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2.
  • Stanaway, Jeffrey D., et al. (author)
  • Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
  • 2018
  • In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
  • Journal article (peer-reviewed)abstract
    • Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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3.
  • Fazey, Ioan, et al. (author)
  • Transforming knowledge systems for life on Earth : Visions of future systems and how to get there
  • 2020
  • In: Energy Research & Social Science. - : Elsevier. - 2214-6296 .- 2214-6326. ; 70
  • Journal article (peer-reviewed)abstract
    • Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.
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4.
  • Fontenelle, Ana Luiza, et al. (author)
  • Leading the Pathway : How Unicamp Is Implementing Sustainable Practices in the Energy Sector in Its Campuses?
  • 2022
  • In: World Sustainability Series. - Cham : Springer International Publishing. - 2199-7381 .- 2199-7373. ; , s. 249-266
  • Book chapter (peer-reviewed)abstract
    • Universities are powerful drivers to create and advance knowledge on sustainable development. Furthermore, they can be used as a controlled environment to apply innovative technologies and approaches. This process also embraces industry and government, in the triple helix innovation model, as in the University of Campinas (Unicamp), Brazil—one of the best Latin American universities (3rd)—and immersed in a significant financial and technological region in Brazil. It has 6 Campuses in 3 different cities, almost 40,000 students (high school, technical education, undergraduate, graduate, residency, and extension courses), and almost 10,000 employees (professors, technicians, and others). Due to its relevance and excellence, Unicamp decides to lead the pathway in urban sustainable development through its Sustainable Campus Project launched out in 2017 in partnership with an energy company (CPFL Energia) and with the Brazilian Electricity Regulatory Agency (ANEEL) through a Research and Development program. This chapter presents the Sustainable Campus Project’s main goals, practices, and current results, such as implementing electric buses, local solar generation, electrical efficiency improvement, and education. Through this case, we aim to show how universities, especially in developing countries, can lead the local pathway to a sustainable world.
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5.
  • Kassebaum, Nicholas J., et al. (author)
  • Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015
  • 2016
  • In: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
  • Journal article (peer-reviewed)abstract
    • Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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6.
  • Kennedy, Patrick J., et al. (author)
  • Fab-conjugated PLGA nanoparticles effectively target cancer cells expressing human CD44v6
  • 2018
  • In: Acta Biomaterialia. - : Elsevier BV. - 1742-7061 .- 1878-7568. ; 81, s. 208-218
  • Journal article (peer-reviewed)abstract
    • Targeting of CD44 isoforms containing exon v6 (CD44v6) represents a viable strategy for the therapy and/or early diagnosis of metastatic cancers of the epithelium (e.g. gastric and colorectal cancer). We developed and characterized poly(lactic-co-glycolic acid) (PLGA)-based nanoparticles (NPs) modified with polyethylene glycol (PEG) and engrafted, by site-directed conjugation, with an engineered human Fab that specifically target human CD44v6 (v6 Fab-PLGA NPs). The v6 Fab-PLGA NPs displayed spherical morphology around 300 nm and were negatively charged. They strongly bound to a CD44v6-derived peptide and, more importantly, to cells that endogenously and exogenously express CD44v6, but not to non expressing cells and cells expressing the standard isoform of CD44. The v6 Fab-PLGA NPs also recognized CD44v6 in tumor sections from cells grown subcutaneously within mice. The NPs had nominal cytotoxicity at 50 mu g/mL and withstood simulated intestinal fluid exposure. Interestingly, v6 Fab-PLGA NPs cryopreserved in 10% trehalose and stored maintained specific cell binding. In conclusion, we envision NPs targeting CD44v6 as potential in vivo diagnostic agents and/or as anti-cancer agents in patients previously stratified with CD44v6(+) carcinomas. Statement of Significance The v6 Fab-PLGA NPs displayed many favorable qualities as a potential CD44v6-targeted drug and/or diagnostic delivery agent. The NPs were designed for optimal ligand orientation and for immediate administration into humans. v6 Fab-PLGA NPs strongly bound to cells that endogenously and exogenously express CD44v6, but not to non-expressing cells and cells expressing the standard isoform of CD44. Binding ability was retained after freeze-drying and long-term storage, providing evidences on the stability of Fab-functionalized NPs. These NPs can potentially be used as an in vivo diagnostic from parenteral or oral/rectal administration.
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7.
  • Lozano, Rafael, et al. (author)
  • 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
  • In: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
  • Journal article (peer-reviewed)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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8.
  • Murray, Christopher J. L., et al. (author)
  • 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
  • In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
  • Journal article (peer-reviewed)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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9.
  • Pereira, Carla, et al. (author)
  • Comparison of East‐Asia and West‐Europe cohorts explains disparities in survival outcomes and highlights predictive biomarkers of early gastric cancer aggressiveness
  • 2021
  • In: International Journal of Cancer. - : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 150:5, s. 868-880
  • Journal article (peer-reviewed)abstract
    • Surgical resection with lymphadenectomy and perioperative chemotherapy is the universal mainstay for curative treatment of gastric cancer (GC) patients with locoregional disease. However, GC survival remains asymmetric in West- and East-world regions. We hypothesize that this asymmetry derives from differential clinical management. Therefore, we collected chemo-naïve GC patients from Portugal and South Korea to explore specific immunophenotypic profiles related to disease aggressiveness and clinicopathological factors potentially explaining associated overall survival (OS) differences. Clinicopathological and survival data were collected from chemo-naïve surgical cohorts from Portugal (West-Europe cohort [WE-C]; n = 170) and South Korea (East-Asia cohort [EA-C]; n = 367) and correlated with immunohistochemical expression profiles of E-cadherin and CD44v6 obtained from consecutive tissue microarrays sections. Survival analysis revealed a subset of 12.4% of WE-C patients, whose tumors concomitantly express E-cadherin_abnormal and CD44v6_very high, displaying extremely poor OS, even at TNM stages I and II. These WE-C stage-I and -II patients tumors were particularly aggressive compared to all others, invading deeper into the gastric wall (P = .032) and more often permeating the vasculature (P = .018) and nerves (P = .009). A similar immunophenotypic profile was found in 11.9% of EA-C patients, but unrelated to survival. Tumours, from stage-I and -II EA-C patients, that display both biomarkers, also permeated more lymphatic vessels (P = .003), promoting lymph node (LN) metastasis (P = .019), being diagnosed on average 8 years earlier and submitted to more extensive LN dissection than WE-C. Concomitant E-cadherin_abnormal/CD44v6_very-high expression predicts aggressiveness and poor survival of stage-I and -II GC submitted to conservative lymphadenectomy.
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10.
  • Proletov, Ian, et al. (author)
  • Primary and secondary glomerulonephritides 1.
  • 2014
  • In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - : Oxford University Press (OUP). - 1460-2385. ; 29 Suppl 3:May, s. 186-200
  • Journal article (peer-reviewed)
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11.
  • Sadio, Ana, et al. (author)
  • Modified-chitosan/siRNA nanoparticles downregulate cellular CDX2 expression and cross the gastric mucus barrier.
  • 2014
  • In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 9:6
  • Journal article (peer-reviewed)abstract
    • Development of effective non-viral vectors is of crucial importance in the implementation of RNA interference in clinical routine. The localized delivery of siRNAs to the gastrointestinal mucosa is highly desired but faces specific problems such as the stability in gastric acidity conditions and the presence of the mucus barrier. CDX2 is a transcription factor critical for intestinal differentiation being involved in the initiation and maintenance of gastrointestinal diseases. Specifically, it is the trigger of gastric intestinal metaplasia which is a precursor lesion of gastric cancer. Its expression is also altered in colorectal cancer, where it may constitute a lineage-survival oncogene. Our main objective was to develop a nanoparticle-delivery system of siRNA targeting CDX2 using modified chitosan as a vector. CDX2 expression was assessed in gastric carcinoma cell lines and nanoparticles behaviour in gastrointestinal mucus was tested in mouse explants. We show that imidazole-modified chitosan and trimethylchitosan/siRNA nanoparticles are able to downregulate CDX2 expression and overpass the gastric mucus layer but not colonic mucus. This system might constitute a potential therapeutic approach to treat CDX2-dependent gastric lesions.
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12.
  • Solorzano, Leslie, 1989-, et al. (author)
  • Towards automatic protein co-expression quantification in immunohistochemical TMA slides
  • 2021
  • In: IEEE journal of biomedical and health informatics. - : Institute of Electrical and Electronics Engineers (IEEE). - 2168-2194 .- 2168-2208. ; 25:2, s. 393-402
  • Journal article (peer-reviewed)abstract
    • Immunohistochemical (IHC) analysis of tissue biopsies is currently used for clinical screening of solid cancers to assess protein expression. The large amount of image data produced from these tissue samples requires specialized computational pathology methods to perform integrative analysis. Even though proteins are traditionally studied independently, the study of protein co-expression may offer new insights towards patients' clinical and therapeutic decisions. To explore protein co-expression, we constructed a modular image analysis pipeline to spatially align tissue microarray (TMA) image slides, evaluate alignment quality, define tumor regions, and ultimately quantify protein expression, before and after tumor segmentation. The pipeline was built with open-source tools that can manage gigapixel slides. To evaluate the consensus between pathologist and computer, we characterized a cohort of 142 gastric cancer (GC) cases regarding the extent of E-cadherin and CD44v6 expression. We performed IHC analysis in consecutive TMA slides and compared the automated quantification with the pathologists' manual assessment. Our results show that automated quantification within tumor regions improves agreement with the pathologists' classification. A co-expression map was created to identify the cores co-expressing both proteins. The proposed pipeline provides not only computational tools forwarding current pathology practices to explore co-expression, but also a framework for merging data and transferring information in learning-based approaches to pathology.
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13.
  • Tremblay, Mark S, et al. (author)
  • Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome.
  • 2017
  • In: The international journal of behavioral nutrition and physical activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 14:1
  • Journal article (peer-reviewed)abstract
    • The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need.First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey.Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided.It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors.
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14.
  • Wang, Haidong, et al. (author)
  • Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
  • 2016
  • In: The lancet. HIV. - : Elsevier. - 2352-3018. ; 3:8, s. e361-e387
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
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15.
  • Abbafati, Cristiana, et al. (author)
  • 2020
  • Journal article (peer-reviewed)
  •  
16.
  • Ademuyiwa, Adesoji O., et al. (author)
  • Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
  • 2016
  • In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
  • Journal article (peer-reviewed)abstract
    • Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
  •  
17.
  • Afshin, Ashkan, et al. (author)
  • Health effects of dietary risks in 195 countries, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017
  • 2019
  • In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10184, s. 1958-1972
  • Journal article (peer-reviewed)abstract
    • Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of diseasespecific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.
  •  
18.
  • Amaral, Rita, et al. (author)
  • Profiling Persistent Asthma Phenotypes in Adolescents : A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies
  • 2021
  • In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
  • Journal article (peer-reviewed)abstract
    • We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
  •  
19.
  • Cabral dos Santos, Alex, 1990, et al. (author)
  • Water masses seasonality and meteorological patterns drive the biogeochemical processes of a subtropical and urbanized watershed-bay-shelf continuum
  • 2020
  • In: Science of the Total Environment. - : Elsevier BV. - 0048-9697. ; 749
  • Journal article (peer-reviewed)abstract
    • © 2020 Elsevier B.V. Understanding the different scales of temporal variability is crucial to improve the knowledge of the biogeochemical processes in the land-ocean interface. In this study, we evaluated the role of continental runoff and intrusion of oceanic water masses in the trophic state of the Bay of Santa Catarina Island (BSCI) over the last three decades (1993–2019) by using multiple biogeochemical and eutrophication assessment tools. The sub-watersheds of BSCI showed high concentrations of nutrients, fecal coliform and chlorophyll-a, directly correlated to the number of inhabitants. Worst-case scenarios were found in summer and fall seasons due to sewage inputs caused by mass tourism and the inefficiency or even absence of treatment systems, boosted by strong rainfall. The intrusion of the South Atlantic Central Water and the Plata Plume Water into the BSCI favored autotrophy in the summer and heterotrophy in the winter, coupled with low and high residence time, respectively. El Niño events enhanced rainfall and continental runoff, exporting elevated nutrients and phytoplankton biomass loads from the eutrophic rivers to the continental shelf. The pattern reverses during La Niña, when chlorophyll and nutrient peaks were detected inside the bay. Eutrophication evaluation indicated that the trophic state oscillated from moderate to high and that these conditions tend to remain the same in future scenarios due to the moderate residence time of the water, anthropogenic pressures, periodic algal blooms and the intrusion of nutrient-rich oceanic water masses. Management actions, such as the improvement of the wastewater treatment system and wetlands restoration, are needed in order to mitigate eutrophication and the loss of ecosystem services and functions.
  •  
20.
  • Cork, Steven, et al. (author)
  • Exploring Alternative Futures in the Anthropocene
  • 2023
  • In: Annual Review Environment and Resources. - 1543-5938 .- 1545-2050. ; 48, s. 25-54
  • Research review (peer-reviewed)abstract
    • Many challenges posed by the current Anthropocene epoch require fundamental transformations to humanity's relationships with the rest of the planet. Achieving such transformations requires that humanity improve its understanding of the current situation and enhance its ability to imagine pathways toward alternative, preferable futures. We review advances in addressing these challenges that employ systematic and structured thinking about multiple possible futures (futures-thinking). Over seven decades, especially the past two, approaches to futures-thinking have helped people from diverse backgrounds reach a common understanding of important issues, underlying causes, and pathways toward optimistic futures. A recent focus has been the stimulation of imagination to produce new options. The roles of futures-thinking in breaking unhelpful social addictions and in conflict resolution are key emerging topics. We summarize cognitive, cultural, and institutional constraints on the societal uptake of futures-thinking, concluding that none are insurmountable once understood.
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21.
  • Davids, Peter R., et al. (author)
  • Multi-, inter-, and transdisciplinary approaches to nature-based flood risk management
  • 2024
  • In: Current Opinion in Environmental Science and Health. - : Elsevier BV. - 2468-5844. ; 38
  • Research review (peer-reviewed)abstract
    • Nature-based solutions (NBS) can act as a valuable complement to conventional ‘grey’ infrastructure for stormwater management (e.g. dams and dikes) in reducing flood risks as these ‘green’ solutions are perceived to be more flexible and multifunctional. However, to achieve effective NBS, a multi-actor approach in developing appropriate measures for specific sites is required as NBS occupy more space than ‘grey’ infrastructure and often overlap with private land. NBS also necessitate a multidisciplinary approach, to maximise environmental, social, and economic benefits. Thus, a transdisciplinary approach is needed for the effective implementation of NBS. Viewing NBS as a boundary concept, focusing on the common ground for different disciplines and actors, can facilitate communication and provide a first step towards effective flood risk mitigation.
  •  
22.
  • de Oliveira Pereira, David Iubel, et al. (author)
  • Assessing challenges, barriers, practices and capability towards digitalization
  • 2020
  • In: Proceedings of the 2020 IISE Annual Conference. ; , s. 736-741
  • Conference paper (peer-reviewed)abstract
    • Digitalization involves transformations of organizational structures, with the establishment of new practices and developing digital capabilities. However, many companies are struggling with the development of their digital strategy and many others’ digital strategies are failing. Due this reason, this paper aims to organize information regarding challenges, barriers, practices and capabilities towards digitalization. To support the objective, this research performs a case study in an automotive plant of an international company situated in Brazil. The data collected comes from interviews, technical documents and visits to the plant. The main results revealed a list of challenges and barriers: few people have the proper digital skills; lack of a common framework; misalignment with headquarters’ strategies and initiatives; higher cost to acquire technologies in Brazil; insufficient understanding of how to implement digital technologies in different contexts. Regarding the practices, the company listed the creation of innovation labs; regular meetings and visits to the shop floor; development of governance policies for processing, storage, management and presentation of data; increase collaboration with universities and research institutes; increasing investments in digital technologies. The processes for developing digital capabilities are based on trainings, workshops and pilot or conceptual projects focused on developing of a new service-based business model.
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23.
  • Ferreira, Carla S. S., et al. (author)
  • Conclusions
  • 2022
  • In: Nature-Based Solutions for Flood Mitigation. - Cham : Springer. - 9783030775049 - 9783030775056 ; , s. 507-513
  • Book chapter (peer-reviewed)abstract
    • Mitigating and adapting to increasing flood risk driven by climate change and growing urbanization is still a challenge for humanity. Over the last decades, the Nature Based Solutions (NBS) approach has received increasing interest from governments, academia and society, but its implementation is still in its infancy. This volume presented an up-to-date compilation about the current knowledge on NBS regarding their potential to mitigate several types of floods recorded in different environments, the associated advantages and limitations, and the barriers affecting their wider implementation. This concluding chapter provides a synthesis of the main messages of the chapters included in this volume, and it highlights the relevant aspects that must be considered for an effective and broader application of NBS. In this regard, particular attention is given to the need to maximize their multifunctionality and to consider the transdisciplinary nature of the NBS approach.
  •  
24.
  • Ferreira, Carla S. S., et al. (author)
  • Introduction : Nature-Based Solutions for Flood Mitigation
  • 2022
  • In: Nature-Based Solutions for Flood Mitigation. - Cham : Springer Nature. ; , s. 1-7, s. 1-7
  • Book chapter (peer-reviewed)abstract
    • Floods are one of the most common natural disasters affecting numerous people worldwide. Over the last years, Nature-Based Solutions (NBS) have gained attention as an emerging approach for flood mitigation that can complement traditional grey infrastructures. NBS provide several ecosystem services, including flood mitigation and improved water quality. Increasing political awareness and interest from the scientific community have led to the implementation of NBS worldwide. This contribution provides an overview of the concept of NBS for flood mitigation, focusing on (1) the environmental impacts of NBS, (2) the effectiveness of NBS in flood mitigation based on several case studies, and (3) the socio-economic aspects of NBS. Compiling the latest research, this book furthers our understanding of the role of NBS for flood mitigation and its relation to environmental aspects, to guide students, managers, practitioners, policy-makers, and scientists in future NBS projects.
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25.
  • Grudzien, David Iubel de Oliveira Pereira, et al. (author)
  • Estratégia de Operações Sustentáveis pautadas nastecnologias digitais da Indústria 4.0: proposta de ummodelo processual [Strategy for sustainable operations based on digital technologies of Industry 4.0: Proposal for a processual model]
  • 2023
  • In: Anais do International Conference on Production Research Americas. - Recife : Even3. - 9788557229136
  • Conference paper (peer-reviewed)abstract
    • A função Operação vislumbra-se como um veículo positivo e eficaz para lidar com as imperativas questões da Sustentabilidade, devendo, então, se tornar a área central da organização e a força motriz da estratégia. Ressalta-se que as tecnologias digitais da Indústria 4.0 têm potencial para gerar capacidades para o cumprimento de tais objetivos sustentáveis. Assim, esta pesquisa temcomo objetivo principal propor um modelo processual de Operações Sustentáveis baseado em tecnologias digitais da I40. Para tanto, duas abordagens são integradas: de processo (Cambridge) e multicritério. Mais especificamente, foram desenvolvidas três principais fases. A primeira fase - denominada "Requerimentos do mercado" - tem como objetivo diagnosticar os objetivos de desempenho mais prioritários pela Matriz Importância & Desempenho. O segundo - denominado "Auditoria sobre a Operação" - visa classificar as tecnologias digitais mais críticas pelo modelo PROMETHEE-ROC. Na terceira fase tem-se o levantamento e priorização das capacitações consideradas mais críticas utilizando o modelo FI-Tradeoff.
  •  
26.
  • Jacome, Cristina, et al. (author)
  • Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App : Analysis of Real-World, Medium-Term Feasibility Studies
  • 2021
  • In: Frontiers in Medical Technology. - : Frontiers Media S.A.. - 2673-3129. ; 3
  • Journal article (peer-reviewed)abstract
    • Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
  •  
27.
  • Kalantari, Zahra, et al. (author)
  • Nature-based solutions to global environmental challenges
  • 2023
  • In: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 880, s. 163227-
  • Journal article (other academic/artistic)abstract
    • Nature-based solutions (NBS) supply many ecosystem services key to wellbeing. There is evidence that several ecosystems that serve as NBS (e.g., forests) are being threatened by land use and climate change. Urban expansion and agriculture intensification is imposing an extensive degradation in several ecosystems, increasing human vulnerability to climate change-related events. Therefore, it is key to rethink how to develop strategies that minimize these effects. Halt ecosystem degradation and establishing NBS in areas of high human pressure (e.g., urban and agriculture) is essential to reduce environmental impacts. Numerous NBS can be helpful in agriculture (e.g., retention of crop residues/mulching) to reduce erosion or diffuse pollution or in urban areas (e.g., urban green spaces) to mitigate urban heat island effects or floods. Although these measures are important, it is crucial to raise awareness among the stakeholders, assess case by case and minimize the tradeoffs associated with the NBS application (e.g., area needed). Overall, NBS are vital in addressing present and future global environmental challenges.
  •  
28.
  • Mokdad, Ali H., et al. (author)
  • Adolescent health in the Eastern Mediterranean Region : findings from the global burden of disease 2015 study
  • 2018
  • In: International Journal of Public Health. - : SPRINGER BASEL AG. - 1661-8556 .- 1661-8564. ; 63, s. 79-96
  • Journal article (peer-reviewed)abstract
    • The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.
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29.
  • Neves, Ana Luisa, et al. (author)
  • Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma : Secondary Analysis of Observational Studies
  • 2021
  • In: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:9
  • Journal article (peer-reviewed)abstract
    • Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were <= 40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
  •  
30.
  • Nowroozalizadeh, Salma, et al. (author)
  • Microbial Translocation Correlates with the Severity of Both HIV-1 and HIV-2 Infections
  • 2010
  • In: Journal of Infectious Diseases. - : Oxford University Press (OUP). - 1537-6613 .- 0022-1899. ; 201:8, s. 1150-1154
  • Journal article (peer-reviewed)abstract
    • Microbial translocation has been linked to systemic immune activation during human immunodeficiency virus (HIV) type 1 infection. Here, we show that an elevated level of microbial translocation, measured as plasma lipopolysaccharide (LPS) concentration, correlates with AIDS in both individuals infected with HIV type 1 and individuals infected with HIV type 2. LPS concentration also correlates with CD4(+) T cell count and viral load independently of HIV type. Furthermore, elevated plasma LPS concentration was found to be concomitant with defective innate and mitogen responsiveness. We suggest that microbial translocation may contribute to loss of CD4(+) T cells, increase in viral load, and defective immune stimuli responsiveness during both HIV type 1 and HIV type 2 infections.
  •  
31.
  • Nowroozalizadeh, Salma, et al. (author)
  • Reply to Redd et al
  • 2011
  • In: Journal of Infectious Diseases. - : Oxford University Press (OUP). - 1537-6613 .- 0022-1899. ; 203:5, s. 746-746
  • Journal article (other academic/artistic)
  •  
32.
  • Nowroozalizadeh, Salma, et al. (author)
  • Studies on toll-like receptor stimuli responsiveness in HIV-1 and HIV-2 infections
  • 2009
  • In: Cytokine. - : Elsevier BV. - 1096-0023 .- 1043-4666. ; 46:3, s. 325-331
  • Journal article (peer-reviewed)abstract
    • Background: HIV-1 and HIV-2 are two related viruses with distinct clinical outcomes, where HIV-1 is more pathogenic and transmissible than HIV-2. The pathogenesis of both infections is influenced by the dysregulation and deterioration of the adaptive immune system. However, their effects on the responsiveness of innate immunity are less well known. Here, we report on toll-like receptor (TLR) stimuli responsiveness in HIV-1 or HIV-2 infections. Methods: Whole blood from 235 individuals living in Guinea-Bissau who were uninfected, infected with HIV-1, infected with HIV-2, and/or infected with HTLV-1, was stimulated with TLR7/8 and TLR9 agonists, R-848 and unmethylated CpG DNA. After TLR7/8 and TLR9 stimuli, the expression levels of IL-12 and IFN-alpha were related to gender, age, infection status, CD4(+) T cell counts. and plasma viral load. Results: Defective TLR9 responsiveness was observed in the advanced disease stage, along with CD4(+) T cell loss in both HIV-1 and HIV-2 infections. Moreover, TLR7/8 responsiveness was reduced in HIV-1 infected individuals compared with uninfected controls. Conclusions: Innate immunity responsiveness can be monitored by whole blood stimulation. Both advanced HIVA and HIV-2 infections may cause innate immunity dysregulation. (C) 2009 Elsevier Ltd. All rights reserved.
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33.
  • Paolini, Lucia, et al. (author)
  • Large-scale production of extracellular vesicles: Report on the “massivEVs” ISEV workshop
  • 2022
  • In: Journal of Extracellular Biology. - : Wiley. - 2768-2811. ; 1:10
  • Journal article (peer-reviewed)abstract
    • Extracellular vesicles (EVs) large-scale production is a crucial point for the translation of EVs from discovery to application of EV-based products. In October 2021, the International Society for Extracellular Vesicles (ISEV), along with support by the FET-OPEN projects, “The Extracellular Vesicle Foundry” (evFOUNDRY) and “Extracellular vesicles from a natural source for tailor-made nanomaterials” (VES4US), organized a workshop entitled “massivEVs” to discuss the potential challenges for translation of EV-based products. This report gives an overview of the topics discussed during “massivEVs”, the most important points raised, and the points of consensus reached after discussion among academia and industry representatives. Overall, the review of the existing EV manufacturing, upscaling challenges and directions for their resolution highlighted in the workshop painted an optimistic future for the expanding EV field.
  •  
34.
  • Pereira, David I. O., et al. (author)
  • A Review Content Analysis Between Industry 4.0 and Sustainable Manufacturing
  • 2020
  • In: Lecture Notes on Multidisciplinary Industrial Engineering. - Cham : Springer International Publishing. - 2522-5022 .- 2522-5030. ; Part F201, s. 12-23, s. 12-23
  • Conference paper (peer-reviewed)abstract
    • Manufacturing companies have been facing a dynamic environment due the Industry 4.0 and sustainable development phenomena and, consequently, a greatest attention from researchers has been attracted to investigate how the 4th Industrial Revolution interact or influence sustainable manufacturing. Therefore, the purpose of this paper is to investigate the academic progress regarding Industry 4.0 and Sustainable Manufacturing simultaneously, offering as the main result a review content analysis. More specifically, a bibliometric analysis provides a list of prominent journals and popular conferences and the summary of the main authors and their institutions. Moreover, a content analysis presents a semantic network, illustrating current research efforts and suggesting future research directions, identified by topics. In sum, the first topic suggests the need to explore and comprehend the interaction between the areas. The second topic brings the importance to analyse and understand requirements needed to successfully implement. The last topic shows the different ways to implement and assess the sustainable manufacturing in the context of Industry 4.0.
  •  
35.
  • Pereira-Gurgel, Virginia M., et al. (author)
  • Abnormal vascular and neural retinal morphology in congenital lifetime isolated growth hormone deficiency
  • 2016
  • In: Growth Hormone and IGF Research. - : Elsevier BV. - 1096-6374 .- 1532-2238. ; 30-31, s. 11-15
  • Journal article (peer-reviewed)abstract
    • © 2016 Elsevier LtdObjective Experimental models demonstrate an important role of GH in retinal development. However, the interactions between GH and the neuro-vascularization of the human retina are still not clear. A model of untreated congenital isolated GH deficiency (IGHD) may clarify the actions of GH on the retina. The purpose of this work was to assess the retinal neuro-vascularization in untreated congenital IGHD (cIGHD). Design In a cross sectional study, we performed an endocrine and ophthalmological assessment of 25 adult cIGHD subjects, homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene and 28 matched controls. Intraocular pressure measurement, retinography (to assess the number of retinal vascular branching points and the optic disc and cup size), and optical coherence tomography (to assess the thickness of macula) were performed. Results cIGHD subjects presented a more significant reduction of vascular branching points in comparison to controls (91% vs. 53% [p=0.049]). The percentage of moderate reduction was higher in cIGHD than in controls (p=0.01). The percentage of individuals with increased optic disc was higher in cIGHD subjects in comparison to controls (92.9% vs. 57.1%). The same occurred for cup size (92.9% vs. 66.7%), p<0.0001 in both cases. There was no difference in macula thickness. Conclusions Most cIGHD individuals present moderate reduction of vascular branching points, increase of optic disc and cup size, but have similar thickness of the macula.
  •  
36.
  • Pick, Cari M., et al. (author)
  • Fundamental social motives measured across forty-two cultures in two waves
  • 2022
  • In: Scientific Data. - : Springer Nature. - 2052-4463. ; 9
  • Journal article (peer-reviewed)abstract
    • How does psychology vary across human societies? The fundamental social motives framework adopts an evolutionary approach to capture the broad range of human social goals within a taxonomy of ancestrally recurring threats and opportunities. These motives-self-protection, disease avoidance, affiliation, status, mate acquisition, mate retention, and kin care-are high in fitness relevance and everyday salience, yet understudied cross-culturally. Here, we gathered data on these motives in 42 countries (N = 15,915) in two cross-sectional waves, including 19 countries (N = 10,907) for which data were gathered in both waves. Wave 1 was collected from mid-2016 through late 2019 (32 countries, N = 8,998; 3,302 male, 5,585 female; M-age = 24.43, SD = 7.91). Wave 2 was collected from April through November 2020, during the COVID-19 pandemic (29 countries, N = 6,917; 2,249 male, 4,218 female; M-age = 28.59, SD = 11.31). These data can be used to assess differences and similarities in people's fundamental social motives both across and within cultures, at different time points, and in relation to other commonly studied cultural indicators and outcomes.
  •  
37.
  • Pinto, Luis, et al. (author)
  • Environmental and socioeconomic factors influencing the use of urban green spaces in Coimbra (Portugal)
  • 2021
  • In: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 792
  • Journal article (peer-reviewed)abstract
    • Urban green spaces (UGS) deliver a wide range of regulating, provisioning and cultural ecosystem services (CES), relevant to support the achievement of some United Nations Sustainable Development Goals (e.g., Goal 11: sustainable cities and communities, and Goal 3: good health and well-being). However, knowledge of preferences and uses of UGS by urban dwellers is still lacking. This study assesses the CES perceived by different users in five distinct urban parks located in Coimbra, Portugal: Manuel Braga (secular park), Botanical garden, Choupal national forest, Mondego green park (large area placed next to the river), and Vale das Flores (linear park located in a residential area). A questionnaire survey was performed in each park to investigate the activities performed and their relevance for the users, users' motivations to develop the activities on that specific UGS, the perceived benefits regarding physical and emotional well-being and social interactions, and users' perception about disservices. The results showed that walking, meeting people, practicing and doing activities with children are the activities performed by most users and are perceived as beneficial for physical and emotional well-being. Multifunctionality is a characteristic of all parks and highly appreciated by the users. Significant differences in socio-demographic characteristics of the users and motivations are recorded between parks. The tranquillity of space and landscape beauty are the main motivations to use Manuel Braga Park and the Botanical garden. Distance to the park and transportation means are particularly important for Botanical garden and Vale das Flores park users. Age group and average monthly income were associated in both Choupal national forest, Mondego green park and Vale das Flores park, denoting that older and wealthier users are more able to enjoy these parks. Users' problems or ecosystem disservices were not identified, although plagues (e.g., mosquitoes) and dangerous animals recorded average concerns in the Choupal national forest and in the Vale das Flores and Mondego green parks. This work's findings can help decision-makers better understand users' needs and expectations, thus improving UGS design and management to attract more citizens.
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38.
  • Pinto, Luís Valença, et al. (author)
  • Assessment of NBS Impact on Pluvial Flood Regulation Within Urban Areas : A Case Study in Coimbra, Portugal
  • 2022
  • In: Nature-Based Solutions for Flood Mitigation. - Cham : Springer Science and Business Media Deutschland GmbH. - 9783030775056 ; , s. 289-312
  • Book chapter (peer-reviewed)abstract
    • The majority of the world population is living in urban areas. As cities expand, soil sealing increases the vulnerability of urban areas to pluvial floods, and the consequent impacts on social and economic domains. Flood mitigation typically relies on grey infrastructures, but the implementation of Nature-Based Solutions (NBS) can be critical to cope with increasing flood hazard driven by urbanization and climate change. By mimicking natural hydrological processes, NBS enhance water retention, infiltration and evapotranspiration through greening, leading to lower runoff and flood hazard. The effectiveness of NBS on flood mitigation is affected by several factors including the type of NBS and the biophysical characteristics of the area. Nevertheless, a relatively limited number of studies have monitored the impact of NBS, and thus the lack of knowledge is still a barrier to the widespread implementation of this approach. This chapter assesses the impact of a Green Infrastructure (GI) located in Coimbra (Portugal), which performs as a NBS for runoff management and flood hazard mitigation. The study applies the widely used Curve Number method to estimate runoff within the Quinta de São Jerónimo study site, driven by rainfall events of 2-, 5-, 10- and 20-years recurrence, based on Intensity–Duration–Frequency precipitation curves. The results show that the implemented NBS can retain runoff produced by 20-years flood, decreasing the flood peak and flood hazard in downstream urban areas. This efficiency is achieved by combining blue, green and grey elements, and proved useful to enhance urban resilience. Furthermore, the green and blue elements of the NBS provide additional ecosystem services, including environmental, social and economic benefits (co-benefits), relevant for human well-being in urban areas.
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39.
  • Pinto, Luís Valença, et al. (author)
  • Ecosystem services and well-being dimensions related to urban green spaces - A systematic review
  • 2022
  • In: Sustainable cities and society. - : Elsevier BV. - 2210-6707. ; 85
  • Research review (peer-reviewed)abstract
    • Urban green spaces (UGS) supply several ecosystem services (ES) key to human wellbeing. In this article, we conducted a systematic review focused on identifying UGS's ES and wellbeing dimensions. From the 3626 articles screened, 218 were used in this review. Most studies were conducted in Europe, China, the United States of America (USA) and South Africa. Among all UGS, parks and gardens were the most investigated, with less of a focus on urban trees, forests, coastal mangroves, golf courses, roadside vegetation, and brownfields/unmanaged urban greenery. Cultural ES were the most studied, although it is well known that UGS also supply many provisioning and regulating ES. Health (mental and physical) and good social relations were the most investigated wellbeing dimensions, and food security received the least attention. Regarding the methodologies used to investigate the UGS contribution to human wellbeing, surveys, indicators, and surveys combined with statistical methods were the most common. Only a few works focusing on spatial modelling were validated, which is critical to ensure the reliability of the spatial models applied to UGS ES studies. Overall, this work identified the research gaps and future perspectives in ES and wellbeing dimensions provided by UGS, key to improving further research.
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40.
  • Pinto, Luís Valença, et al. (author)
  • Urban green spaces accessibility in two European cities : Vilnius (Lithuania) and Coimbra (Portugal)
  • 2022
  • In: Geography and Sustainability. - : Elsevier BV. - 2096-7438 .- 2666-6839. ; 3:1, s. 74-84
  • Journal article (peer-reviewed)abstract
    • Urban green spaces (UGS) are essential for human well-being, contributing towards quality of life and promoting social interactions and inclusion. Accessibility to recreational UGS is key to human well-being in urban areas. However, there is a lack of works focused on recreational UGS accessibility in cities from different countries, using different types of transport. In this work, we studied the accessibility to recreational UGS in Vilnius (Lithuania) and Coimbra (Portugal) through four transport modes (foot, bike, bus and car) within 5- and 10-minute distance. The results showed important differences between cities. Vilnius had higher accessibility to recreational UGS than Coimbra in all transport modes. In both cities, the accessibility was highest by car and lowest by bus. Also, the percentage of population covered by 5- and 10-minute distance UGS accessibility in Vilnius is higher than in Coimbra, despite the lower population density in Vilnius. A large number of recreational UGS, their geographic distribution, the dispersed population pattern, and the location of several urbanizations near recreational UGS increased the inhabitant’s accessibility to recreational UGS in Vilnius. The differences in accessibility between cities were mainly attributed to the large number of recreational UGS and higher road network density, cycleways and footways density, and bus lines in Vilnius, compared to Coimbra. This work identified the areas where recreational UGS accessibility is difficult in using different transport modes and need to be improved in study areas. This is essential to support urban planners and increase cities’ well-being. The findings of this work will be important for the management of the studied urban areas.
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41.
  • Telak, Leon Josip, et al. (author)
  • Short-Term Impact of Tillage on Soil and the Hydrological Response within a Fig (Ficus Carica) Orchard in Croatia
  • 2020
  • In: Water. - : MDPI AG. - 2073-4441. ; 12:11
  • Journal article (peer-reviewed)abstract
    • Tillage is well known to have impacts on soil properties and hydrological responses. This work aims to study the short-term impacts of tillage (0-3 months) on soil and hydrological responses in fig orchards located in Croatia. Understanding the soil hydrological response in the study area is crucial for soil management due to frequent autumn floods. The hydrological response was investigated using rainfall simulation experiments (58 mm h(-1), for 30 min, over 0.785 m(2) plots). The results show that the bulk density was significantly higher 3 months after tillage than at 0 and 1 months. The water holding capacity and amount of soil organic matter decreased with time. The water runoff and phosphorous loss (P loss) increased over time. The sediment concentration (SC) was significantly higher 3 months after tillage than in the previous monitoring periods, while sediment loss (SL) and carbon loss (C loss) were significantly lower 0 months after tillage than 3 months after tillage. Overall, there was an increase in soil erodibility with time (high SC, SL, C loss, and P loss), attributed to the precipitation patterns that increase the soil water content and therefore the hydrological response. Therefore, sustainable agricultural practices are needed to avoid sediment translocation and to mitigate floods and land degradation.
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42.
  • Wang, Haidong, et al. (author)
  • Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
  • 2016
  • In: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
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