La Rosa custodiada. Participación ciudadana y gestión pública en Reus 1999-2003

El presente trabajo tiene como objetivo principal la exploración de un ámbito de interacción poco definido y acaso ambiguo, que es complejo y difuso, pero que sin duda resulta emergente y central para el actual ejercicio político: es el referido a la participación de los ciudadanos en la gestión pública local. Trata sobre todo, de relaciones, formas y canales, de actores y sectores que interactúan, y que, en el caso que nos ocupa, tiene como protagonistas principales a la clase política y sus brazos técnico-ejecutivos del Ajuntament, a las diversas entidades civiles y a la ciudadanía no organizada. Son estos los sectores o actores que inciden localmente en la vida pública de Reus, lugar donde se realizó este trabajo, una ciudad que concentra casi toda la población del municipio del mismo nombre, situado en la Cataluña meridional, y por lo tanto, dentro del ámbito político español y europeo, cuya influencia ha sido y sigue siendo muy relevante en la vida local. Un sitio donde el tema participativo mantiene una particular relevancia, motivada por sus nutridos antecedentes históricos de implicación de la población en la vida pública y política, incluso más allá de lo local; donde hasta hoy existe una intensa actividad participativa de variada raigambre que se canaliza por vías ciudadanas.La tesis comprende siete capítulos temáticos, más un octavo y final de conclusiones, seguido de bibliografía. El primero corresponde a la propuesta teórica y metodológica que fundamenta nuestro estudio, revisando primeramente las aportaciones que desde la antropología se han hecho para el estudio de los fenómenos políticos, para luego, en un segundo apartado, referir los aspectos metodológicos. El segundo contiene una necesaria reflexión teórica sobre el tema de la participación, repasando la evolución histórica de conceptos como el espacio de lo público, el carácter de la ciudadanía y los cambios en la concepción de la democracia, centrando la exposición en el contexto europeo. Revisa también sus implicaciones para un momento como el actual, caracterizado, entre otras cosas, por el surgimiento de lo "glocal", que alude a la forma en que influencias lejanas inciden en el nivel local. El tercero, abocado más específicamente a nuestro estudio de caso, explora las raíces históricas mediante las cuales en Reus se ha estructurado lo político, abarcando para tal objetivo tanto hechos históricos previos a su conformación como ciudad, como situaciones diferenciales derivadas de su condición catalana dentro del Estado Español. Las particularidades del sistema político español constituyen a su vez el tema del cuarto capítulo, que describe sus actuales bases enfatizando en torno a la repartición de competencias entre los distintos niveles que lo estructuran en el marco del Estado de las Autonomías.El quinto ("En nom de la Rosa"), ofrece una semblanza de la ciudad de Reus en sus aspectos etnográficos más generales, incluyendo, además de elementos impresionistas, una descripción de sus aspectos básicos como núcleo urbano y poblacional. El sexto ("Desde la Plaça del Mercadal") presenta un panorama de la forma en que la gestión pública es asumida a nivel local por el Ajuntament de Reus, presentando especial atención a aspectos que consideramos relevantes para el tema de la participación. Un séptimo intenta resumir posiciones rescatadas desde la ciudadanía organizada y no, describiendo el mundo asociativo ciudadano de Reus y las expectativas que los ciudadanos tienen sobre las posibilidades de participar en la gestión que se realiza desde el Ajuntament. Finalmente, el octavo y último capítulo presenta conclusiones derivadas de nuestro estudio, en plan de reflexiones y lineamiesntos para la implementación de experiencias participativas en el nivel local.The main purpose of the present work is to explore a field of interaction which, although poorly defined and perhaps ambiguous because of growing importance to current political praxis: citizen participation in local public government. The study deals specifically with relationships, means and channels, and links between interacting actors and sectors. The political class, the technical and administrative personnel of the Ajuntament or municipality, the variety of civil associations and the non-organized citizens are the protagonists of this study. They are the local actors that shape public life in Reus, a city that hosts almost the entire population of the municipality of the same name, located in the south of Catalonian and, therefore, within the political influence of Spain and the European Union, which remains strong over the local level. It is also a place where public participation still has special importance due to a very rich local history of commitment and participation of the people of Reus in political and public life beyond the local level.The thesis contains seven thematic chapters and a conclusion, followed by the bibliography. The first chapter discusses the theoretical and methodological issues related to our study, reviewing some contributions from anthropological visions to the study of the political, followed by the methodological aspects of our work in terms of time and ethnographic techniques. The second chapter consist of a necessary theoretical reflection on the subject of participation, the historical evolution of concepts and terms such as public space, the nature of citizenship, and changes in the idea of democracy, all within the European context and paying special attention to the implications that issues of participation have in actuality considering, among others, the emergence of the "glocal", which alludes to how far external influences act on local levels, including the political arena. The third chapter, which refers more directly to our case study, explores the historical roots of political power in Reus, from ancient times to the present, and explores the special situation of this city as a municipality within Spain and Catalonia. The particularities of the current Spanish political system are the topic of the fourth chapter, focusing on the repartition of competences between the different levels that compose it, in the model of the "Estado de las Autonomías".The fifth chapter ("En nom de la Rosa"), offers a general assessment of the city of Reus from an ethnographic perspective, it also includes an overviewof its basic urban and demographical issues, the economics of the city and the political behaviour of its habitants. The sixth chapter ("Desde la Plaga del Mercadal"), presents a panoramic review of the current organization within the public government at the local level in the Ajuntament de Reus, stressing aspects related to issues of participation. The seventh chapter summarizes the viewpoints of organized and non-organized citizens, describing the associative world of citizens in Reus, and their expectations regarding the possibilities of participating in the management of public interests from the municipal gooovernment. Finally, the eighth and final chapter presents some conclusions derived from our study, in the form of reflections and recommendations or considerations for the implementation of participative experiences at the local level

Versatility of the estlander flap: upper lip, lower lip and comissure reconstruction due to a dog bite

Background: Dog bites continue to be a frequent cause for plastic and reconstructive services in the world. The grand majority of these cases affect the head and neck area; and more often than not they involve the commissure and the lips. The latter leading to an increased level of difficulty and a substantial decrease on the posibilities for a successful reconstruction. This case report focuses on the exploration of the Abbe-Estlander flap as an efficient alternative in most of these cases.Methods: We present two clinical cases involving dog bites where the affected area of both patients was estimated to be one third of the total volume of the lip. Both patients required emergency reconstructive surgery. An Estlander flap was successfully performed in both instances. The purpose of the article is to share the results and motivate the medical community to continue to use this method as a strong avenue for an effective recovery.Results: After two months of the surgery, the team followed up with both patients and they were satisfied with the results. Patient A presented adequate healing of the wound; a lack of alignment of the mucocutaneous rim and rounding of the commissure was observed. Phonation, oral continence without any leakage and complete closure of the lip were also part of the recovery assessment. Patient B presented adequate healing of the wound, phonation and medium oral continence with occasional leakage of liquids and incomplete closure.Conclusions: The Abbe-Estlander flap is still an excellent reconstructive alternative for upper and lower lip reconstruction where the affected area is up to one third of the total volume. As long as the commissure involvement represents minimum difficulty, both aesthetic and functional objectives can be successfully attained using this flap

Bienestar de oro: Una propuesta para mejorar la calidad de vida del adulto mayor de Lima Metropolitana

Bienestar de Oro a través de su plataforma permitirá al adulto mayor mantenerse activo y saludable, con las actividades que ofrece a libre elección, con contenidos variados y renovados de forma permanente a propuesta del usuario. Además busca familiarizar al adulto mayor en tecnología mediante una capacitación gratuita en el uso de redes sociales y en las funciones básicas para el uso de su smartphone. Se resume el proceso mediante el cual se identificó, en las personas adultas mayores la necesidad de interactuar con nuevas personas y desarrollar actividades que le permitan salir de la rutina, en base a ello se planteó la solución con el uso de metodologías ágiles lo cual generó un modelo de negocio sostenible. La propuesta se llama Bienestar de Oro, solución innovadora, que ofrece a las personas adultos mayores una forma digital, fácil y sencilla de adquirir diferentes actividades desde el lugar donde se encuentre a través de su smartphone, cuyo propósito es impartir conocimientos y a su vez brindar la posibilidad al adulto mayor de generarse ingresos impartiendo conocimiento a otros adultos mayores. Nuestro público objetivo son personas mayores de 60 a 75 años de los niveles socioeconómicos alto, medio alto y medio que aún trabajan, buscan mantenerse activos, tienen interés por aprender, enseñar sus conocimientos y experiencias. El proyecto se desarrollará en Lima Metropolitana; iniciará con 1,954 usuarios en el año 1 y 45,474 usuarios al año 5, atracción de usuarios generada a través de una inversión publicitaria en marketing digital y medios publicitarios tradicionales. En cuanto al entorno competitivo, los servicios para el adulto mayor se presentan a través de la oferta pública y privada en el país, en donde las actividades que ofrece Bienestar de Oro en las entidades se ofrecen como actividades complementarias o como servicios principales. En ambos casos buscan mejorar la calidad de vida de las personas adultas mayores. En el proceso de diseño, se validó la hipótesis de deseabilidad realizando pruebas de uso del prototipo con el usuario, donde la aplicación tuvo aceptación, dado que es fácil de usar, es amigable y satisfacen las necesidades del usuario. Asimismo se validó la hipótesis de factibilidad, donde el plan de mercadeo generará un retorno de ingresos mayor a la inversión en publicidad para captar nuevos usuarios cada año. Por último, Bienestar de Oro es un proyecto financieramente viable ya que inicia con una inversión de S/2,049,373 soles, incrementa volumen de ventas con flujos financieros exponenciales en una proyección de cinco años, con una VAN de S/3,927,751 soles y una TIR del 39%; asimismo, un VAN Social de S/56,369,394 soles. Está alineado con alcanzar la meta 3.d de la ODS, promoviendo el bienestar mediante los talleres de yoga, baile, danzas y otras actividades físicas; 4.3 de la ODS número 4 brindando cursos sobre tecnología y emprendimiento para el adulto mayor; 8.3 de la ODS número 8 capacitándose en talleres para emprender un nuevo negocio y 10 .3 de la ODS número 10 eliminado la desigualdad y discriminación para empoderar al adulto mayor en sus capacidades y aportes a la sociedad.“Bienestar de Oro” through its platform will allow the elderly people to stay active and healthy, with activities offered a free choice. This offers varied and permanently renewed content at the user's suggestion. It also seeks to familiarize the elderly people with technology through free training in the use of social networks and the basic functions of their smartphone. In the process, it was identified that older adults need to interact with new people and develop activities that allow them to get out of the routine, based on this, the solution was proposed with the use of agile methodologies, which generated a sustainable business model. The proposal is called “Bienestar de Oro”, an innovative solution that offers elderly people a digital, easy and simple way to acquire different activities from the place where they are from their smartphone, whose purpose is to impart knowledge and in turn provide the possibility for the elderly to generate income by imparting knowledge to other elderly adults. Our target audience is people over 60 to 75 years old from high, medium-high and medium socioeconomic levels who still work, seek to stay active, have an interest in learning, teaching their knowledge and experiences. The project will be developed in Metropolitan Lima; it will start with 1,954 users in year 1 and 45,474 users in year 5. The attraction of users will be generated through an advertising investment in digital marketing and traditional advertising media. Regarding the competitive environment, services for the elderly people are presented through public and private offerings in the country, where the activities offered by “Bienestar de Oro” in the entities are offered as complementary activities or as main services. In both cases, they seek to improve the quality of life of the elderly. In the design process, the desirability hypothesis was validated by testing the use of the prototype with the user, where the application was accepted, given that it is easy to use, it is friendly and satisfies the needs of the user. Likewise, the feasibility hypothesis was validated, where the marketing plan will generate a higher return on income, which is greater than the investment in advertising to attract new users each year. Finally, “Bienestar de Oro” is a financially viable project since it begins with an investment of S/2,049,373 soles, increases sales volume with exponential financial flows in a five-year projection, with a NPV of S / 3,927,751 soles and an IRR of 39%: likewise, a social NPV of S/56,369,394 soles. It is aligned with achieving goal 3.d of SDG number 3 by promoting well-being through yoga, dance, and other physical activities workshops; 4.3 of SDG number 4, offering courses on technology and entrepreneurship for the elderly people; 8.3 of SDG number 8 by training in workshops to start a new business and 10.3 of SDG number 10 eliminated inequality and discrimination to empower the elderly people in their capacities and contributions to society

Prediction of fatty acid composition in intact and minced fat of European autochthonous pigs breeds by near infrared spectroscopy

The fatty acids profile has been playing a decisive role in recent years, thanks to technological, sensory and health demands from producers and consumers. The application of NIRS technique on fat tissues, could lead to more efficient, practical, and economical in the quality control. The study aim was to assess the accuracy of Fourier Transformed Near Infrared Spectroscopy technique to determine fatty acids composition in fat of 12 European local pig breeds. A total of 439 spectra of backfat were collected both in intact and minced tissue and then were analyzed using gas chromatographic analysis. Predictive equations were developed using the 80% of samples for the calibration, followed by full cross validation, and the remaining 20% for the external validation test. NIRS analysis of minced samples allowed a better response for fatty acid families, n6 PUFA, it is promising both for n3 PUFA quantification and for the screening (high, low value) of the major fatty acids. Intact fat prediction, although with a lower predictive ability, seems suitable for PUFA and n6 PUFA while for other families allows only a discrimination between high and low values.info:eu-repo/semantics/publishedVersio

Screening risk assessment tools for assessing the environmental impact in an abandoned pyritic mine in Spain

This is the author’s version of a work that was accepted for publication in Science of the Total Environment. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Science of the Total Environment 409.4 (2011): 692-703 http://dx.doi.org/10.1016/j.scitotenv.2010.10.056This paper describes a new methodology for assessing site-specific environmental impact of contaminants. The proposed method integrates traditional risk assessment approaches with real and variable environmental characteristics at a local scale. Environmental impact on selected receptors was classified for each environmental compartment into 5 categories derived from the whole (chronic and acute) risk assessment using 8 risk levels. Risk levels were established according to three hazard quotients (HQs) which represented the ratio of exposure to acute and chronic toxicity values. This tool allowed integrating in only one impact category all the elements involved in the standard risk assessment. The methodology was applied to an abandoned metal mine in Spain, where high levels of As, Cd, Zn and Cu were detected. Risk affecting potential receptors such as aquatic and soil organisms and terrestrial vertebrates were assessed. Whole results showed that impact to the ecosystem is likely high and further investigation or remedial actions are necessary. Some proposals to refine the risk assessment for a more realistic diagnostic are included.This work has been financed by Madrid Community through EIADES Project S-505/AMB/0296, and by Spanish MinistryfEducation and Science, project CTM-2007-66401-CO2/TECN

Bacteria-inducing legume nodules involved in the improvement of plant growth, health and nutrition

Bacteria-inducing legume nodules are known as rhizobia and belong to the class Alphaproteobacteria and Betaproteobacteria. They promote the growth and nutrition of their respective legume hosts through atmospheric nitrogen fixation which takes place in the nodules induced in their roots or stems. In addition, rhizobia have other plant growth-promoting mechanisms, mainly solubilization of phosphate and production of indoleacetic acid, ACC deaminase and siderophores. Some of these mechanisms have been reported for strains of rhizobia which are also able to promote the growth of several nonlegumes, such as cereals, oilseeds and vegetables. Less studied are the mechanisms that have the rhizobia to promote the plant health; however, these bacteria are able to exert biocontrol of some phytopathogens and to induce the plant resistance. In this chapter, we revised the available data about the ability of the legume nodule-inducing bacteria for improving the plant growth, health and nutrition of both legumes and nonlegumes. These data showed that rhizobia meet all the requirements of sustainable agriculture to be used as bio-inoculants allowing the total or partial replacement of chemicals used for fertilization or protection of crops

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

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

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\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), 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\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) 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\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% 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\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. 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\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) 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\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) 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\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) 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\ub70% 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

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe