of Brazilian farmers who shift to sugarcane : an interview-based assessment with discussion of implications for land-use change
- 2016
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Ingår i: Land use policy. - Kidlington : Elsevier. - 0264-8377 .- 1873-5754. ; 57, s. 594-604
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Tidskriftsartikel (refereegranskat)abstract
- Sugarcane ethanol systems can deliver large greenhouse gas emissions savings if emissions associated with land-use change are kept low. This qualitative study documents and analyzes actions and opinions among Brazilian farmers who shift to sugarcane production. Semi-structured interviews were held with 28 actors associated with sugarcane production in three different regions: one traditional sugarcane region and two regions where sugarcane is currently expanding. Most farmers considered sugarcane a land diversification option with relatively low economic risk, although higher risk than their previous land use. Beef production was considered a low-risk option, but less profitable than sugarcane. In conjunction with converting part of their land to sugarcane, most farmers maintained and further intensified their previous agricultural activity, often beef production. Several farmers invested in expanded production in other regions with relatively low land prices. Very few farmers in the expansion regions shifted all their land from the former, less profitable, use to sugarcane. Very few farmers in this study had deforested any land in connection with changes made when shifting to sugarcane. The respondents understand "environmental friendliness" as compliance with the relevant legislation, especially the Brazilian Forest Act, which is also a requirement for delivering sugarcane to the mills. Indirect land-use change is not a concern for the interviewed farmers, and conversion of forests and other native vegetation into sugarcane plantations is uncontroversial if legal. We derive hypotheses regarding farmers' actions and opinions from our results. These hypotheses aim to contribute to better understanding of what takes place in conjunction with expansion of sugarcane and can, when tested further, be of use in developing, e.g., policies for iLUC-free biofuel production.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Gorasso, Vanessa, et al.
(författare)
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Burden of disease attributable to risk factors in European countries: a scoping literature review
- 2023
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Ingår i: Archives of Public Health. - 0778-7367 .- 2049-3258. ; 81:1
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Forskningsöversikt (refereegranskat)abstract
- Objectives: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. Methods: We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. Results: A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Conclusions: Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates.
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| 18. |
- Hoshino, Ayuko, et al.
(författare)
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Extracellular Vesicle and Particle Biomarkers Define Multiple Human Cancers
- 2020
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Ingår i: Cell. - : CELL PRESS. - 0092-8674 .- 1097-4172. ; 182:4, s. 1044-
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Tidskriftsartikel (refereegranskat)abstract
- There is an unmet clinical need for improved tissue and liquid biopsy tools for cancer detection. We investigated the proteomic profile of extracellular vesicles and particles (EVPs) in 426 human samples from tissue explants (TEs), plasma, and other bodily fluids. Among traditional exosome markers, CD9, HSPA8, ALIX, and HSP90AB1 represent pan-EVP markers, while ACTB, MSN, and RAP1B are novel pan-EVP markers. To confirm that EVPs are ideal diagnostic tools, we analyzed proteomes of TE- (n =151) and plasma-derived (n =120) EVPs. Comparison of TE EVPs identified proteins (e.g., VCAN, TNC, and THBS2) that distinguish tumors from normal tissues with 90% sensitivity/94% specificity. Machine-learning classification of plasma-derived EVP cargo, including immunoglobulins, revealed 95% sensitivity/90% specificity in detecting cancer Finally, we defined a panel of tumor-type-specific EVP proteins in TEs and plasma, which can classify tumors of unknown primary origin. Thus, EVP proteins can serve as reliable biomarkers for cancer detection and determining cancer type.
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| 19. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Martins, Leila Droprinchinski, et al.
(författare)
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Extreme value analysis of air pollution data and their comparison between two large urban regions of South America
- 2017
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Ingår i: Weather and Climate Extremes. - : Elsevier BV. - 2212-0947. ; 18, s. 44-54
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Tidskriftsartikel (refereegranskat)abstract
- Sixteen years of hourly atmospheric pollutant data (1996-2011) in the Metropolitan Area of São Paulo (MASP), and seven years (2005-2011) of data measured in the Metropolitan Area of Rio de Janeiro (MARJ), were analyzed in order to study the extreme pollution events and their return period. In addition, the objective was to compare the air quality between the two largest Brazilian urban areas and provide information for decision makers, government agencies and civil society. Generalized Extreme Value (GEV) and Generalized Pareto Distribution (GPD) were applied to investigate the behavior of pollutants in these two regions. Although GEV and GPD are different approaches, they presented similar results. The probability of higher concentrations for CO, NO, NO2, PM10 and PM2.5 was more frequent during the winter, and O3 episodes occur most frequently during summer in the MASP. On the other hand, there is no seasonally defined behavior in MARJ for pollutants, with O3 presenting the shortest return period for high concentrations. In general, Ibirapuera and Campos Elísios stations present the highest probabilities of extreme events with high concentrations in MASP and MARJ, respectively. When the regions are compared, MASP presented higher probabilities of extreme events for all analyzed pollutants, except for NO; while O3 and PM2.5 are those with most frequent probabilities of presenting extreme episodes, in comparison other pollutants.
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| 21. |
- Marto, João Pedro, et al.
(författare)
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Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.
- 2023
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Ingår i: Neurology. - 1526-632X. ; 100:7
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT).Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60).Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis.The study was registered under ClinicalTrials.gov identifier NCT04895462.
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| 22. |
- Mazzaro de Freitas, Flavio Luiz, et al.
(författare)
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Potential increase of legal deforestation in Brazilian Amazon after Forest Act revision
- 2018
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Ingår i: Nature Sustainability. - : Springer Nature. - 2398-9629. ; 1, s. 665-670
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Tidskriftsartikel (refereegranskat)abstract
- The Brazilian Amazon rainforest is protected largely by command and control regulation of public and private land. The Brazilian Forest Act requires private landholders within the Amazon to set aside 80% of their land as legal reserves for nature protection, but this requirement can be reduced to 50% if more than 65% of a state’s territory is protected public land (for example, public conservation units and indigenous reserves). In the ongoing land designation process in Brazil, some Amazonian states may cross this 65% threshold. We assess the potential reduction in the legal reserve requirement from 80% to 50%, through spatially explicit modelling of scenarios concerning land tenure consolidation, employing up-to-date databases on land ownership. Depending on the outcome of land designation processes and political priorities, some 6.5–15.4 million hectares of private land previously protected as legal reserves may become available for legal deforestation. While protection of public land is crucial for safeguarding the Amazon, revisions of federal and state legislation may be needed to avoid the further extension of protected public land triggering increased legal deforestation on private lands. Zero-deforestation commitments and other initiatives may mitigate impacts in the absence of such revision.
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| 23. |
- Muniz Rocha, João Victor, 1990-
(författare)
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Hospitalizations for Ambulatory Care-Sensitive Conditions in Brazil and Portugal : A Comparative Study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Ambulatory Care Sensitive Conditions (ACSC) are health conditions for which adequate management, treatment and interventions delivered in outpatient setting could avoid the need of hospital admission. Hospitalizations for ACSC have been used to assess access, quality, and performance of the Primary Health Care (PHC). Portugal and Brazil have carried out reforms in their PHC delivery system in the last years, with similar organizational characteristics and objectives. While inter-country comparison provides opportunities for cross-country learning, ACSC have limitations as an indicator for quality of care. The aim of this thesis was to analyze the dynamics of hospitalizations for Ambulatory Care Sensitive Conditions in Brazil and Portugal.Methods: Firstly, a literature review was conducted to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing hospitalizations for ACSC across countries. Secondly, hospitalizations for ACSC in Brazil and Portugal were compared in the dimensions of occurrence, rates, causes, sociodemographic characteristics, costs of hospitalizations and economic impact, geographic distribution and variations, and identification of spatial clusters. The data for this comparison was obtained from administrative databases of all hospitalizations in public hospital in each country for the year 2015. ACSC were classified according to the methodology by the Agency for Healthcare Research and Quality. Thirdly, a longitudinal analysis was carried out to investigate if expansion of PHC reform in Brazil and Portugal (using coverage of Family Health Units as proxy) was associated to hospitalizations for ACSC. This analysis was conducted for the period 2007 and 2016 using the same administrative databases, and possible associations analyzed using Spearman’s correlation analysis, Kruskal-Wallis tests, and linear regressions.Results: The inter-country comparison of hospitalizations for ACSC can suggest health policy implications and potential points of improvements to reduce these events; however there are factors in the dimension of methods, population and health system that need to be accounted for. Hospitalizations for ACSC accounted for around 7 and 10% of all hospitalizations in Brazil and Portugal in 2015, respectively. Both countries have similarities in standardized rates and which conditions were more common, and differences in crude rates and age distribution. Each hospitalization for ACSC had an estimated cost of US$ PPP 1,919 and 4,278 in Brazil and Portugal, respectively. Both countries presented expressive geographic variations in rates of hospitalizations for ACSC. These indicate room of improvement and efficiency gains in Brazil and Portugal. Rates of hospitalizations for ACSC between 2007 and 2016 decreased in Brazil and increased in Portugal; although there were indications that expansion of PHC reform may be associated to reductions in ACSC hospitalizations, these results only applied for specific conditions and geographic areas within each country, and for some conditions results were discordant between the two countries.Conclusions: It is important to reduce ACSC hospitalizations given the impact these events represent for health systems and for society. The existing literature on inter-country comparison of hospitalizations for ACSC agree that strengthening PHC and promoting access provides opportunities to reduce these events. There was no robust evidence of the association between expansion of PHC reforms in Brazil and Portugal and reduction of hospitalizations for ACSC, indicating that the PHC reforms did not produce the same results neither within or between countries and not for all conditions. Findings indicate that focused actions can be more effective to reduce such events, with examples in both countries serving as valuable clues for the learning process and improvement.
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| 24. |
- Murray, Christopher J. L., et al.
(författare)
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Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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| 25. |
- Pereira, Ana Margarida, et al.
(författare)
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Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support Systems
- 2023
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Ingår i: Journal of Medical Internet Research. - : JMIR PUBLICATIONS, INC. - 1438-8871. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Most mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component , pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.
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| 26. |
- Santos, João Vasco, et al.
(författare)
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The state of health in the European Union (EU-27) in 2019 : a systematic analysis for the Global Burden of Disease study 2019.
- 2024
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Ingår i: BMC Public Health. - 1471-2458. ; 24:1, s. 1374-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.METHODS: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).RESULTS: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%).CONCLUSIONS: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.
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| 27. |
- Xavier, Ana Carolina Freitas, et al.
(författare)
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Evaluation of Quantile Delta Mapping as a bias-correction method in maximum rainfall dataset from downscaled models in São Paulo state (Brazil)
- 2022
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Ingår i: International Journal of Climatology. - : Wiley. - 0899-8418 .- 1097-0088. ; 42:1, s. 175-190
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Tidskriftsartikel (refereegranskat)abstract
- An essential step for improving climate change models' performance is to evaluate their ability to represent the current climate conditions, especially extreme events. On such background, this study aims at evaluating the performance of the Quantile Delta Mapping (QDM) as a bias correction method for annual maximum daily precipitation series (bmax) generated from downscaled climate change models under tropical–subtropical conditions of Brazil. We selected the QDM due to its ability to correct bias in extreme quantile of wet days. Climate projections obtained from 20 NASA Earth Exchange Daily Downscaled Projections models (NEX-GDDP) from 1950 to 2005 were subjected to validation processes based on the QDM method. Two climate change scenarios (RCP 4.5 and RCP 8.5 W m−2) have also been considered. Several goodness-of-fit measures, such as root-mean-square-error (RMSE), SD, percentual bias (pbias), mean absolute error (MAE), Pearson correlation test, modified Willmott test (dm), have been calculated from the outcomes of the models and their corresponding observed data (obtained from rain gauges). These goodness-of-fit measures were calculated before and after applying the QDM method. The QDM was able to correct virtually all biases. More specifically, the QDM successfully adjusted the empirical cumulative distribution of climate change projections, removing the systematic error of raw data. The QDM also presented a suitable performance when applied to future projections (2020–2095). This statement holds for all NEX-GDDP models, except for the ACCESS1-0 model in RCP 8.5. In such a scenario, this latter model presented unrealistic rainfall values. Finally, with the improvement resulting from applying the bias correction method QDM, there was an increase in the number of climate projections suitable for end-users in the study region.
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