Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

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

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. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Courting political opportunity.

The phenomenon of legal change is complex, involving multiple actors and proceeding within multiple structural constraints. Traditional approaches to examining this phenomenon, however, have tended to focus on a particular agent of change, such as the impact of doctrine, judicial attitudes and judicial turnover, executive and legislative actions, interest group litigation, and public opinion. As a result, although we know quite a bit about specific genitors of legal change, we know very little about how they interact. In this dissertation, I offer a new theoretical framework for examining the conditions under which judges, litigators, the law, and the political environment interact to facilitate or retard legal change. My legal opportunity structure model seeks to explain legal change through an examination of the institutional and socio-legal factors that shape the decisions made by legal actors. These factors include access to the formal institutional structure of the law, the configuration of elites with respect to a given legal issue, the alliance and conflict systems surrounding a particular legal issue, and the availability of both legal frames (the amalgam of existing laws) and cultural frames (the amalgam of cultural values and beliefs). Specifically, I argue that legal change is a product of legal actors, including judges and litigators, engaging in a process of competitive framing which is situated within a larger structure of legal opportunities. The empirical focus of this dissertation is on the outcomes of gay rights litigation. I examine three key areas of litigation: sodomy reform, anti-gay initiatives, and family law. The legal opportunity structure approach, I show, offers a richer and more accurate explanation of the dynamics of legal change with respect to gay rights than do traditional, segmented approaches.Ph.D.LawPolitical scienceSocial SciencesSociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131595/2/9929777.pd

Etter fylkesnemnda - hva med foreldrene? Oppfølging av foreldre etter omsorgsovertakelse - ansvar og rollefordeling

Ifølge barnevernloven skal barneverntjenesten vurdere mulig gjenforening mellom foreldre og barn idet de fremmer forslag om omsorgsovertakelse til fylkesnemnda. Uavhengig av om gjenforening er aktuelt, skal barneverntjenesten tilby foreldre oppfølging og veiledning umiddelbart etter en omsorgovertakelse. Den europeiske menneskerettsdomstolen (EMD) har kritisert det norske barnevernet for manglende oppfølging av foreldre etter omsorgsovertakelse, og for ikke å ha jobbet aktivt for gjenforening mellom barn og foreldre (Sørensen, 2020). Slik vi ser det, står en allerede presset barneverntjeneste overfor store oppgaver knyttet til oppfølging av foreldre og gjenforening mellom barn og foreldre etter en omsorgsovertakelse. I disse sakene er relasjonen mellom barnevern og foreldre ofte krevende, noe som blant annet kan forklares med at barneverntjenesten står i en vanskelig dobbeltrolle som både hjelper og kontrollør. Hvordan skal barneverntjenesten komme i posisjon til å gi veiledning og oppfølging som oppleves meningsfull for foreldrene, samt lykkes med å få til gode prosesser knyttet til gjenforening mellom barn og foreldre

Study protocol for a randomised trial evaluating the effect of a “birth environment room” versus a standard labour room on birth outcomes and the birth experience

Introduction: In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on birth outcomes. The birth environment might have an important role in facilitating the production of the hormone oxytocin that causes contractions during labour. Oxytocin is released in a safe, secure and confidence-inducing environment, and environments focused on technology and medical interventions to achieve birth may disrupt the production of oxytocin and slow down the progress of labour. An experimental “birth environment room” was designed, inspired by knowledge from evidence-based healthcare design, which advocates bringing nature into the room to reduce stress. The purpose is to examine whether the ‘birth environment room’, with its design and decor to minimise stress, has an impact on birth outcomes and the birth experience of the woman and her partner. Materials and methods: A randomised controlled trial will recruit 680 nulliparous women at term who will be randomly allocated to either the “birth environment room” or a standard room. The study will take place at the Department of Obstetrics and Gynecology at Herning Hospital, with recruitment from May 2015. Randomisation to either the “birth environment room” or standard room takes place just before admission to a birth room during labour. The primary outcome is augmentation of labour, and the study has 80% power to detect a 10% difference between the two groups (two-sided α = 0.05). Secondary outcomes are duration of labour, use of pharmacological pain relief, mode of birth, and rating of the birth experience by women and their partners. Trial registration: NCT02478385(10/08/2016)

Experiences from Introducing Standardized High Dose 131I-mIBG Treatment of Children with Refractory Neuroblastoma: Differences in Effective Dose to Patients and Exposure to Caregivers

Aims: High dose 131I-meta iodobenzylguanidine (131I-mIBG) combined with radiosensitizing topotecan and peripheral blood stem cell support is a promising treatment regimen for children with neuroblastoma (NB). Here we present our first experiences, with particular focus on in vivo whole-body dosimetry and radiation exposure to family caregivers and hospital staff. Methods: Five children with relapsed or refractory NB were treated during 2012-2014. 131I-mIBG was administered in two fractions at two weeks apart, aiming for a total whole-body radiation-absorbed dose of 4 Gy. The 131I-mIBG activity for the 2nd administration was calculated on the basis of the measured whole-body dose following the 1st administration. Patients were isolated in a lead-shielded room, and all caregivers and staff received radiation safety training, and carried an electronic personal dosimeter. Results: The total administered activity ranged from 5.1 to 28.6 GBq (median: 22.9 GBq), resulting in effective whole-body doses ranging from 2.1 to 4.3 Gy (median: 3.8 Gy). Two out of five patients deviated from the anticipated dose exposure defined by the treatment protocol; one patient received 4.3 Gy after a single administration, and for one patient the total whole-body dose was lower than anticipated (2.1 Gy). Radiation dose to family caregivers ranged from 0.1 to 8.0 mSv. For staff members, the overall radiation dose was low, and provided no concern regarding personal dosimetry. Conclusion: High-dose 131I-mIBG treatment of children with NB has been successfully established at our institution. Radiation doses to caregivers and hospital staff are acceptable and in compliance with national and international guidelines. Two out of five patients deviated from the anticipated dose exposure, hence, accurate dosimetry-guidance during administration of high dose 131I-mIBG treatment is necessary

Special issue: “Darkness matters”

This special issue is based on an experimental weekend workshop: “Methodologies of Darkness” held around the darkest time of the year, the end of November, in 2015 in Nokia, Finland. For this event scholars from a variety of disciplines, however all connected to education, were gathered to engage with darkness in a forest without knowing what this might produce or create. We were gathered to re-educate ourselves and to disrupt methodological habits that we might perform, that perform us, and that perform educational research. Further, we deliberately wanted to unsettle notions of methodology as a process where the eyes have signified what Haraway writes of as a ‘perverse capacity’ that has distanced the knowing subject from everything around in an ‘interest of unfettered power’ (2002, p. 677). Finally, yet importantly, we were gathered to collaboratively experiment with ways of knowing and sensing in the dark